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A few interesting links:

Why are clinical trials expensive?

Why haven’t biologists cured cancer? asks Ruxandra Teslo in my new-favorite Substack newsletter, and answers with a lengthy analysis of biology, medicine and mathematics. Clinical trial costs inevitably come up, and I know it is a minor point in an otherwise well-reasoned argument but this paragraph stood out as wrong:

Clinical trials, the main avenue through which we can get results on whether drugs work in humans, are getting more expensive. The culprits are so numerous and so scattered across the medical world, that it’s hard to nominate just one: everything from HIPAA rules to Institutional Review Boards (IRBs) contribute to making the clinical trial machine a long and arduous slog.

What happened here is the classical question substitution, switching out a hard question (Why are clinical trials getting more and more expensive?) with an easy one (What is the most annoying issue with clinical trials?). Yes, trials involve red tape, but IRB costs pale in comparison to other payments. Ditto for costs of privacy protection.

If we are picking out likely reasons, I would single out domain-specific inflation fueled by easy zero-interest money flowing from whichever financial direction into the biotech and pharmaceutical industries, leading to many well-coined sponsors competing for a limited — and shrinking! — pool of qualified sites and investigators. It is a pure supply-and-demand mechanic at heart which is, yes, made worse by a high regulatory burden, but that burden does not directly lead to more expensive trials.

There are some indirect effects of too much regulation, and at the very least it may have contributed to more investigators quitting their jobs and decreasing supply. They also contributed to regulatory capture: part of the reason why industry has been overtaking academia for the better part of this century is that it’s better at dealing with dealing with bureaucracy. But again, these costs pale in comparison to direct clinical trial costs.

Another nit I could pick is the author’s very limited view of epigenetics: if more people read C.H. Waddington maybe we could find a better mathematical model to interrogate gene regulatory networks, which are a much more important part of the epigenetic landscape than the reductionists' methylation and the like. But I’d better stop before I get too esoteric.

Breaking my “no politics until November” promise to self in order to quote today’s Stratechery update:

[The] Democrats gave up the enviable position of being the default choice for people who didn’t want to think about politics at all.

And this is exactly what has been bothering me since 2016. I spent my whole childhood and young adulthood in a country (Serbia) where you had no choice but to think about politics, and a big part of coming to the US was not having to think about it too hard. Alas, instead of the Balkans becoming westernized the West has been balkanized.

If there had been a webpage monitoring the progress of the actual moonshot in the 1960s, it would have said stuff like “we built a rocket” and “we figured out how to get the landing module back to the ship.” In 1969, it would have just said, “hello, we landed on the moon.” It would not have said, “we are working to establish the evidence base on multilevel interventions to increase the rates of moon landings.”

This is Adam Mastroianni skewering the “science moonshot” initiatives, and rightfully so. If all we have to show for them are 2,000 papers full of mealy-mouthed prose, it was a ground shot at best.

A few links to start off your morning with:

In today’s not-a-linkblog blog:

Have a great weekend, all.

This is not a linkblog. But here are some links that, if it were, I would have posted today:

Happy Thursday, etc.

Condemnation games

From Albert Wenger on his blog Continuations: I am quoting almost half of his fairly short blog post here but you should still go see it in context, click on the links and check out the rest of the blog while you’re at it.

Second, the world is continuing to descend back into tribalism. And it has been exhausting trying to maintain a high rung approach to topics amid an onslaught of low rung bullshit. Whether it is Israel-Gaza, the Climate Crisis or Artificial Intelligence, the online dialog is dominated by the loudest voices. Words have been rendered devoid of meaning and reduced to pledges of allegiance to a tribe. I start reading what people are saying and often wind up feeling isolated and exhausted. I don’t belong to any of the tribes nor would I want to. But the effort required to maintain internally consistent and intellectually honest positions in such an environment is daunting. And it often seems futile.

Tangential to this is a trend, particularly regarding the Capitalized Content above but also about News of the Day on any particular day, is an expectation to condemn of the “if you are not saying something publicly, you are complicit” variety. Show your colors. Plant your flag. Choose your hill or whatnot. To which I can only say: why?

A few years ago I have somehow gotten onto a list of potential democratic donor and am routinely solicited for money, even though as a non-US citizen I can’t vote or donate to a political party. It gave me a window into what declared American democrats are exposed to, and I assume republicans get the same raw deal: a barrage of emails in ALL CAPS declaring whatever is happening on any given day to be The Most Consequential Event of Our Lives, click this link to donate. I can only imagine that, slowly at first and then as a torrent, that language drips drips drips into people’s minds until it’s part of the background mental processing.

So with such a loud background it is no wonder that people feel like they need to yell to get heard, and who cares about whatever small project you’re working on in your provincial unimportant back yard when there is Important Stuff Happening over here. Being social and wanting to get heard, we start yelling out things which we believe people we would want to like us would want to hear. And if you think that sentence is confusing, well, yes it is, but not any more confusing than the predicament we’re in.

Because those things actually are important, and it’s good to have a dialogue about them, around the dinner table, at the water cooler, at the game, with people we know and care about in contexts other than internet screaming matches that, mold-like, spread over constructive online dialogue until it’s rotten to its core. So for this blog and the general and generally wonderful micro.blog community, I will have thoughts on science, coffee, books, an occasional photo, and come October maybe even some basketball. Not as consequential to the world perhaps, but consequential to me.

(↬Thought Shrapnel)

The Junk Charts blog sometimes links to charts that are not junk at all, today being one of those times. The link is to some beautiful storytelling on the many neighborhoods of New York City and now I wish the Washington Post had something similar for DC.

There is a phrase in Serbian when someone is bamboozling you that they are “trying to sell you a horn for a candle”. I have no idea how it came about, but here are some researchers trying to sell us social media for the internet and the phrase came to mind. (ᔥTyler Cowen)