Astral Codex Ten Podcast

SSRIs are the most widely used class of psychiatric medications, helpful for depression, anxiety, OCD, panic, PTSD, anger, and certain personality disorders (Why should the same drug treat all these things? Great question!) They've been pretty thoroughly studied, but there's still a lot we don't understand about them. The SSC Survey is less rigorous than most existing studies, but its many questions and very high sample size provide a different tool to investigate some of these issues. I asked fifteen questions about SSRIs on the most recent survey and received answers from 2,090 people who had been on SSRIs. The sample included people on all six major SSRIs, but there were too few people on fluvoxamine (15) to have reliable results, so it was not included in most comparisons. Here's what we found: 1. Do SSRIs work? People seem to think so: Made me feel much worse: 6% Made me feel slightly worse: 7.4% No net change in how I felt: 23.7% Made me feel slightly better: 41.4% Made me feel much better: 21.4% Of course, these statistics include the placebo effect and so cannot be taken entirely at face value. 2. Do some SSRIs work better than others? I asked people to rate their experience with the medication, on a scale from 1 to 10. Here were the results: Lexapro (356): 5.7 Zoloft (470): 5.6 Prozac (339): 5.5 Celexa (233): 5.4 Paxil (126): 4.6 Paxil differed significantly from the others; the others did not differ significantly among themselves. In a second question where participants were just asked to rate their SSRIs from -2 ("made me feel much worse") to +2 ("made me feel much better"), the ranking was preserved, and Lexapro also separated from Celexa. This ranking correlates at r = 0.98 (!?!) with my previous study of this taken from drugs.com ratings. I don't generally hear that Paxil is less effective than other SSRIs, but I have heard that it causes worse side effects. The survey question (probably wrongly) encouraged people to rate side effects as "negative efficacy". My guess is that the difference here is mostly driven by side effects.

I. I don't know much about gay history, but the heavily mythicized version of it I heard goes like this: At first open homosexuality was totally taboo. A few groups of respectable people with hilariously upper-class names like The Mattachine Society and The Daughters Of Bilitis quietly tried to influence elites in favor of more tolerance, using whatever backchannels elites use to influence one another. They had limited success, but they comforted themselves that at least they were presenting a likeable and respectable face for homosexuality that was improving the lifestyle's public reputation. Then a few totally-non-respectable outsiders with nothing to lose – addicts, drag queens, men with lots of chest hair who dressed in leather and called themselves "bears" – publicly came out as gay, held pride parades, shouted things about "WE'RE HERE, WE'RE QUEER", et cetera. They were very easy to dislike and most people easily disliked them. But once they did this enough, people who were maybe 10% of the way to being respectable – people not addicted to quite so many drugs, men without quite so much chest hair – felt comfortable joining in. Once enough of them were out, people who were 20% of the way to being respectable felt comfortable coming out, and so on. Then 30% respectable people, then 40% respectable people, all the way up to the present day where there are a bunch of openly gay members of Congress. I know there are lots of debates over whether this kind of "respectability cascade" is the way it really happened, but it's a neat model of a way that these things can happen. II. And it's especially interesting because it's the opposite of the way I usually think about these things. When I did pre-med in college, I learned physiology from a distinguished professor whose focus was herpetology – the study of reptiles and amphibians. His pet issue was endocrine disruption – hormone-like pollutants that were changing the sexual maturation of frogs and other animals, and which were suspected to have deleterious effects on humans. He made us read a bunch of papers on this, all of which demonstrated a clear scientific consensus that this was a well-known environmental problem and all the respectable environmentalists and herpetologists were concerned about it. After college I went about a decade without thinking about it. Then people started making fun of Alex Jones' CHEMICALZ R TURNING TEH FROGZ GAY!!! shtick. I innocently said that this was definitely happening and definitely deserved our concern, and discovered that this was no longer an acceptable thing to talk about in the Year Of Our Lord Two Thousand And Whatever. Okay. Lesson learned.

I. Zero To One might be the first best-selling business book based on a Tumblr. Stanford student Blake Masters took Peter Thiel's class on startups. He posted his notes on Tumblr after each lecture. They became a minor sensation. Thiel asked if he wanted to make them into a book together. He did. The title comes from Thiel's metaphor that ordinary businessmen like restaurant owners take a product "from 1 to n" (shouldn't this be from n to n+1?) – they build more of something that already exists. But the greatest entrepreneurs bring something "from 0 to 1" – they invent something that has never been seen before. The book has various pieces of advice for such entrepreneurs. Three sections especially struck me: on monopolies, on secrets, and on indefinite optimism. II. A short review can't fully do justice to the book's treatment of monopolies. Gwern's look at commoditizing your complement almost does (as do some tweets). But the basic economic argument goes like this: In a normal industry (eg restaurant ownership) competition should drive profit margins close to zero. Want to open an Indian restaurant in Mountain View? There will be another on the same street, and two more just down the way. If you automate every process that can be automated, mercilessly pursue efficiency, and work yourself and your employees to the bone – then you can just barely compete on price. You can earn enough money to live, and to not immediately give up in disgust and go into another line of business (after all, if you didn't earn that much, your competitors would already have given up in disgust and gone into another line of business, and your task would be easier). But the average Indian restaurant is in an economic state of nature, and its life will be nasty, brutish, and short. This was the promise of the classical economists: capitalism will optimize for consumer convenience, while keeping businesses themselves lean and hungry. And it was Marx's warning: businesses will compete so viciously that nobody will get any money, and eventually even the capitalists themselves will long for something better. Neither the promise nor the warning has been borne out: business owners are often comfortable and sometimes rich. Why? Because they've escaped competition and become at least a little monopoly-like. Thiel says this is what entrepreneurs should be aiming for. He hates having to describe how businesses succeed, because he thinks it's too anti-inductive to reduce to a formula: Tolstoy opens Anna Karenina by observing "All happy families are alike; each unhappy family is unhappy in its own way." Business is the opposite. All happy companies are different: each one earns a monopoly by solving a unique problem. All failed companies are the same: they failed to escape competition. But he grudgingly describes four ways that a company can successfully reach monopolyhood:

At the beginning of every year, I make predictions. At the end of every year, I score them. So here are a hundred more for 2019. Rules: all predictions about what will be true on January 1, 2020. Any that involve polling will be settled by the top poll or average of polls on Real Clear Politics on that day. Most predictions about my personal life, or that refer to the personal lives of other people, have been redacted to protect their privacy. I'm using the full 0 – 100 range in making predictions this year, but they'll be flipped and judged as 50 – 100 in the rating stage, just like in previous years. I've tried to avoid doing specific research or looking at prediction markets when I made these, though some of them I already knew what the markets said. Feel free to get in a big fight over whether 50% predictions are meaningful. US 1. Donald Trump remains President: 90% 2. Donald Trump is impeached by the House: 40% 3. Kamala Harris leads the Democratic field: 20% 4. Bernie Sanders leads the Democratic field: 20% 5. Joe Biden leads the Democratic field: 20% 6. Beto O'Rourke leads the Democratic field: 20% 7. Trump is still leading in prediction markets to be Republican nominee: 70% 8. Polls show more people support the leading Democrat than the leading Republican: 80% 9. Trump's approval rating below 50: 90% 10. Trump's approval rating below 40: 50% 11. Current government shutdown ends before Feb 1: 40% 12. Current government shutdown ends before Mar 1: 80% 13. Current government shutdown ends before Apr 1: 95% 14. Trump gets at least half the wall funding he wants from current shutdown: 20% 15. Ginsberg still alive: 50%

Lots of people have asked me to recommend them a psychiatrist or therapist. I've done a terrible job responding: it's a conflict of interest to recommend my own group, and I don't know many people outside of it. So now I've put together a list (by which I mostly mean blatantly copied a similar list made by fellow community member Anisha M) of mental health professionals whom members of the rationalist community have had good experiences with. So far it's short and mostly limited to the Bay Area. You can find it at the "Psychiat-List" button on the top of the blog, or at this link. My hope is to crowd-source additional recommendations to expand the list to more providers and cities. Please let me know, either on this post or on the comments to the list itself, if you have any extra recommendations to add – especially if you're in a city likely to have many other SSC readers. Please also let me know if you've had any positive or negative experiences with people already on the list, so I can change their status accordingly.

At the beginning of every year, I make predictions. At the end of every year, I score them. Here are 2014, 2015, 2016, and 2017. And here are the predictions I made for 2018. Strikethrough'd are false. Intact are true. Italicized are getting thrown out because I can't decide if they're true or not. Please don't complain that 50% predictions don't mean anything; I know this is true but there are some things I'm genuinely 50-50 unsure of. US: 1. Donald Trump remains president at end of year: 95% 2. Democrats take control of the House in midterms: 80% 3. Democrats take control of the Senate in midterms: 50% 4. Mueller's investigation gets cancelled (eg Trump fires him): 50% 5. Mueller does not indict Trump: 70% 6. PredictIt shows Bernie Sanders having highest chance to be Dem nominee at end of year: 60% 7. PredictIt shows Donald Trump having highest chance to be GOP nominee at end of year: 95% 8. [This was missing in original] 9. Some sort of major immigration reform legislation gets passed: 70% 10. No major health-care reform legislation gets passed: 95% 11. No large-scale deportation of Dreamers: 90% 12. US government shuts down again sometime in 2018: 50% 13. Trump's approval rating lower than 50% at end of year: 90% 14. …lower than 40%: 50% 15. GLAAD poll suggesting that LGBQ acceptance is down will mostly not be borne out by further research: 80%

Thanks to everyone who commented on the review of The Structure Of Scientific Revolutions. From David Chapman: It's important to remember that Kuhn wrote this seven decades ago. It was one of the most influential books of pop philosophy in the 1960s-70s, influencing the counterculture of the time, so it is very much "in the water supply." Much of what's right in it is now obvious; what's wrong is salient. To make sense of the book, you have to understand the state of the philosophy of science before then (logical positivism had just conclusively failed), and since then (there has been a lot of progress since Kuhn, sorting out what he got right and wrong). The issue of his relativism and attitude to objectivity has been endlessly rehashed. The discussion hasn't been very productive; it turns out that what "objective" means is more subtle than you'd think, and it's hard to sort out exactly what Kuhn thought. (And it hasn't mattered what he thought, for a long time.) Kuhn's "Postscript" to the second edition of the book does address this. It's not super clear, but it's much clearer than the book itself, and if anyone wants to read the book, I would strongly recommend reading the Postscript as well. Given Scott's excellent summary, in fact I would suggest *starting* with the Postscript. The point that Kuhn keeps re-using a handful of atypical examples is an important one (which has been made by many historians and philosophers of science since). In fact, the whole "revolutionary paradigm shift" paradigm seems quite rare outside the examples he cites. And, overall, most sciences work quite differently from fundamental physics. The major advance in meta-science from about 1980 to 2000, imo, was realizing that molecular biology, e.g., works so differently from fundamental physics that trying to subsume both under one theory of science is infeasible. I'm interested to hear him say more about that last sentence if he wants. Kaj Sotala quotes Steven Horst quoting Thomas Kuhn on what he means by facts not existing independently of paradigms: [Kuhn wrote that]: A historian reading an out-of-date scientific text characteristically encounters passages that make no sense. That is an experience I have had repeatedly whether my subject is an Aristotle, a Newton, a Volta, a Bohr, or a Planck. It has been standard to ignore such passages or to dismiss them as products of error, ignorance, or superstition, and that response is occasionally appropriate. More often, however, sympathetic contemplation of the troublesome passages suggests a different diagnosis. The apparent textual anomalies are artifacts, products of misreading. For lack of an alternative, the historian has been understanding words and phrases in the text as he or she would if they had occurred in contemporary discourse. Through much of the text that way of reading proceeds without difficulty; most terms in the historian's vocabulary are still used as they were by the author of the text. But some sets of interrelated terms are not, and it is [the] failure to isolate those terms and to discover how they were used that has permitted the passages in question to seem anomalous. Apparent anomaly is thus ordinarily evidence of the need for local adjustment of the lexicon, and it often provides clues to the nature of that adjustment as well. An important clue to problems in reading Aristotle's physics is provided by the discovery that the term translated 'motion' in his text refers not simply to change of position but to all changes characterized by two end points. Similar difficulties in reading Planck's early papers begin to dissolve with the discovery that, for Planck before 1907, 'the energy element hv' referred, not to a physically indivisible atom of energy (later to be called 'the energy quantum') but to a mental subdivision of the energy continuum, any point on which could be physically occupied. These examples all turn out to involve more than mere changes in the use of terms, thus illustrating what I had in mind years ago when speaking of the "incommensurability" of successive scientific theories. In its original mathematical use 'incommensurability' meant "no common measure," for example of the hypotenuse and side of an isosceles right triangle. Applied to a pair of theories in the same historical line, the term meant that there was no common language into which both could be fully translated. (Kuhn 1989/2000, 9–10) While scientific theories employ terms used more generally in ordinary language, and the same term may appear in multiple theories, key theoretical terminology is proprietary to the theory and cannot be understood apart from it. To learn a new theory, one must master the terminology as a whole: "Many of the referring terms of at least scientific languages cannot be acquired or defined one at a time but must instead be learned in clusters" (Kuhn 1983/2000, 211). And as the meanings of the terms and the connections between them differ from theory to

In 2010, Ben Tilly of the blog Random Observations wrote Analysis Vs. Algebra Predicts Eating Corn?, which said: I like learning about odd connections between disparate things. This probably is the oddest example that I know. Broadly speaking, mathematicians can be divided into those who like analysis, and those who like algebra. The distinction between the two types runs throughout math. Even those who work in areas that are far from analysis or algebra are very aware of the difference between them, and usually are very clear on which their preference is. I'll delve into this in more depth soon, but for now let's just take it for granted that this is a well-known distinction, and it has meaning for mathematicians. Back when I was in grad school there was a department lunch with corn on the cob. Partway through the meal one of the analysts looked around the room and remarked, "That's odd, all of the analysts are eating corn one way and the algebraists are eating corn another!" Everyone looked around. In fact everyone was eating the corn in one of two ways. One way was to munch over the length of the corn in a straight line, back up, turn slightly, and do another row across. Kind of like how an old typewriter goes. The other way was to go around in a spiral. All of the analysts were eating in spirals, and the algebraists in rows. There were a number of mathematicians present whose fields of study didn't make it clear whether they were on the analysis or algebra side of things. We went around and asked, and in every case the way they ate corn matched their preference. Since then I've made a point of amusing myself by asking mathematicians I meet whether they prefer algebra or analysis, and then predicting which way they will eat corn. I'm probably up to 40 or so by now, and in every case but one I've been able to correctly predict how they eat corn. The one exception was a logician who claimed to be exactly on the fence between the two. When I explained the corn thing to him he looked surprised, and said that he had an unusual way of eating corn. He went in loose spirals! In other words he truly was a perfect combination of algebra and analysis!

[Content warning: References to anti-Semitic and anti-Catholic canards] I feel deep affection for Gary Allen's None Dare Call It Conspiracy, a bizarre screed about the Federal Reserve/Communist/Trilateral Commission plot for a one world government. From its ridiculous title to its even-more-ridiculous cover image, this is a book that accepts its own nature. In the Aristotelian framework, where everything is trying to be the most perfect example of whatever it is, None Dare Call It Conspiracy has reached a certain apotheosis. But my problem is the opposite of Allen's. Too many people dare call too many things conspiracy. Perfectly reasonable hypotheses get attacked as conspiracy theories, derailing the discussion into arguments over when you're allowed to use the phrase. These arguments are surprisingly tough. Which of the following do you think should be classified as "conspiracy theories"? Which ones are so deranged that people espousing them should be excluded from civilized discussion? 1. Donald Trump and his advisors secretly met with Russian agents to discuss how to throw the 2016 election in his favor. 2. Donald Trump didn't collaborate with any Russians, but Democrats are working together to convince everyone that he did, in the hopes of getting him indicted or convincing the electorate that he's a traitor. 3. Insurance companies are working to sabotage any proposal for universal health care; if not for their constant machinations, we would have universal health care already. 4. The ruling classes constantly use lobbyists and soft power to sabotage tax increases, labor laws, and any other policy that increase the relative power of the poor. 5. America's aid to Israel is not in America's best interest, but is maintained through the power of AIPAC and other pro-Israel groups mainly supported by America's Jewish community. 6. The Jews are behind Brexit as a plot to weaken Western Europe. 7. Climate scientists routinely exaggerate or massage their studies to get the results they want, or only publish studies that get the results they want, both because of their personal political leanings and because they know it is good for their field to constantly be discovering exciting things that their funders and their supporters among the public want to hear.

Thanks to the 8,171 people who took the 2019 Slate Star Codex survey. Some of the links below will say 13,171 people took the survey, but that's a bug – sometimes Google just adds 5,000 to things. You can: – See the questions for the SSC survey. – See the results from the SSC survey. I'll be publishing more complicated analyses over the course of the next year, hopefully starting later this week. If you want to scoop me, or investigate the data yourself, you can download the answers of the 7000 people who agreed to have their responses shared publicly. The public datasets will not exactly match the full version, nor will they include some of the sensitive sections like illegal drug use and sexual partners. Download the public data (.xlsx, .odf)

Related to: Book Review: The Structure Of Scientific Revolutions Every good conspiracy theorist needs their own Grand Unified Chart; I'm a particular fan of this one. So far, my own Grand Unified Chart looks like this: All of these are examples of interpreting the world through a combination of pre-existing ideas what the world should be like (first column), plus actually experiencing the world (last column). In all of them, the world is too confusing and permits too many different interpretations to understand directly. You wouldn't even know where to start gathering more knowledge. So you take all of your pre-existing ideas (which you've gotten from somewhere) and interpret everything as behaving the way your pre-existing ideas tell you they will. Then as you gradually gather discrepancies between what you expected and what you get (middle column), you gradually become more and more confused until your existing categories buckle under the strain and you generate a new and self-consistent set of pre-existing ideas to see the world through, and then the process begins again. All of these domains share an idea that the interaction between facts and theories is bidirectional. Your facts may eventually determine what theory you have. But your theory also determines what facts you see and notice. Nor do contradictory facts immediately change a theory. The process of theory change is complicated, fiercely resisted by hard-to-describe factors, and based on some sort of idea of global tension that can't be directly reduced to any specific contradiction. (I linked the Discourse and Society levels of the chart to this post where I jokingly sum up the process of convincing someone as "First they ignore you, then they laugh at you, then they fight you, then they fight you half-heartedly, then they're neutral, then they grudgingly say you might have a point even though you're annoying, then they say on balance you're mostly right although you ignore some of the most important facets of the issue, then you win." My point is that ideological change – most dramatically religious conversion, but also Republicans becoming Democrats and vice versa – doesn't look like you "debunking" one of their facts and them admitting you are right. It is less like Popperian falsification and more like a Kuhnian paradigm shift or a Yudkowskian crisis of faith.)

When I hear scientists talk about Thomas Kuhn, he sounds very reasonable. Scientists have theories that guide their work. Sometimes they run into things their theories can't explain. Then some genius develops a new theory, and scientists are guided by that one. So the cycle repeats, knowledge gained with every step. When I hear philosophers talk about Thomas Kuhn, he sounds like a madman. There is no such thing as ground-level truth! Only theory! No objective sense-data! Only theory! No basis for accepting or rejecting any theory over any other! Only theory! No scientists! Only theories, wearing lab coats and fake beards, hoping nobody will notice the charade! I decided to read Kuhn's The Structure Of Scientific Revolutions in order to understand this better. Having finished, I have come to a conclusion: yup, I can see why this book causes so much confusion. At first Kuhn's thesis appears simple, maybe even obvious. I found myself worrying at times that he was knocking down a straw man, although of course we have to read the history of philosophy backwards and remember that Kuhn may already be in the water supply, so to speak. He argues against a simplistic view of science in which it is merely the gradual accumulation of facts. So Aristotle discovered a few true facts, Galileo added a few more on, then Newton discovered a few more, and now we have very many facts indeed. In this model, good science cannot disagree with other good science. You're either wrong – as various pseudoscientists and failed scientists have been throughout history, positing false ideas like "the brain is only there to cool the blood" or "the sun orbits the earth". Or you're right, your ideas are enshrined in the Sacristry Of Settled Science, and your facts join the accumulated store that passes through the ages.

This post is about the 2019 SSC Survey. If you've read at least one blog post here before, please take the surveyif you haven't already. Please don't read on until you've taken it, since this post could bias your results. 1. Can we confirm or disconfirm different corn-eating profiles of algebraists vs. analysts? 2. Can we replicate the study showing that people who eat more beef jerky are more likely to be hospitalized for bipolar mania? 3. Are there differences in side effects among SSRIs? (to be limited to people taking an SSRI one month or more, will be looked at both effect by effect, and with a lumped-together side effect index where each mild effect counts as 1 point and each severe effect as 3 points) 4. Is there a difference in people's efficacy ratings for SSRIs (SSRI Effectiveness, SSRI Overall) depending on whether the person was taking the SSRI for depression vs. for anxiety? 5. What percent of people coming off SSRIs experience discontinuation symptoms? Are there differences among different agents? (main analysis to be limited to people who were taking an SSRI at least a few months, discontinued with a gradual taper lasting at least a few weeks, and were not cross-tapering onto any other psychiatric medication).

0. Introduction I grew up in the 90s, which meant watching movies about plucky children fighting Pollution Demons. Sometimes teachers would show them to us in class. None of us found that strange. We knew that when we grew up, this would be our fight: to take on the loggers and whalers and seal-clubbers who were destroying our planet and save the Earth for the next generation. What happened to that? I don't mean the Pollution Demons: they're still around, I think one of them runs Trump's EPA now. What happened to everything else? To those teachers, those movies, that whole worldview? Save The Whales. Save The Rainforest. Save Endangered Species. Save The Earth. Stop Slash-And-Burn. Stop Acid Rain. Earth Day Every Day. Reduce, Reuse, Recycle. Twenty-five years ago, each of those would invoke a whole acrimonious debate; to some, a battle-cry; to others, a sign of a dangerous fanaticism that would destroy the economy. Today they sound about as relevant as "Fifty-four forty or fight" and "Remember the Maine". Old slogans, emptied of their punch and fit only for bloodless historical study. If you went back in time, turned off our Pollution Demon movie, and asked us to predict what would come of the environment twenty-five years, later, in 2018, I think we would imagine one of two scenarios. In the first, the world had become a renewable ecotopia where every child was taught to live in harmony with nature. In the second, we had failed in our struggle, the skies were grey, the rivers were brown, wild animals were a distant memory – but at least a few plucky children would still be telling us it wasn't too late, that we could start the tough job of cleaning up after ourselves and changing paths to that other option. The idea that things wouldn't really change – that the environment would neither move noticeably forward or noticeably backwards – but that everyone would stop talking about environmentalism – that you could go years without hearing the words "endangered species" – that nobody would even know whether the rainforests were expanding or contracting – wouldn't even be on the radar. It would sound like some kind of weird bizarro-world. Just to prove I'm not imagining all this:

Please take the 2019 Slate Star Codex Survey. The survey helps me learn more about SSC readers and plan community events. But it also provides me with useful informal research data for questions I'm interested it, which I then turn into interesting posts. My favorite from last year was Fight Me, Psychologists: Birth Order Effects Exist And Are Very Strong, which I think made a real contribution to individual differences psychology and which could not have happened without your cooperation. The survey is open to anyone who has ever read a post on this blog before December 27 2018. Please don't avoid taking the survey just because you feel like you're not enough of a "regular". It will ask you how much of a "regular" you are, so there's no risk you'll "dilute" the results. The survey will stay open until mid-January, and I will probably be begging and harassing you to take it about once a week or so until then. This year's survey is in two parts. Part I asks the same basic questions as previous years and should take about ten minutes. Part II asks more questions on research topics I'm interested in and should take about fifteen minutes. It would be great if you could take both parts, but if 25 minutes sounds like too much surveying to you, you can also just take Part I. As always, the survey is plagued by fundamental limitations, poor technology, and my own carelessness, but a couple of things to watch for: – Once you click a box on a Google form, you cannot un-click it – i.e. you can change your answer but you can't unanswer the question. If you click a box you didn't mean to, please switch your answer to "Other" if available; if not, then choose the most boring inoffensive answer that is least likely to produce surprising results. I realize how bad this is but there is apparently no way around it. – Some of the questions are America-centric, because I either have to learn everything about every culture or be something-centric, and America seemed like a good place to center around. Sorry to non-American readers. Feel free to skip any questions that don't apply to you.

Aquinas famously said: beware the man of one book. I would add: beware the man of one study. For example, take medical research. Suppose a certain drug is weakly effective against a certain disease. After a few years, a bunch of different research groups have gotten their hands on it and done all sorts of different studies. In the best case scenario the average study will find the true result – that it's weakly effective. But there will also be random noise caused by inevitable variation and by some of the experiments being better quality than others. In the end, we might expect something looking kind of like a bell curve. The peak will be at "weakly effective", but there will be a few studies to either side. Something like this: We see that the peak of the curve is somewhere to the right of neutral – ie weakly effective – and that there are about 15 studies that find this correct result. But there are also about 5 studies that find that the drug is very good, and 5 studies missing the sign entirely and finding that the drug is actively bad. There's even 1 study finding that the drug is very bad, maybe seriously dangerous. This is before we get into fraud or statistical malpractice. I'm saying this is what's going to happen just by normal variation in experimental design. As we increase experimental rigor, the bell curve might get squashed horizontally, but there will still be a bell curve. In practice it's worse than this, because this is assuming everyone is investigating exactly the same question. Suppose that the graph is titled "Effectiveness Of This Drug In Treating Bipolar Disorder". But maybe the drug is more effective in bipolar i than in bipolar ii (Depakote, for example) Or maybe the drug is very effective against bipolar mania, but much less effective against bipolar depression (Depakote again). Or maybe the drug is a good acute antimanic agent, but very poor at maintenance treatment (let's stick with Depakote). If you have a graph titled "Effectiveness Of Depakote In Treating Bipolar Disorder" plotting studies from "Very Bad" to "Very Good" – and you stick all the studies – maintenence, manic, depressive, bipolar i, bipolar ii – on the graph, then you're going to end running the gamut from "very bad" to "very good" even before you factor in noise and even before even before you factor in bias and poor experimental design. So here's why you should beware the man of one study. If you go to your better class of alternative medicine websites, they don't tell you "Studies are a logocentric phallocentric tool of Western medicine and the Big Pharma conspiracy." They tell you "medical science has proved that this drug is terrible, but ignorant doctors are pushing it on you anyway. Look, here's a study by a reputable institution proving that the drug is not only ineffective, but harmful." And the study will exist, and the authors will be prestigious scientists, and it will probably be about as rigorous and well-done as any other study. And then a lot of people raised on the idea that some things have Evidence and other things have No Evidence think holy s**t, they're right! On the other hand, your doctor isn't going to a sketchy alternative medicine website. She's examining the entire literature and extracting careful and well-informed conclusions from… Haha, just kidding. She's going to a luncheon at a really nice restaurant sponsored by a pharmaceutical company, which assures her that they would never take advantage of such an opportunity to shill their drug, they just want to raise awareness of the latest study. And the latest study shows that their drug is great! Super great! And your doctor nods along, because the authors of the study are prestigious scientists, and it's about as rigorous and well-done as any other study.

Ribbonfarm likes to talk about refactoring, a conceptual change in how you see the world. I'm not totally sure I understand it, but I think it means things like memetics – where you go from the usual model of people deciding what ideas they want, to a weird and inside-out (but not objectively wrong) model of ideas competing to colonize people. Here is a refactoring I think about a lot: imagine a world where people considered culture the fourth branch of government. Imagine that civics textbook writers taught high school students that the US government had four branches: executive, legislative, judicial, and cultural. I think about this because I have a bias to ignore anything that isn't nailed down and explicit. Culture isn't nailed down. But if it were in the Constitution in nice calligraphy right beside the Presidency and the Supreme Court, why, then it would be as explicit as it gets. Like many other people, I was hopeful that nation-building Iraq (or Afghanistan, or…) would quickly turn it into a liberal democracy (in my defense, I was eighteen at the time). Like many other people, I was disappointed and confused when it didn't. The people in the world that considers culture the fourth branch of government weren't confused. Bush forgot to nation-build an entire branch of government. If he'd given Iraq a western-style Supreme Court, marble facade and all, but left their executive and legislature exactly how they were before, that would be a recipe for conflict, confusion, and eventually nothing getting done. So why should westernizing their executive, legislature, and courts – but not their culture – work any better? The world that considers culture the fourth branch of government doesn't get all confused calling hunter-gatherers or peasant villagers "primitive communism" or "anarchism" or "ruled by elders" or things like that. Those people's governments have a cultural branch but not much else. Why should we be surprised? Medieval Iceland had onlylegislative and judicial branches; medieval Somalia only had a judiciary; some dictatorships run off just an executive. Each branch of government enforces rules in its own way. The legislature passes laws. The executive makes executive orders. The judiciary rules on cases. And the culture sets norms. In our hypothetical world, true libertarians are people who want less of all of these. There are people who want less of the first three branches but want to keep strong cultural norms about what is or isn't acceptable – think Lew Rockwell and other paleoconservatives who hope that the retreat of central government will create strong church-based communities of virtuous citizens. These people aren't considered libertarians. They might be considered principled constitutionalists, the same way as people who worry about the "imperial presidency" and its use of executive orders. But in the end, what they want to strengthen some branches of government at the expense of others. The real libertarians also believe that cultural norms enforced by shame and ostracism are impositions on freedom, and fight to make these as circumscribed as possible.

A recent discussion: somebody asked why people in Silicon Valley thought that only high-tech solutions to climate change (like carbon capture or geoengineering) mattered, and why they dismissed more typical solutions like international cooperation and political activism. Another person cited statements from the relevant Silicon Valley people, who mostly say that they think political solutions and environmental activism were central to the fight against climate change, but that we should look into high-tech solutions too. This is a pattern I see again and again. Popular consensus believes 100% X, and absolutely 0% Y. A few iconoclasts say that X is definitely right and important, but maybe we should also think about Y sometimes. The popular consensus reacts "How can you think that it's 100% Y, and that X is completely irrelevant? That's so extremist!" Some common forms of this: Reversed moderation of planning, like in the geoengineering example. One group wants to solve the problem 100% through political solutions, another group wants 90% political and 10% technological, and the first group thinks the second only cares about technological solutions. Reversed moderation of importance. For example, a lot of psychologists talk as if all human behavior is learned. Then when geneticists point to experiments showing behavior is about 50% genetic, they get accused of saying that "only genes matter" and lectured on how the world is more complex and subtle than that. Reversed moderation of interest. For example, if a vegetarian shows any concern about animal rights, they might get told they're "obsessed with animals" or they "care about animals more than humans". Reversed moderation of certainty. See for example my previous article Two Kinds Of Caution. Some researcher points out a possibility that superintelligent AI might be dangerous, and suggests looking into this possibility. Then people say it doesn't matter, and we don't have to worry about it, and criticize the researcher for believing he can "predict the future" or thinking "we can see decades ahead". But "here is a possibility we need to investigate" is a much less certain claim than "no, that possibility definitely will not happen". I can see why this pattern is tempting. If somebody said the US should allocate 50% of its defense budget to the usual global threats, and 50% to the threat of reptilian space invaders, then even though the plan contains the number "50-50" it would not be a "moderate" proposal. You would think of it as "that crazy plan about fighting space reptiles", and you would be right to do so. But in this case the proper counterargument is to say "there is no reason to spend any money fighting space reptiles", not "it's so immoderate to spend literally 100% of our budget breeding space mongooses". "Moderate" is not the same as "50-50" is not the same as "good". Just say "Even though this program leaves some money for normal defense purposes, it's stupid". You don't have to deny that it leaves anything at all.

Donald Trump has been called a setback for many things. America. The global community. The environment. Civil service. Civil society. Civility. Civilization. The list goes on. One might think he has at least been useful to his own cause. That he could at least claim to have benefited the ideas of populism, nationalism, immigration control, and protectionism. That if anything could avoid being devastated by Trump, it would be Trumpism. But here are some polls from the past few years. They're all on slightly different things, but I think together they tell an interesting story: Support for global free trade mysteriously spiked around 2016. So did moral support for immigrants. …and, less clearly but still there, support for increasing the number of immigrants (though see here for an apparently contrary source). …and opposition to deporting illegal immigrants. So did belief in racial discrimination as a major cause of inequality, according to this chart with a completely unbiased title which is willing to let readers decide how to think about this issue for themselves. And so did trust in the New York Times and other mainstream media sources. The clearest example I can find of this effect doesn't come from the US at all. It's Minkus, Deutschmann & Delhey (2018). They find that a large European poll asked the same question about support for the EU the week before and after Trump's election. Just after the election, there was a giant spike in support for the EU, "considerable in size, roughly equivalent to three years of education". They conclude that: The election of Trump as a right-wing nationalist with a declared aversion to supranational institutions including the EU — did not trigger a domino effect in the same direction in Europe. To the contrary, a rally effect occurred, in which Europe moved closer together, rallying around the EU's "flag." This indicates that an event that may at first sight appear to be a global victory for nationalism can immediately trigger measurable sentiments of resistance in another part of the world, actually leading to new impetus for supranationalism.

One interesting thing I took from Evolutionary Psychopathology was a better understanding of the diametrical theory of the social brain. There's been a lot of discussion over whether schizophrenia is somehow the "opposite" of autism. Many of the genes that increase risk of autism decrease risk of schizophrenia, and vice versa. Autists have a smaller-than-normal corpus callosum; schizophrenics have a larger-than-normal one. Schizophrenics smoke so often that some researchers believe they have some kind of nicotine deficiency; autists have unusually low smoking rates. Schizophrenics are more susceptible to the rubber hand illusion and have weaker self-other boundaries in general; autists seem less susceptible and have stronger self-other boundaries. Autists can be pathologically rational but tend to be uncreative; schizophrenics can be pathologically creative but tend to be irrational. The list goes on. I've previously been skeptical of this kind of thinking because there are many things that autists and schizophrenics have in common, many autistics who seem a bit schizophrenic, many schizophrenics who seem a bit autistic, and many risk factors shared by both conditions. But Del Giudice, building on work by Badcock and Crespipresents the "diametrical model": schizophrenia and autism are the failure modes of opposing sides of a spectrum from high functioning schizotypy to high functioning autism, ie from overly mentalistic cognition to overly mechanistic cognition. Schizotypy is a combination of traits that psychologists have discovered often go together. It's classified as a personality disorder in the DSM. But don't get too caught up on that term – it's a disorder in the same sense as narcissistic or antisocial tendencies, and like those conditions, some schizotypals do very well for themselves. Classic schizotypal traits include tendency toward superstition, disorganized communication, and nonconformity (if it sounds kind of like "schizophrenia lite", that's not really a coincidence).

[Content note: eating disorders] Anorexia has a cultural component. I'm usually reluctant to assume anything is cultural – every mediocre social scientist's first instinct is always to come up with a cultural explanation which is simple, seductive, flattering to all our existing prejudices, and wrong. But after seeing enough ballerinas and cheerleaders who became anorexic after pressure to lose weight for the big competition, even I have to throw up my hands and admit anorexia has a cultural component. But nobody ever tells you the sequel. That ballerina who's losing weight for the big competition at age 16? At age 26, she's long since quit ballet, worried it would exacerbate her anorexia. She's been in therapy for ten years; for eight of them she's admitted she has a problem, that her anorexia is destroying her life. Her romantic partners – the ones she was trying to get thin to impress – have long since left her because she looks skeletal and weird. She understands this and would do anything to cure her anorexia and be a normal weight again. But she finds she isn't hungry. She hasn't eaten in two days and she isn't hungry. In fact, the thought of food sickens her. She goes to increasingly expert therapists and dieticians, asking them to help her eat more. They recommend all the usual indulgences: ice cream, french fries, cookies. She tries all of them and finds them inexplicably disgusting. Sometimes with a prodigious effort of will she will manage to finish one cookie, and congratulate herself, but the next day she finds the task of eating dessert as daunting as ever. Finally, after many years of hard work, she is scraping the bottom end of normal weight by keeping to a diet so regimented it would make a Prussian general blush. And nobody ever tells you about all the people who weren't ballerinas. The young man who stops eating because it gives him a thrill of virtue and superiority to be able to demonstrate such willpower. The young woman who stops eating in order to show her family how much their neglect hurts her. If they pursue their lack of appetite far enough, they end up the same way as the ballerina – admitting they have a problem, admitting they need to eat more, hiring all sorts of doctors and dieticians to find them a way to eat more, but discovering themselves incapable of doing so.

I. Evolutionary psychology is famous for having lots of stories that make sense but are hard to test. Psychiatry is famous for having mountains of experimental data but no idea what's going on. Maybe if you added them together, they might make one healthy scientific field? Enter Evolutionary Psychopathology: A Unified Approach by psychology professor Marco del Giudice. It starts by presenting the theory of "life history strategies". Then it uses the theory – along with a toolbox of evolutionary and genetic ideas – to shed new light on psychiatric conditions. Some organisms have lots of low-effort offspring. Others have a few high-effort offspring. This was the basis of the old r/k selection theory. Although the details of that theory have come under challenge, the basic insight remains. A fish will lay 10,000 eggs, then go off and do something else. 9,990 will get eaten by sharks, but that still leaves enough for there to be plenty of fish in the sea. But an elephant will spend two years pregnant, three years nursing, and ten years doing at least some level of parenting, all to produce a single big, well-socialized, and high-prospect-of-life-success calf. These are two different ways of doing reproduction. In keeping with the usual evolutionary practice, del Giudice calls the fish strategy "fast" and the elephant strategy "slow". To oversimplify: fast strategies (think "live fast, die young") are well-adapted for unpredictable dangerous environments. Each organism has a pretty good chance of randomly dying in some unavoidable way before adulthood; the species survives by sheer numbers. Fast organisms should grow up as quickly as possible in order to maximize the chance of reaching reproductive age before they unpredictably die. They should mate with anybody around, to maximize the chance of mating before they unpredictably die. They should ignore their offspring, since they expect most offspring to unpredictably die, and since they have too many to take care of anyway. They should be willing to take risks, since the downside (death without reproducing) is already their default expectation, and the upside (becoming one of the few individuals to give birth to the 10,000 offspring of the next generation) is high. Slow strategies are well-adapted for safer environments, or predictable complex environments whose intricacies can be mastered with enough time and effort. Slow strategy animals may take a long time to grow up, since they need to achieve mastery before leaving their parents. They might be very picky maters, since they have all the time in the world to choose, will only have a few children each, and need to make sure each of those children has the best genes possible. They should work hard to raise their offspring, since each individual child represents a substantial part of the prospects of their genetic line. They should avoid risks, since the downside (death without reproducing) would be catastrophically worse than default, and the upside (giving birth to a few offspring of the next generation) is what they should expect anyway.

I. The Mind Illuminated is a guide to Buddhist meditation by Culadasa, aka John Yates, a Buddhist meditation teacher who is also a neuroscience PhD. At this point I would be more impressed to meet a Buddhist meditation teacher who wasn't a neuroscience PhD. If I ever teach Buddhist meditation, this is going to be my hook. "Come learn advanced meditation techniques with Scott Alexander, whose lack of a neuroscience PhD gives him a unique perspective that combines ancient wisdom with a lack of modern brain science." I think the world is ready for someone to step into this role. But Culadasa is not that person, and The Mind Illuminated is not that book. I am trying not to read too many books on spiritual practices until I'm ready to practice some spirituality. I made an exception for TMI because lots of people recommended it to me for its description of how the brain works. This seems like the sort of thing that Buddhist meditation teachers who are also neuroscientists could have insight on, so I decided to check it out. Tradition divides meditation into two parts: concentration meditation, where you sharpen and control your focus, versus insight meditation, where you investigate the nature of perception and reality. TMI follows a long tradition of focusing on concentration meditation, with the assumption that insight meditation will become safer and easier once you've mastered concentration, and maybe partly take care of itself. Its course divides concentration meditation into ten stages. Early stages contain basic tasks like setting up a practice, focusing on the breath, and overcoming distractability. Later stages are more interesting; the ninth stage is learning how to calm the intensity of your meditative joy; apparently without special techniques "overly intense joy" becomes a big problem. I usually hate meditation manuals, because they sound like word salad. "One attains joy by combining pleasure with happiness. Pleasure is a state of bliss which occurs when one concentrates focus on the understanding of awareness. Happiness is a state of joy that occurs when one focuses concentration on the awareness of understanding. By focusing awareness on bliss, you can increase the pleasure of understanding, which in turn causes concentration to be pleasant and joy to be blissful, and helps you concentrate on understanding your awareness of happiness about the bliss of focus." At some point you start thinking "Wait, were all the nouns in that paragraph synonyms for each other?"

[This post was up a few weeks ago before getting taken down for complicated reasons. They have been sorted out and I'm trying again.] Is scientific progress slowing down? I recently got a chance to attend a conference on this topic, centered around a paper by Bloom, Jones, Reenen & Webb (2018). BJRW identify areas where technological progress is easy to measure – for example, the number of transistors on a chip. They measure the rate of progress over the past century or so, and the number of researchers in the field over the same period. For example, here's the transistor data: This is the standard presentation of Moore's Law – the number of transistors you can fit on a chip doubles about every two years (eg grows by 35% per year). This is usually presented as an amazing example of modern science getting things right, and no wonder – it means you can go from a few thousand transistors per chip in 1971 to many million today, with the corresponding increase in computing power. But BJRW have a pessimistic take. There are eighteen times more people involved in transistor-related research today than in 1971. So if in 1971 it took 1000 scientists to increase transistor density 35% per year, today it takes 18,000 scientists to do the same task. So apparently the average transistor scientist is eighteen times less productive today than fifty years ago. That should be surprising and scary. But isn't it unfair to compare percent increase in transistors with absolute increase in transistor scientists? That is, a graph comparing absolute number of transistors per chip vs. absolute number of transistor scientists would show two similar exponential trends. Or a graph comparing percent change in transistors per year vs. percent change in number of transistor scientists per year would show two similar linear trends. Either way, there would be no problem and productivity would appear constant since 1971. Isn't that a better way to do things? A lot of people asked paper author Michael Webb this at the conference, and his answer was no. He thinks that intuitively, each "discovery" should decrease transistor size by a certain amount. For example, if you discover a new material that allows transistors to be 5% smaller along one dimension, then you can fit 5% more transistors on your chip whether there were a hundred there before or a million. Since the relevant factor is discoveries per researcher, and each discovery is represented as a percent change in transistor size, it makes sense to compare percent change in transistor size with absolute number of researchers. Anyway, most other measurable fields show the same pattern of constant progress in the face of exponentially increasing number of researchers. Here's BJRW's data on crop yield: The solid and dashed lines are two different measures of crop-related research. Even though the crop-related research increases by a factor of 6-24x (depending on how it's measured), crop yields grow at a relatively constant 1% rate for soybeans, and apparently declining 3%ish percent rate for corn. BJRW go on to prove the same is true for whatever other scientific fields they care to measure. Measuring scientific progress is inherently difficult, but their finding of constant or log-constant progress in most areas accords with Nintil's overview of the same topic, which gives us graphs like …and dozens more like it. And even when we use data that are easy to measure and hard to fake, like number of chemical elements discovered, we get the same linearity:

[Content warning: scrupulosity] I. "There is no ethical consumption under late capitalism". I hear this from a bunch of people. Sometimes it is taken to its conclusion; no currently living person is morally acceptable. People who aren't activists reorienting their entire lives around acknowledging and combating the evils of the world aren't even on the scale. And people who are such activists are (in the words of one of my friends who is close to that community) "only making comfortable sacrifices that let them think of themselves as a good person within their existing comfortable moral paradigm, instead of confronting the raw terrible truth." IE "If you think you're one of the good ones, you're wrong". I have heard this sentiment raised by animal rights activists. The average meat-eater isn't even on the scale. The average vegetarian still eats milk and cheese, and so is barely even trying. Even most vegans probably use some medical product with gelatin, or something tested on lab rats, or are just benefitting from animal suffering in some indirect way. And I have heard it raised by environmentalists. The average SUV driver isn't even on the scale. The average conscientious liberal might think they're better because they bike to work and recycle, but they still barely think about how they're using electricity generated by coal plants and eating food grown with toxic pesticides. Everyone could be doing more. And I have heard raised by labor activists. Most of us use stuff made in sweatshops. Even if you avoid sweatshops, you probably use stuff made at less than a living wage. Even if you avoid that, are you doing everything you can to help and support workers who earn less than you do? Even if you aren't an animal rights activist, environmentalist, or labor advocate, do you believe in anything? Are you a Christian, a social justice advocate, or rationalist? Do you know anyone who really satisfies you as being sinless, non-racist, and/or rational? Then perhaps you too believe nobody is good.

I. A lot of people pushed back against my post on preschool, so it looks like we need to discuss this in more depth. A quick refresher: good randomized controlled trials have shown that preschools do not improve test scores in a lasting way. Sometimes test scores go up a little bit, but these effects disappear after a year or two of regular schooling. However, early RCTs of intensive "wrap-around" preschools like the Perry Preschool Program and the Abecedarians found that graduates of those programs went on to have markedly better adult outcomes, including higher school graduation rates, more college attendance, less crime, and better jobs. But these studies were done in the 60s, before people invented being responsible, and had kind of haphazard randomization and followup. They were also small sample sizes, and from programs that were more intense than any of the scaled-up versions that replaced them. Modern scaled-up preschools like Head Start would love to be able to claim their mantle and boast similar results. But the only good RCT of Head Start, the HSIS study, is still in its first few years. It's confirmed that Head Start test score gains fade out. But it hasn't been long enough to study whether there are later effects on life outcomes. We can expect those results in ten years or so. For now, all we have is speculation based on a few quasi-experiments. Deming 2009 is my favorite of these. He looks at the National Longitudinal Survey of Youth, a big nationwide survey that gets used for a lot of social science research, and picks out children who went to Head Start. These children are mostly disadvantaged because Head Start is aimed at the poor, so it would be unfair to compare them to the average child. He's also too smart to just "control for income", because he knows that's not good enough. Instead, he finds children who went to Head Start but who have siblings who didn't, and uses the sibling as a matched control for the Head Starter. This ensures the controls will come from the same socioeconomic stratum, but he acknowledges it raises problems of its own. Why would a parent send one child to Head Start but not another? It might be that one child is very stupid and so the parents think they need the extra help preschool can provide; if this were true, it would mean Head Starters are systematically dumber than controls, and would underestimate the effect of Head Start. Or it might be that one child is very smart and the so the parents want to give them education so they can develop their full potential; if this were true, it would mean Head Starters are systematically smarter than controls, and would inflate the effect of Head Start. Or it might be that parents love one of their children more and put more effort into supporting them; if this meant these children got other advantages, it would again inflate the effect of Head Start. Or it might mean that parents send the child they love more to a fancy private preschool, and the child they love less gets stuck in Head Start, ie the government program for the disadvantaged. Or it might be that parents start out poor, send their child to Head Start, and then get richer and send their next child to a fancy private preschool, while that child also benefits from their new wealth in other ways. There are a lot of possible problems here.

In 2016, I wrote Ketamine Research In A New Light, which discussed the emerging consensus that, contra existing theory, ketamine's rapid-acting antidepressant effects had nothing to do with NMDA at all. I discussed some experiments which suggested they might actually be due to a related receptor, AMPA. The latest development is Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism, which finds that the opioid-blocker naltrexone prevents ketamine's antidepressant effects. Naltrexone does not prevent dissociation or any of the other weird hallucinatory effects of ketamine, which are probably genuinely NMDA-related. This suggests it's just a coincidence that NMDA antagonism and some secondary antidepressant effect exist in the same drug. If you can prevent an effect from working by blocking the opiate system, a natural assumption is that the effect works on the opiate system, and the authors suggest this is probably true. (unexpected national news tie-in: Kavanaugh accuser Christine Blasey Ford is one of the authors of this paper) In retrospect, there were warnings. The other study to have found an exciting rapid-acting antidepressant effect for an ordinary drug was Ultra-Low-Dose Buprenorphine As A Time-Limited Treatment For Severe Suicidal Ideation. It finds that buprenorphine (the active ingredient in suboxone), an opiate painkiller also used in treating addictions to other opiates, can quickly relieve the distress of acutely suicidal patients. This didn't make as big a splash as the ketamine results, for two reasons. First, everyone knows opiates feel good, and so maybe this got interpreted as just a natural extension of that truth (the Scientific American article on the discovery focused on an analogy where "mental pain" was the same as "physical pain" and so could be treated with painkillers). Second, we're currently fighting a War On Opiates, and discovering new reasons to prescribe them seems kind of like giving aid and comfort to the enemy.

Four years ago I examined the claim that SSRIs are little better than placebo. Since then, some of my thinking on this question has changed. First, we got Cipriani et al's meta-analysis of anti-depressants. It avoids some of the pitfalls of Kirsch and comes to about the same conclusion. This knocks down a few of the lines of argument in my part 4 about how the effect size might look more like 0.5 than 0.3. The effect size is probably about 0.3. Second, I've seen enough to realize that the anomalously low effect size of SSRIs in studies should be viewed not as an SSRI-specific phenomenon, but as part of a general trend towards much lower-than-expected effect sizes for every psychiatric medication (every medication full stop?). I wrote about this in my post on melatonin: The consensus stresses that melatonin is a very weak hypnotic. The Buscemi meta-analysis cites this as their reason for declaring negative results despite a statistically significant effect – the supplement only made people get to sleep about ten minutes faster. "Ten minutes" sounds pretty pathetic, but we need to think of this in context. Even the strongest sleep medications, like Ambien, only show up in studies as getting you to sleep ten or twenty minutes faster; this NYT article says that "viewed as a group, [newer sleeping pills like Ambien, Lunesta, and Sonata] reduced the average time to go to sleep 12.8 minutes compared with fake pills, and increased total sleep time 11.4 minutes." I don't know of any statistically-principled comparison between melatonin and Ambien, but the difference is hardly (pun not intended) day and night. Rather than say "melatonin is crap", I would argue that all sleeping pills have measurable effects that vastly underperform their subjective effects. Or take benzodiazepines, a class of anxiety drugs including things like Xanax, Ativan, and Klonopin. Everyone knows these are effective (at least at first, before patients develop tolerance or become addicted). The studies find them to have about equal efficacy as SSRIs. You could almost convince me that SSRIs don't have a detectable effect in the real world; you will never convince me that benzos don't. Even morphine for pain gets an effect size of 0.4, little better than SSRI's 0.3 and not enough to meet anyone's criteria for "clinically significant". Leucht 2012provides similarly grim statistics for everything else. I don't know whether this means that we should conclude "nothing works" or "we need to reconsider how we think about effect sizes".

[Originally to be titled "Marijuana: I Was Wrong", but looking back I was suitably careful about everything, and my reward is not having to say that.] Five years ago, I reviewed the potential costs and benefits of marijuana legalization and concluded that there wasn't enough evidence for a firm conclusion. I found that using some made-up math, the effects looked slightly positive, but this was very sensitive to small changes in how made-up the math was. The only really interesting conclusion was that most of the objective costs or benefits of legalization came from road traffic accidents. Either stoned driving would increase such accidents, killing thousands. Or people using marijuana instead of alcohol would decrease those accidents, saving thousands. I concluded: We should probably stop [emphasizing direct] health effects of marijuana and imprisonment for marijuana-related offenses, and concentrate all of our research and political energy on how marijuana affects driving. Using the best evidence available at the time, I predicted that marijuana legalization would probably decrease road traffic accidents. Now several states have legalized marijuana, data are in, and we have some preliminary evidence on how marijuana affects driving. And I was wrong. A study by the Highway Loss Data Institute in June of last year finds that states that legalized marijuana saw insurance claims for auto accidents increase about 3% over the general national trend for the time. An updated study by the same group finds 6% according to insurance claims, and 5.2% according to police reports.

Kelsey Piper has written an article for Vox: Early Childhood Education Yields Big Benefits – Just Not The Ones You Think. I had previously followed various studies that showed that preschool does not increase academic skill, academic achievement, or IQ, and concluded that it was useless. In fact, this had become a rallying point of movement for evidence-based social interventions; the continuing popular support for preschool proved that people were morons who didn't care about science. I don't think I ever said this aloud, but I believed it in my heart. I talked to Kelsey about some of the research for her article, and independently came to the same conclusion: despite the earlier studies of achievement being accurate, preschools (including the much-maligned Head Start) do seem to help children in subtler ways that only show up years later. Children who have been to preschool seem to stay in school longer, get better jobs, commit less crime, and require less welfare. The thing most of the early studies were looking for – academic ability – is one of the only things it doesn't affect. This suggests that preschool is beneficial not because of the curriculum or because of "teaching young brains how to learn" or anything like that, but for purely social reasons. Kelsey reviews some evidence that it might improve child health, but this doesn't seem to be the biggest part of the effect. Instead, she thinks that it frees low-income parents from childcare duties, lets them get better jobs (or in the case of mothers, sometimes lets them get a job at all), and improves parents' human capital, with all the relevant follow-on effects. More speculatively, if the home environment is unusually bad, it gives the child a little while outside the home environment, and socializes them into a "normal" way of life. I'll discuss a slightly more fleshed-out model of this in an upcoming post. My only caveat in agreeing with this perspective is that Chetty finds the same effect (no academic gains, but large life-outcome gains years later) from children having good rather than bad elementary school teachers. This doesn't make sense in the context of freeing up parents' time to get better jobs, or of getting children out of a bad home environment. It might make sense in terms of socializing them, though I would hate to have to sketch out a model of how that works. But since the teacher data and the Head Start data agree, that gives me more reason to think both are right. I can't remember ever making a post about how Head Start was useless, but I definitely thought that, and to learn otherwise is a big update for me. I've written before about how when you make an update of that scale, it's important to publicly admit error before going on to justify yourself or say why you should be excused as basically right in principle or whatever, so let me say it: I was wrong about Head Start. That having been said, on to the self-justifications and excuses

These are my preliminary choices for California elected positions and ballot initiatives. Some of them are based on Ozy's recommendations and the Berkeley EA and rationalist community's recommendations. I agree with the latter's note that because California ballot propositions are weird superlaws that permanently overrule the legislature unless repealed by voters, in general we should be very cautious about them (though some of them were recommended by the legislature itself, since for complicated reasons it needs voter support to do certain things). I'm giving first-level justifications for my votes (ie "I support this person because she wants higher taxes") but not always second-level justifications ("here's why higher taxes are good"). You can usually find discussion of these on other blog posts. Governor of California is the big one. Democrat Gavin Newsom is a former successful businessman, mayor of San Francisco, and lieutenant governor of California (also second cousin of musician Joanna Newsom). He has stated that if elected, he will let people call him "the Gavinator". Republican John Cox is a former successful businessman, best known for sponsoring a ballot initiative to make legislators wear the logos of their top 10 donors on the State Assembly floor, "much like NASCAR drivers". He also has a fascinating plan to reform politics from the ground up with a 12,000 (!) member legislature. I don't really like Newsom – he led a movement called "Care Not Cash" to restrict giving money to the homeless, and supposedly opposed anti-gay Proposition 8 so incompetently that his statements may have increased support for the measure. He also had an affair with his campaign manager's wife in a scandal that seemed unusually scummy even for a politician. I like John Cox as a person, but he doesn't seem to have any relevant governing experience. And he was anti-Trump until Trump became popular among Republicans, then about-faced and decided Trump was his new best friend, and now he's basically just a Trumpist. I am going with Newsom; God help me, God help California.

[Epistemic status: low. You tell me if you think this works.] Commenter no_bear_so_low has been doing some great work with Google Trends recently – see for example his Internet searches increasingly favour the left over the right wing of politics or Googling habits suggest we are getting a lot more anxious. I wanted to try some similar things, and in the process I learned that this is hard. Existing sites on how to use Google Trends for research don't capture some of the things I learned, so I wanted to go over it here. Suppose I want to measure the level of interest in "psychiatry" over the past few years: Looks like interest is going down. But what if I search for "psychiatrist" instead? Uh oh, now it looks like interest is going up. I guess what I'm really interested in is mental health more generally, what if I put in "suicide"? Now everything else is invisible, and the data are dominated by a spike in August 2016, which as far as I can tell is related to the release of the movie "Suicide Squad". I could try other terms, like "depression" and "anxiety", but no_bear's data already tells us those two are moving in opposite directions. Also, depression has a spike in late 2008, which must be related to the stock market crash and people's expectations of an economic depression. This doesn't seem like a great way to figure out anything. I wondered if averaging a bunch of things might take away some of the noise. I chose nine terms that seemed related to psychiatry in some way: psychiatry, psychiatrist, psychotherapy, mental illness, mental health, suicide, depression, antidepressants, and anxiety. Google won't let you combine that many terms in a single query, but that's okay – I don't want to see them relative to one another, I just want to get standardized data on each. There's a button to download any individual Google Trends query as a spreadsheet:

[Epistemic status: fiction] Thanks for letting me put my story on your blog. Mainstream media is crap and no one would have believed me anyway. This starts in September 2017. I was working for a small online ad startup. You know the ads on Facebook and Twitter? We tell companies how to get them the most clicks. This startup – I won't tell you the name – was going to add deep learning, because investors will throw money at anything that uses the words "deep learning". We train a network to predict how many upvotes something will get on Reddit. Then we ask it how many likes different ads would get. Then we use whatever ad would get the most likes. This guy (who is not me) explains it better. Why Reddit? Because the upvotes and downvotes are simpler than all the different Facebook reacts, plus the subreddits allow demographic targeting, plus there's an archive of 1.7 billion Reddit comments you can download for training data. We trained a network to predict upvotes of Reddit posts based on their titles. Any predictive network doubles as a generative network. If you teach a neural net to recognize dogs, you can run it in reverse to get dog pictures. If you train a network to predict Reddit upvotes, you can run it in reverse to generate titles it predicts will be highly upvoted. We tried this and it was pretty funny. I don't remember the exact wording, but for /r/politics it was something like "Donald Trump is no longer the president. All transgender people are the president." For r/technology it was about Elon Musk saving Net Neutrality. You can also generate titles that will get maximum downvotes, but this is boring: it will just say things that sound like spam about penis pills.

I've gotten a chance to discuss The Whole City Is Center with a few people now. They remain skeptical of the idea that anyone could "deserve" to have bad things happen to them, based on their personality traits or misdeeds. These people tend to imagine the pro-desert faction as going around, actively hoping that lazy people (or criminals, or whoever) suffer. I don't know if this passes an Intellectual Turing Test. When I think of people deserving bad things, I think of them having nominated themselves to get the short end of a tradeoff. Let me give three examples: 1. Imagine an antidepressant that works better than existing antidepressants, one that consistently provides depressed people real relief. If taken as prescribed, there are few side effects and people do well. If ground up, snorted, and taken at ten times the prescribed dose – something nobody could do by accident, something you have to really be trying to get wrong – it acts as a passable heroin substitute, you can get addicted to it, and it will ruin your life. The antidepressant is popular and gets prescribed a lot, but a black market springs up, and however hard the government works to control it, a lot of it gets diverted to abusers. Many people get addicted to it and their lives are ruined. So the government bans the antidepressant, and everyone has to go back to using SSRIs instead. Let's suppose the government is being good utilitarians here: they calculated out the benefit from the drug treating people's depression, and the cost from the drug being abused, and they correctly determined the costs outweighed the benefits. But let's also suppose that nobody abuses the drug by accident. The difference between proper use and abuse is not subtle. Everybody who knows enough to know anything about the drug at all has heard the warnings. Nobody decides to take ten times the recommended dose of antidepressant, crush it, and snort it, through an innocent mistake. And nobody has just never heard the warnings that drugs are bad and can ruin your life.

[Epistemic status: so, so, so speculative. I do not necessarily endorse taking any of the substances mentioned in this post.] There's been recent interest in "smart drugs" said to enhance learning and memory. For example, from the Washington Post: When aficionados talk about nootropics, they usually refer to substances that have supposedly few side effects and low toxicity. Most often they mean piracetam, which Giurgea first synthesized in 1964 and which is approved for therapeutic use in dozens of countries for use in adults and the elderly. Not so in the United States, however, where officially it can be sold only for research purposes. Piracetam is well studied and is credited by its users with boosting their memory, sharpening their focus, heightening their immune system, even bettering their personalities. Along with piracetam, a few other substances have been credited with these kinds of benefits, including some old friends: "To my knowledge, nicotine is the most reliable cognitive enhancer that we currently have, bizarrely," said Jennifer Rusted, professor of experimental psychology at Sussex University in Britain when we spoke. "The cognitive-enhancing effects of nicotine in a normal population are more robust than you get with any other agent. With Provigil, for instance, the evidence for cognitive benefits is nowhere near as strong as it is for nicotine." But why should there be smart drugs? Popular metaphors speak of drugs fitting into receptors like "a key into a lock" to "flip a switch". But why should there be a locked switch in the brain to shift from THINK WORSE to THINK BETTER? Why not just always stay on the THINK BETTER side? Wouldn't we expect some kind of tradeoff? Piracetam and nicotine have something in common: both activate the brain's acetylcholine system. So do three of the most successful Alzheimers drugs: donepezil, rivastigmine, and galantamine. What is acetylcholine and why does activating it improve memory and cognition?

[I briefly had a different piece up tonight discussing a conference, but the organizers asked me to hold off on writing about it until they've put up their own synopsis. It will be back up eventually; please accept this post instead for now.] In Jewish legend, the Chamber of Guf is a pit where all the proto-souls hang out whispering and murmuring. Whenever a child is born, an angel reaches into the chamber, scoops up a soul, and brings it into the world. In the syncretist mindset where every legend has to be a metaphor for the human mind, I map the Chamber of Guf to all the thoughts that exist below the level of consciousness, fighting for attention. We already know something like this happens for behaviors. From Guyenet's The Hungry Brain: How does the lamprey decide what to do? Within the lamprey basal ganglia lies a key structure called the striatum, which is the portion of the basal ganglia that receives most of the incoming signals from other parts of the brain. The striatum receives "bids" from other brain regions, each of which represents a specific action. A little piece of the lamprey's brain is whispering "mate" to the striatum, while another piece is shouting "flee the predator" and so on. It would be a very bad idea for these movements to occur simultaneously – because a lamprey can't do all of them at the same time – so to prevent simultaneous activation of many different movements, all these regions are held in check by powerful inhibitory connections from the basal ganglia. This means that the basal ganglia keep all behaviors in "off" mode by default. Only once a specific action's bid has been selected do the basal ganglia turn off this inhibitory control, allowing the behavior to occur. You can think of the basal ganglia as a bouncer that chooses which behavior gets access to the muscles and turns away the rest. This fulfills the first key property of a selector: it must be able to pick one option and allow it access to the muscles. So in the process of deciding what behavior to do, the (lamprey) brain subconsciously considers many different plausible behaviors, all of which compete to be enacted. I don't know how this extends to humans, but it would make sense that maybe only the top few candidate behaviors even make it to consciousness, with the rest getting rejected without conscious consideration.

The best thing about personalized medicine is that it's obviously right. The worst thing is we mostly have no idea how to do it. We know that different people respond to different treatments. But outside a few special cases like cancer, we don't know how to predict which treatment will work for which person. Some psychiatric researchers claim they can do this at a high level; I think they're wrong. For most treatments and most conditions, there's no way to figure out whether a given sometimes-effective treatment will work on a given individual besides trying it and seeing. This suggests that some chronic conditions might do best with a model centered around a controlled process of guess-and-check. When it's safe and possible, we should be maximizing throughput – finding out how to test as many medications as we can in the short time before we exhaust our patients' patience, and how to best assess the effects of each. The process of treating each individual should mirror the process of medicine in general, balancing the need to run controlled trials and gather more evidence with the need to move quickly. I don't know how seriously to take this idea, but I would like to try it.

There's some literature suggesting that people are more careful when they think in probabilities. If you ask them for a definite answer, they might give it and sound very confident, but if you encourage them to think probabilistically they might admit there's more uncertainty. I wanted to look into this in the context of the recent Supreme Court confirmation hearings, so I asked readers to estimate their probability that Judge Kavanaugh was guilty of sexually assaulting Dr. Ford. I got 2,350 responses (thank you, you are great). Here was the overall distribution of probabilities. Horizontal axis is percent chance he did it; vertical axis is number of people who responded with that percent: This looks weird because people were most likely to give numbers rounded off the the nearest ten. I separated responses into bins from 0 – 9%, 10 – 19%, and so on to 90 – 100%. Keep in mind that the last bin is slightly larger than the others, so it might make it unfairly look like more people gave extreme high answers than extreme low answers. I also switched the vertical axis to percent of responses in each bin. Smoothed out, it looks like this: This looks pretty balanced, and it is: the average probability is 52.64%. This is probably a fake balance based on all the different demographic skews involved cancelling out: 2.5x as many Democrats as Republicans answered the survey, but 9x as many men as women did.

Thanks to the 129 people who tried altering their nighttime carbon dioxide levels after my post on this, and who reported back to me. There was no difference between people who pre-registered for the study and people who didn't, on any variable, so I ignored pre-registration. 126 people reported one intervention they performed. The most common was sleeping with a window open: People generally reported slight but positive changes: When asked to rate the magnitude of improvement to well-being on a 0 to 5 scale, they averaged 1.4: I mentioned in the post that succulents could help in theory, but you needed to get the right kind of succulents and you needed at least ten of them. I was skeptical that anyone really got ten succulents in their room, so I wondered whether that might work as a crypto-placebo group. If so, the intervention failed to separate from placebo. Succulent users had an average improvement of 1.29, compared to about 1.50 for people who did other things. The difference wasn't significant, although admittedly the sample size was low. Looking at the various groups, the most striking difference was actually people who left a window open (1.57) vs. people who did one of the other named options (1.31). A few people who left windows open mentioned this made their room cooler, which seemed to help with sleep. But this is very post hoc, and this difference wasn't significant either.

[Content note: attempt to consider real people's real problems using angel-on-pinhead impractical reasoning and ideas] I. Imagine the state of nature, except for some reason there are cities. Some people in these cities play the drums all night and keep everyone else awake. The sleep-deprived people get together and agree this is unacceptable. They embark on a long journey to the wilderness where they found their own community of Nodrumia. They form a company, the Nodrumia Corporation, which owns all the property in the area. The corporation distributes usage rights via a legal instrument that looks suspiciously like private property: people who own usage rights keep them forever, can do whatever they want with the land, and can freely transfer and sell them to others. The only difference is that the usage rights have a big asterisk on them saying "contract is null and void if you break the rules of the Nodrumia Corporation". These rules are set by a board chosen democratically by the inhabitants, and are all things like "You can't play drums at night", and "You can't sell property to people who will play the drums at night", and "Anyone who plays the drums at night shall be exiled". One day a Nodrumian wants to move out, so he puts his house up for sale. The highest bidder is a drummer who wants to use the property as a studio so he can play the drums at night. The Corporation steps in and bans the sale. The property owner protests, saying that he is being oppressed. According to libertarian philosophy, who is in the right? The argument against the drummer: the land is basically the private property of the Nodrumia Corporation, and libertarians believe that private landowners should be able to determine what happens on their property. And more fundamentally, the people there have a strong preference against living near drummers, and that preference seems fundamentally satisfiable if their property rights are respected, and it seems stupid to legislate a world where people are forever forbidden from satisfying a fundamentally satisfiable preference and have to be unhappy all the time.

Quixote writes: It's odd to me how bad San Francisco is, when other large cities like New York or Paris are basically utopias. But just a few comments down, Lasagna says: I despise (I'm choosing that word carefully) [New York City]. I still commute there every day, and I can't stand it – the broken infrastructure, the horrible smells, the $14 for a yogurt and coffee in the morning, the massive crowds of unpleasant people (how could we NOT be? We're walking through an open sewer). There's a litany of other things that keep me permanently angry and depressed (just the thought of how much earlier I would have started a family if I didn't live there….) I find it decadent, selfish, shallow – pick your bad adjective. I'll stop now. Where I live now is nice. We have a town we can walk to, a lawn for the kids to play on and me to mow, we cook at home, we have enough room for our family to live and the kids to get exercise, even indoors. There's no WAY I'm giving that up so I can live in an apartment again, all so NYC can squeeze MORE people into its area. If I had my way, we'd be much further away from the metro area than we are now, in a bigger, cheaper home with more land. But that isn't possible; NYC is where my job is, and that's that. Fine. But let's not make things worse, and make NYC (and San Francisco, and DC, and Boston) even MORE indispensable generators of jobs. And please don't think for a second that there aren't sizable numbers of people like me, and like you, who do not want these things for our families […] Thanks for letting me rant. You should have seen the first draft of this thing. Twice as long, Scott. A litany of woes and anger. This would be fascinating if it weren't so predictable. One person describes NYC as "basically utopia", and another person can't stop ranting about how much he hates it and is glad to have escaped it. In the same vein, from Cerastes: "I think neurotypical people usually underestimate how bad cities are for people with noise sensitivities, anxiety, purity intuitions, or just a need for nature and green things in their environment, …" THIS!!! A MILLION TIMES THIS!! The concept of living somewhere that isn't green is literally nauseating to me, and the idea of a place that isn't teeming with wild animals feels like suffocating. My house is in as wild a place as possible given my commute, budget, and region, and almost every room has a fully planted vivarium with an animal (as well as my office). The amount of urbanist triumphalist crap drives me up the wall, as if these people cannot see why someone would not want to live in conditions far inferior to even low-quality zoos, or why someone might need to balance a job in a city with such desires. Being 100% honest, I actually feel like there's something genuinely wrong with people who don't feel the need to spend time in nature, especially if they also lack pets. They're like sterile androids in some sort of weird dystopia, utterly cut off from life.

[Epistemic status: very unsure. I sympathize with many YIMBY ideas and might support them on net; this post is me exaggerating the NIMBY parts of my brain to a degree I'm not sure I honestly support. This focuses on San Francisco to make it easier, but other cities exist too. Thanks to Nintil for some of the bright-line argument in part four. Conflict of interest notice: I live in a lower-density part of Oakland] Everyone I know is a YIMBY – ie "Yes In My Back Yard" – ie somebody who wants cities (usually San Francisco dominates the discussion) to build more and denser housing. This is a reasonable position, and is held by apparently-reasonable people – centrists, rationalists, economists, self-proclaimed neoliberals. Since everyone involved holds reason and civility as an important value, I would expect the discourse around housing to be unusually reasonable and civil. I have a weird habit of encountering the best parts of some movements and the worst parts of other movements, in a way that doesn't match other people's experiences. And certainly I know many YIMBYs who are amazing people who I love. But as for the movement as a whole, I feel like apparently-reasonable people have dropped the ball on this one. Sorry for having to say this, but YIMBYism is one of the most tribal, most emotional, most closed-minded movements I have ever seen this side of a college campus. So much so that even though I agree with much of what it says, I cannot resist writing a 5,000 word steelman of their enemies just to piss them off. So here are some YIMBY claims and why I cannot be entirely on board with them.

Grand Prize ($1000): Does The Education System Adequately Serve Advanced Students? Editor's Choice ($500): Should Transgender Children Transition? Honorable Mentions ($250): Should Childhood Vaccination Be Mandatory?, Are Islam And Liberal Democracy Compatible? I'm sorry for jerking the number and value of the prizes around so many times, but I wanted to balance my preferences, the contestants' preferences, and readers' preferences – and this was the best way I could think of to do it. Nobody has gotten less money than they expected, although some prize categories have gotten more money than I originally said. In the end I could not in good conscience let any of these escape without getting a prize. Thanks to this blog's Patreon supporters for making this possible. All winners should email me with their preferred form of payment (I can do Paypal, Bitcoin, or donations to a charity of their choice). The overwhelming winner of the popular vote was the collaboration on education. I agree this one was excellent. It cited a lot of research, analyzed it very well, and mostly came to conclusions. Its only flaw from my perspective was a lack of focus; it discussed many different educational interventions, some of which were similar enough that it was hard for me to keep track of what was going on. I chose the collaboration on transgender children. I thought it did an exceptional job of addressing a specific hot-button issue many people are concerned about, presenting all the evidence on both sides, and mostly coming to conclusions. My strongest complaint was that it ignored some of the potential side effects of puberty blockers which commenters pointed out, and sort of trivialized bone problems that are not trivial; given that the side effects of puberty blockers was a major crux of this question, I found that to be a major weakness. I was still very impressed with the piece's ability to break down and navigate such a controversial question.

A neglected gem from Less Wrong: Why The Tails Come Apart, by commenter Thrasymachus. It explains why even when two variables are strongly correlated, the most extreme value of one will rarely be the most extreme value of the other. Take these graphs of grip strength vs. arm strength and reading score vs. writing score: In a pinch, the second graph can also serve as a rough map of Afghanistan Grip strength is strongly correlated with arm strength. But the person with the strongest arm doesn't have the strongest grip. He's up there, but a couple of people clearly beat him. Reading and writing scores are even less correlated, and some of the people with the best reading scores aren't even close to being best at writing. Thrasymachus gives an intuitive geometric explanation of why this should be; I can't beat it, so I'll just copy it outright: I thought about this last week when I read this article on happiness research. The summary: if you ask people to "value their lives today on a 0 to 10 scale, with the worst possible life as a 0 and the best possible life as a 10", you will find that Scandinavian countries are the happiest in the world. But if you ask people "how much positive emotion do you experience?", you will find that Latin American countries are the happiest in the world. If you check where people are the least depressed, you will find Australia starts looking very good. And if you ask "how meaningful would you rate your life?" you find that African countries are the happiest in the world. It's tempting to completely dismiss "happiness" as a concept at all, but that's not right either. Who's happier: a millionaire with a loving family who lives in a beautiful mansion in the forest and spends all his time hiking and surfing and playing with his kids? Or a prisoner in a maximum security jail with chronic pain? If we can all agree on the millionaire – and who wouldn't? – happiness has to at least sort of be a real concept. The solution is to understand words as hidden inferences – they refer to a multidimensional correlation rather than to a single cohesive property. So for example, we have the word "strength", which combines grip strength and arm strength (and many other things). These variables really are heavily correlated (see the graph above), so it's almost always worthwhile to just refer to people as being strong or weak. I can say "Mike Tyson is stronger than an 80 year old woman", and this is better than having to say "Mike Tyson has higher grip strength, arm strength, leg strength, torso strength, and ten other different kinds of strength than an 80 year old woman." This is necessary to communicate anything at all and given how nicely all forms of strength correlate there's no reason not to do it.

A prodrome is an early stage of a condition that might have different symptoms than the full-blown version. In psychiatry, the prodrome of schizophrenia is the few-months-to-few-years period when a person is just starting to develop schizophrenia and is acting a little bit strange while still having some insight into their condition. There's a big push to treat schizophrenia prodrome as a critical period for intervention. Multiple studies have suggested that even though schizophrenia itself is a permanent condition which can be controlled but never cured, treating the prodrome aggressively enough can prevent full schizophrenia from ever developing at all. Advocates of this view compare it to detecting early-stage cancers, or getting prompt treatment for a developing stroke, or any of the million other examples from medicine of how you can get much better results by catching a disease very early before it has time to do damage. These models conceptualize psychosis as "toxic" – not just unpleasant in and of itself, but damaging the brain while it's happening. They focus on a statistic called Duration of Untreated Psychosis. The longer the DUP, the more chance psychosis has had to damage the patient before the fire gets put out and further damage is prevented. Under this model it's vitally important to put people who seem to be getting a little bit schizophrenic on medications as soon as possible. There has been a lot of work on this theory, but not a lot of light has been shed. Observational studies testing whether duration of untreated psychosis correlates with poor outcome mostly find it does a little bit, but there's a lot of potential confounding – maybe lower-class uneducated people take longer to see a psychiatrist, or maybe people who are especially psychotic are especially bad at recognizing they are psychotic. The relevant studies try their hardest to control for these factors, but remember that this is harder than you think. The randomized controlled trials of what happens if you intervene earlier in psychosis tend to do very badly and rarely show any benefit, but randomly intervening earlier in psychosis is hard, especially if you also need an ethics board's permission to keep a control group of other people who you are not going to intervene early on. Overall I could go either way on this.

I. Writing a review of The Black Swan is a nerve-wracking experience. First, because it forces me to reveal I am about ten years behind the times in my reading habits. But second, because its author Nassim Nicholas Taleb is infamous for angry Twitter rants against people who misunderstand his work. Much better men than I have read and reviewed Black Swan, messed it up, and ended up the victim of Taleb's acerbic tongue. One might ask: what's the worst that could happen? A famous intellectual yells at me on Twitter for a few minutes? Isn't that normal these days? Sure, occasionally Taleb will go further and write an entire enraged Medium article about some particularly egregious flub, but only occasionally. And even that isn't so bad, is it? But such an argument betrays the following underlying view: It assumes that events can always be mapped onto a bell curve, with a peak at the average and dropping off quickly as one moves towards extremes. Most reviews of Black Swan will get an angry Twitter rant. A few will get only a snarky Facebook post or an entire enraged Medium article. By the time we get to real extremes in either directions – a mere passive-aggressive Reddit comment, or a dramatic violent assault – the probabilities are so low that they can safely be ignored. Some distributions really do follow a bell curve. The classic example is height. The average person is about 5'7. The likelihood of anyone being a different height drops off dramatically with distance from the mean. Only about one in a million people should be taller than 7 feet; only one in a billion should be as tall as 7'5. Nobody is order-of-magnitude differences in height from anyone else. Taleb calls the world of bell curves and minor differences Mediocristan. If Taleb's reaction to bad reviews dwells alongside height in Mediocristan, I am safe; nothing an order-of-magnitude difference from an angry Twitter rant is likely to happen in entire lifetimes of misinterpreting his work. But other distributions are nothing like a bell curve. Taleb cites power-law distributions as an example, and calls their world Extremistan. Wealth inequality lives in Extremistan. If wealth followed a bell curve around the median household income of $57,000, and a standard deviation scaled the same way as height, then a rich person earning $70,000 would be as remarkable as a tall person hitting 7 feet. Someone who earned $76,000 would be the same kind of prodigy of nature as the 7'6 Yao Ming. Instead, people earning $70,000 are dirt-common, some people earn millions, and the occasional tycoon can make hundreds of millions of dollars per year. In Mediocristan, the extremes don't matter; in Extremistan, sometimes only the extremes matter. If you have a room full of 99 average-height people plus Yao Ming, Yao only has 1.3% of the total height in the room. If you have a room full of 99 average-income people plus Jeff Bezos, Bezos has 99.99% of the total wealth.

The collective intellect is change-blind. Knowledge gained seems so natural that we forget what it was like not to have it. Piaget says children gain long-term memory at age 4 and don't learn abstract thought until ten; do you remember what it was like not to have abstract thought? We underestimate our intellectual progress because every every sliver of knowledge acquired gets backpropagated unboundedly into the past. For decades, people talked about "the gene for height", "the gene for intelligence", etc. Was the gene for intelligence on chromosome 6? Was it on the X chromosome? What happens if your baby doesn't have the gene for intelligence? Can they still succeed? Meanwhile, the responsible experts were saying traits might be determined by a two-digit number of genes. Human Genome Project leader Francis Collins estimated that there were "about twelve genes" for diabetes, and "all of them will be discovered in the next two years". Quanta Magazine reminds us of a 1999 study which claimed that "perhaps more than fifteen genes" might contribute to autism. By the early 2000s, the American Psychological Association was a little more cautious, was saying intelligence might be linked to "dozens – if not hundreds" of genes.

When you first take the Artifact, you will see a vision of ALPHANION, Demon-Sultan of the Domain of Order, who appears as a grid of spheres connected by luminous lines. Alphanion will urge you to use the Artifact to enforce cosmic order, law at its most fundamental. He will show you visions of all the most brutal and sadistic crimes of history, of all the wars caused by nations that could not live together in harmony, and he will tell you they are all preventable. He will show you dreams of perfectly clean cities with wide open streets, where everyone earns exactly the optimal amount of money and public transportation is accurate to the second. He will tell you it is all attainable. But if you hesitate even an instant to take Alphanion's offer, you will see a vision of CTHGHFZXAY, Demon-Shah of the Domain of Chaos, who appears as a shifting multicolored cloud. Cthghfzxay will urge you to use the Artifact to promote cosmic chaos, the ultimate principle of freedom. She will condemn the works of Order as a lie, a dystopia bought at the cost of true human liberty. She will show you visions of primaeval forests, where no two flowers are alike, where each glade holds a new mystery, where people run wild in search of new adventure. She will tell you it can all be yours. As you weigh these two offers, you will see a vision of ZAMABAMAZ, Demon-Pharaoh of the Domain of Balance, who appears as a man and woman conjoined. They will tell you that neither Order nor Chaos is at the root of human flourishing, but an ability to strike the right balance between the two. That a virtuous life is one spent in moderation between total wild liberty and a stifling concept of rote rule-following. That Alphanion and Cthfhfzxay are the two poles of the universe, and that righteousness exists in the space created by their interaction. They will ask you to devote the Artifact and its power to the Domain of Balance, so all people can better manage the interaction of Order and Chaos in their own lives. This will seem reasonable to you, but then there will appear a vision of IYYYYYYYYYYYYYYYYYYYYYYY, Demon-Raja of the Domain of Excess, who appears as a blinding violet light. It will tell you that both Order and Chaos present coherent visions of the world, but that for the love of God, choose one or the other instead of being a wishy-washy milquetoast who refuses to commit to anything. It will tell you that blinding white and pitch black are both purer and more compelling than endless pointless grey. It will ask you to give the Artifact to somebody – anybody – other than Zamabamaz.

This is the bi-weekly visible open thread (there are also hidden open threads twice a week you can reach through the Open Thread tab on the top of the page). Post about anything you want, ask random questions, whatever. You can also talk at the SSC subreddit or the SSC Discord server – and also check out the SSC Podcast. Also: 1. Comment of the week is Stefferi on the circumstances leading to the rise of Hitler. See also idontknow: "The strongest defense against extreme right wingers is a moderate right wing party that is vigorous." 2. Please vote for your favorite adversarial collaboration from the last week. The entries were: a. Does The Education System Adequately Serve Advanced Students? b. Are Islam And Liberal Democracy Compatible? c. Should Childhood Vaccination Be Mandatory? d. Should Transgender Children Transition? After some discussion with the contestants, the winner of the popular vote will get a $500 prize, and the winner of my vote will get a second $500 prize; these may or may not be the same entry. After you've read all the entries, you can vote here.

[This is an entry to the Adversarial Collaboration Contest by flame7926 and a_reader.] [Content note: suicide, depression, transphobia, self-harm] Transgender childhood transition is a hotly debated topic, with extensive media coverage devoted to it in recent years. (pro: BBC, The Lancet and The New York Times ; contra: The Cut, New Statesman and The Globe and Mail).We see plenty of stories of transgender children (or gender dysphoric children and gender nonconforming children), both in the media and in the blogosphere. As early as 2 or 3, defying the expectations of their family, those children show a persistent and insistent preference for many things associated with the other sex: little boys want long hair and love dresses, Barbie dolls, Disney princesses and mermaids; little girls, instead, dislike stereotypically feminine activities and prefer rough and tumble play, refuse to wear dresses and insist to have their hair shorter and shorter. Sometimes, from the very beginning, the toddler corrects the parents: "I'm a boy /girl!", but more frequently cross-gender behavior is more prevalent. This is only sometimes followed with the child expressing preferences that would be termed gender dysphoria. The child (born and currently living as a as one sex) says to their parents something like "God made a mistake" or "something went wrong in Mommy's tummy" because he should have been a girl, not a boy (or the other way around). The worried parents search information on the internet and seek out the advice of an expert. There, they usually find one or both of these contradicting opinions: Gender-affirming approach Listen to your child – he/she knows best his/her gender. Let your child be his/her true self. It's your responsibility as a parent to support your child in all stages of his/her transition: social transition now, puberty blockers at the beginning of puberty, cross-sex hormones in adolescence, surgery at 18. To oppose it is child abuse. Transphobia costs lives: 41% of transgenders attempt suicide. Do you prefer a happy daughter or a dead son? Or: Therapeutic approach Your child is just confused. He/she is too young to understand gender and to take such important decision. 80% of gender nonconforming children desist. You, as a parent, have the responsibility to correct his/her wrong behavior. If you tolerate it, gender dysphoria will be reinforced by repetition and persist to adulthood. To encourage your child's delusion is child abuse. Transgenders individuals face lifelong struggle and often suffer from poor mental health: 41% of transgenders attempt suicide. Do you really want that for your son, when he could instead come to accept the body he was born with? The first approach is promoted by transgender activists, the second by the conservative media, but both are supported by some experts. The "Gender-affirming approach" is supported by the Dutch team from the Gender Clinic at VU Medical Centre, Amsterdam, who elaborated the typical transition treatment for minors, with puberty blockers at 12 and cross-sex hormones at 16, and, in the US, by Kristina Olson and others from the TransYouth Project. The "Therapeutic approach" is supported by Kenneth Zucker and his team from the Gender Identity Service at Centre for Addiction and Mental Health, Toronto, and, in the US, by Paul McHugh at Johns Hopkins University School of Medicine. There are also experts such as Debra Soh, once a gender nonconforming girl herself, that advise parents to wait and see until adolescence, because in many cases gender dysphoria desists spontaneously, without intervention. Who to believe when the experts disagree? Let's see the evidence.