jeberts

• jeberts 13 Nov 2023 21:07 UTC

  1 point

  0 ∶ 0

  in reply to: George3d6’s comment on: Don’t Donate A Kid­ney To A Stranger

  I don’t think so, no, in part because I don’t think that there’s a linear relationship between hypothesized market size and the like likelihood of a product being developed. A breast cancer vaccine could be worth like a hundred billion dollars, but of course, there are real scientific obstacles there. Maybe we can get something like a universal breast cancer vaccine some day, but in the mean time, it seems rather absurd to argue that chemotherapy is net harmful because it suppresses the need for vaccine development.
  
  Weight loss represents an enormous industry in the US. This has been true for decades. (Not devoting a lot of time to research, I found this figure cited in an FTC report based on research by the Atlanta Business Chronicle: ” consumers spent an estimated $34.7 billion in 2000 on weight-loss products and programs.”) But development of obesity drugs has been extremely difficult — historically, “a bottomless pit into which people shove money and time,” according to one journalist. In other words, there’s far more than market size at play.

  That a relatively small number of kidney donors somehow suppress (tens of?) billions of dollars worth of value does not seem plausible to me, and moreover, I still don’t think that extra hypothetical market size is likely to substantially influence whether artificial organ transplants are developed faster.

• jeberts 13 Nov 2023 3:02 UTC

  6 points

  3 ∶ 0

  on: Don’t Donate A Kid­ney To A Stranger

  The “active harm by donating” argument is very unconvincing for me. Specifically, the analogy to blood donation does not strike me as adequate. It’s just not true that “the existence of altruistic blood donors means that ruthless capitalists are not going to invest in creating artificial blood” — a quick Google search shows that there have been numerous startups that have sought to do so and are seeking to do so. That very poorly attested $7.6 billion number is huge, especially considering that number is just for US sales! That’s about the value of US sales of Ozempic generated in 2022 — a drug that has resulted in such enormous flows of money to its Danish producers that it’s impacting the country’s monetary policy.

  So that analogy really does not hold, and I think it doesn’t hold in the same ways it does not hold for kidney donation — even with altruistic kidney donors, thousands die every year waiting for a kidney, and there is enormous demand for organs in general (again, a casual Google search for “artificial organ market” suggests it’d be in the tens of billions of dollars per year). A single person donating their kidney could save someone’s life; it is very unclear how that marginal donation and life saved sets back artificial organ research.

• jeberts 27 Oct 2023 18:06 UTC

  3 points

  0 ∶ 0

  in reply to: Jason’s comment on: Why 1Day Sooner Needs EAs to Sign Up for Hep C Challenge Studies

  Woops, link fixed (here it is again). That article is part of a dedicated supplement to HCV challenge/​CHIM.

  Speaking in my personal capacity, I agree — I’d love for insurance/​that sort of compensation to be the norm. That does not happen enough in medical research, challenge or otherwise.

  I can see why an insurance agency would be very wary. Establishing causation of cancer in general is hard. Even if someone were screened and in perfect liver health during the CHIM, that doesn’t mean they won’t later adopt common habits (e.g. smoking or excessive drinking) that are risk factors for liver cancer.

  Relatedly, another article in Clinical Infectious Diseases reviewed liver cancer risks due to CHIM, concluding that “[a]lthough it is difficult to precisely estimate HCC risk from an HCV CHIM, the data suggest the risk to be very low or negligible.” This was based on analysis of three separate cohorts/​datasets of people who had previously been infected with hepatitis C in other contexts. Still, the risk cannot be discounted entirely, and there are risks other than liver cancer that our FAQ document discusses, too.

  Perhaps a workaround could be to establish some sort of trust that pays out to any former CHIM participant who develops liver cancer not obviously traceable to something like alcohol abuse disorder, and have this fund liquidate its assets after a certain number of decades. That would be very novel, expensive, and probably legally complicated, and I don’t think it’s been raised before.

• jeberts 26 Oct 2023 22:17 UTC

  2 points

  0 ∶ 0

  in reply to: Damin Curtis’s comment on: Why 1Day Sooner Needs EAs to Sign Up for Hep C Challenge Studies

  Thanks for reading!

  The donation equivalent aspect is pretty interesting. A study probably would not allow a participant not to take a donation, so in practice it might just be however much money from the study one chooses to donate to effective causes (minus taxes; trial income is usually treated as taxable income, which is probably bad policy). I might be misunderstanding your point, though.

  I’ll reiterate (this probably should’ve been worded clearer in the post), one of the arguments we make here is that assuming all participants who make it into the study are about equally useful, we think EAs are more likely to be effective as pre-participants as well. This is because the study is still under consideration: there are decisions about the study’s design that may make it go faster, and informed advocacy from earnest pre-participants could be very persuasive for regulators and ethicists who might otherwise reject certain study design decisions on paternalistic grounds. The community and shared worldview of EA makes us think EAs will, on average, be more engaged when it comes to voicing their views on study design.

  This interactive model app based on the paper we mention in footnote 4 lets you tinker with a bunch of variables related to challenge model development and vaccine deployment. Based on that, and after a conversation with the lead author, we get about 200 years of life saved for every day sooner the model is developed. (The app isn’t that granular/​to the day yet but it is supposed to be updated soon.) So pushing for stud decisions that condense things even by a month or two could be huge.

• jeberts 25 Oct 2023 16:48 UTC

  8 points

  1 ∶ 0

  in reply to: John Salter’s comment on: Why 1Day Sooner Needs EAs to Sign Up for Hep C Challenge Studies

  Part of our work has included pushing for higher compensation in general, both because we believe it can make recruitment easier (and faster) but also because we think that pay should be more commensurate with the social value generated. I and a few other former human challenge volunteers wrote this paper published in Clinical Infectious Diseases calling for US$20,000 in compensation as a baseline. That’s far higher than the norm for challenge studies; the highest I’ve seen is under $8,0000.

  Re: Why EAs specifically, we delve into that a bit in footnote 9. In short, the study is still in a stage where it can be modified to substantially increase potential QALYs/​DALYs saved. The voices of prospective participants could be very, very persuasive to researchers, regulators, ethicists when considering study design. Non-EAs are certainly capable of advocating and supporting changes as well, but we think EAs are much more likely to a) grasp the case for certain changes and b) be willing to advocate for them.

  No one should feel like they’re obligated to be in a study as an EA (or as a “normie,” though I dislike that dichotomy with EAs). There are certainly people for whom time is better spent elsewhere, EA or not. But not everyone on the forum necessarily works for an EA organization, and there are also certainly people who feel they’d have spare capacity and time that they’d like to commit to this sort of thing.

Why 1Day Sooner Needs EAs to Sign Up for Hep C Challenge Studies

For the Boyz: Zika Challenge in DC/​Baltimore

• jeberts 30 Apr 2023 14:27 UTC

  1 point

  0 ∶ 0

  in reply to: Brad West’s comment on: Ghana has ap­proved the use of a malaria vac­cine with >70% efficacy

  I agree with this! People get filtered out of the studies for reasons completely beyond their control, even if they really want to join. You just can’t help it if your white blood cell count is a tad too low or you have a slight fever the day of study admission.

• jeberts 20 Apr 2023 14:29 UTC

  87 points

  22 ∶ 0

  on: Ghana has ap­proved the use of a malaria vac­cine with >70% efficacy

  Shoutout to the 130-ish people in the UK who volunteered to be infected with malaria in two separate studies at various stages of the R21 development process! Those studies helped identify Matrix-M as the ideal adjuvant, and also provided insight into the optimal dose/​vaccination schedule.

• jeberts 20 Jan 2023 18:30 UTC

  23 points

  10 ∶ 5

  on: FLI FAQ on the re­jected grant pro­posal controversy

  I feel motivated as a former due diligence/​investigative research guy to expand briefly on where my frustration came from. I think it’s hard to understate how stunning a failure of due diligence this was in the first round.

  Due diligence for corporate work involves much more than Googling, but, like, the first step is often just Googling. When you Google Nya Dagbladet, the Swedish Wikipedia page pops up. (The English one did not exist last year.)

  Skimming the page as it existed circa fall 2022 thru Google Translate should have immediately raised several red flags, even for people not familiar with Swedish politics. These flags obviously would be taken with a grain of salt, because it’s Wikipedia, but it stuns me that they were ignored at first. These immediately apparent flags include:

  • The links to the far-right party Nationaldemokraterna/​National Democrats

  • The use of at least once columnist noted for antisemitic conspiracy theories (this guy)

  • The “ethnopluralist” label

  • Irresponsible and misleading reporting related to vaccines (This was added after the letter of intent was signed, so assuming it was not clear)

  Some of those flags don’t immediately check out — e.g., the ethnopluralist label is cited to the paper’s about page, but is not specifically there (nor was it there in archived version of the website). But unless we assume the Wikipedia page is a straight up hit job — which is unlikely, and would be ruled out by checking even a few of the references — then proper due diligence research would have started with a very, very heavy level of scrutiny.

  But it sounds like what happened is they merely checked the Nya Dagbladet website and proposal and didn’t see anything suspicious (again, a due diligence failure, but the website is not quite as blatant at first glance as say, Breitbart News), and wrote off the evidence of far-right ties and views because “quality of public discourse worldwide has degraded so badly” such that you can’t be sure.

  The baseline Wikipedia + sources check took about twenty minutes to do, including typing this up here. Strong due diligence work is really important. I get that they ultimately did not give the grant, but to me, it’s very disturbing that it even made it past the first half-hour sniff test.

• jeberts 6 Dec 2022 22:24 UTC

  2 points

  1 ∶ 0

  on: EA Taskmas­ter Game

  If you’re not already aware of the University of Chicago’s Scav, I’d highly recommend poaching some ideas from them if you ever need inspiration. (E.g., Item 10 from 2021: “A collection of baseball cards for members of the Los Angeles Biblically Accurate Angels baseball team” or Item 262, 2015, “a series of cartoons [drawn] on at least 30 tissues such that when they are rapidly pulled out of a tissue box, they create an animation.”)

• jeberts 30 Nov 2022 15:40 UTC

  1 point

  0 ∶ 0

  in reply to: Henry Howard’s comment on: Come get malaria with me?

  It’s great that you know the results. While relatively minor in the grand scheme of things, it’s frustrating that trials, at least here in the US, don’t often share results with participants, even though it’s theoretically as simple as a mass email along the lines of “here’s what we learned” — presumably an email they’re already sending to colleagues, funders, etc., in some form. I had to ask the people running the Shigella trial for my data (not available yet, but I really wanna see if I got the placebo or not)!

Come get malaria with me?

• jeberts 24 Nov 2022 20:08 UTC

  4 points

  1 ∶ 0

  in reply to: SiebeRozendal’s comment on: Stop Think­ing about FTX. Think About Get­ting Zika In­stead.

  Hi! These are all valid concerns, and I’ll note that many of them are covered in the study eligibility criteria (see NCT05123222). People are excluded if there is any “[e]vidence of clinically significant neurologic, cardiac, pulmonary, hepatic, rheumatologic, autoimmune, or renal disease”, among many other factors.

  The approx. 2.0 per 10,000 Guillain-Barré incidence estimate is based on the published scientific literature. The 2018 review (Romero, Delorey, Sjevar & Johansson 2018) covers outbreaks or sub-outbreaks in 11 places. Like I stated above, I was unable to find comprehensive estimates for other neurological conditions, which occur with lower frequency. If you have more recent estimates, I’d be happy to update.

  Whether or not someone participates is, of course, up to them. I was able to get work done during my inpatient Shigellosis stay and enjoyed the experience, to the extent you can “enjoy” getting awful diarrhea. I don’t think this is very much a waste of human capital for everyone — plenty of people may have downtime they’re willing to donate to a cause. For Zika, the productivity loss is probably relatively minor (if you can work remotely) for reasons outlined in the post. I do not agree that it would be a “very bad use” of EA human capital, which I think is a pretty high bar.

  Participation in any medical study involving exposure to a pathogen necessarily entails risk and no one should ever feel pressured to participate in any study, especially if they’re worried about potential health consequences. I’ll note that several trials are run even though there are no rescue treatments, e.g. Covid-19, in which 1Day Sooner has had several volunteers, and norovirus. It is often precisely because treatments are lackluster that these sort of trials are important. There have been no deaths in a human challenge trial to our knowledge since at least 1980 (Adams-Phipps et al. 2022, based on research 1Day Sooner commissioned) (this, of course, is not predictive of what happens in a Zika challenge trial, but does underscore that these trials are generally designed with participant safety as the foremost priority).

Stop Think­ing about FTX. Think About Get­ting Zika In­stead.