Long Covid Is Not Necessarily Your Biggest Problem

Introduction

At this point, people I know are not that worried about dying from covid. We’re all vaccinated, we’re mostly young and healthy(ish), and it turns out the odds were always low for us. We’re also not that worried about hospitalization: it’s much more likely than death, but maintaining covid precautions indefinitely is very costly so by and large we’re willing to risk it.

The big unknown here has been long covid. Losing a few weeks to being extremely sick might be worth the risk, but a lifetime of fatigue and reduced cognition is a very big deal. With that in mind, I set out to do some math on what risks we were running. Unfortunately baseline covid has barely been around long enough to have data on long covid, most of it is still terrible, and the vaccine and Delta variant have not been widespread long enough to have much data at all. 

In the end, the conclusion I came to was that for vaccinated people under 40 with <=1 comorbidiy, the cognitive risks of long covid are lost in the noise of other risks they commonly take. Coming to this conclusion involved reading a number of papers, but also a lot of emotional processing around risk and health. I’ve included that processing under a “personal stuff” section, which you can skip if you just want the info but I encourage you to read if you feel yourself starting to yell that I’m not taking small risks of great suffering seriously. I do encourage you to read the caveats section before deciding how much weight to put on my conclusions.

Personal Stuff

This post took a long time to write, much longer than I wanted, because this is not an abstract topic to me. I have chronic pain from nerve damage in my jaw caused by medical incompetence, and my attempts to seek treatment for this continually run into the brick wall of a medical system that doesn’t consider my pain important (tangent: if you have a pain specialist you trust, anywhere in the US, please e-mail me (elizabeth@acesounderglass.com)). I empathize very much with the long covid sufferers who are being told their suffering doesn’t exist because it’s too hard to measure and we can’t prove what caused it.

Additionally, I’m still suffering from side effects from my covid vaccine in April. It’s very minor, chest congestion that doesn’t seem to affect my lung capacity (but I don’t have a clear before picture, so hard to say for sure). But it’s getting worse and while my medical practitioners are taking it seriously, this + the experience with dental pain make me very sensitive to the possibility they might stop if it becomes too much work for them. As I type this, I am taking a supplement stack from a high end internet crackpot because first line treatment failed and there aren’t a lot of other options. And that’s just from the vaccine; I imagine if I actually had covid I would not be one of the people who shakes it off the way I describe later in this post. 

All this is to say that when I describe the long term cognitive impact of covid as being too small to measure with our current tools against our current noise levels, that is very much not the same as saying it’s zero. It’s much worse than that. What I’m saying is that you are taking risks of similar levels of suffering and impairment constantly, which our health system is very bad at measuring, and against that background long covid does not make much of a difference for people within certain age and health parameters. 

A common complaint when people say “X isn’t dangerous to the young and healthy” is that it implies the death and suffering of those who aren’t young and healthy don’t matter. I’m not saying that. It matters a lot, and it’s impossible for me to forget that because I’m very unlikely to be one of the people who gets to totally walk covid off if I catch it. But from looking at the data, there don’t seem to be very many of us in my age group.

Caveats

Medical research in general is really bad, research of a live issue in a pandemic is worse, you should assume these are low quality studies unless I indicate otherwise.

This research was compiled for LessWrong and Redwood Research, with the goal of assessing safety for their office spaces populated by mostly-but-not-entirely-healthy people 25-40, who were much more interested in the cognitive and fatigue sequelae than the physical. Much of this research is applicable outside that group or the sources can be used in that way, but you should know that’s what I focused on.

There isn’t any data on long covid in vaccinated people with breakthrough delta-variant infections. Neither vaccines nor delta have been around long enough for that to exist. Baseline covid has barely been around long enough to have long-term data. What I have here is:

  • Data showing that strength of acute infection correlates with long term impact, although not perfectly
  • Data on the long term impact of baseline covid, given the strength of an initial infection
  • Data on how the vaccine impacts the strength of acute infections
  • Data on how delta impacts the strength of acute infections

Data

Long term outcomes correlate with short term outcomes

By far the best study (best does not mean good) comes out of the UK, where the BBC coincidentally started an online intelligence test in January 2020 (giving them a pre-covid baseline) and in May began asking participants if they’d had covid and if so how bad a case. When I said “assume the studies are terrible unless I note otherwise”, this is the study I wanted to highlight as reasonably good. Because they can compare test-takers in a given time period with and without covid they can control for some of the effects of changing a study population over time, which would be the biggest concern. Additionally, my statistical consultant described the paper as “not having any errors that affect the conclusion”, which is extremely good for a medical paper. This study was not ideal for determining sequelae persistence, but they did check if size of effect was correlated with time since symptom onset, and it wasn’t (but their average was only 2 months).

This study showed a very direct correlation between the severity of the acute infection and cognitive decline. I don’t trust its absolute numbers, but the pattern that more severe disease -> more severe persistent effects is very clear

A second study in Wuhan, China (hat tip Connor Flexman) examined long term outcomes of hospitalized patients, based on the intensity of their care (hospitalization, supplemental oxygen, ventilation) found an increase in acute severity was correlated with an increase in sequelae, although it didn’t hold for every symptom (there are a lot of symptoms and the highest-intervention group is small), and they barely looked at cognitive symptoms.

Taquet et al used electronic health records to get a relatively unbiased six figure sample size, that also showed a strong correlation between acute and long term outcomes, which we’ll talk about more below.

From this I conclude that your overall risk of long covid is strongly correlated with the strength of the initial infection.

Odds of acute outcomes

Sah et al estimate that 35% of covid cases (implied to be baseline and pre-vaccination) are asymptomatic, with large variation by age. Children (<18) are 46% likely to be asymptomatic, adults 18-59 are 32% likely, adults >=60 are 20% likely. I’m going to round the non-elderly adult number to ⅓ to make the math easier.

The Economist has a great calculator showing your pre-vaccine, pre-Delta risk of hospitalization and death, given your age, sex, and comorbidities. Note that this calculator only includes diagnosed cases, so it excludes both asymptomatic cases and those that did have symptoms but didn’t drive people to seek medical care. Here’s a few sample people:

  • A healthy 30 year old man has a 2.7% chance of hospitalization, and <0.1% risk of death
  • A healthy 30 year old woman has a 1.7% chance of hospitalization, and <0.1% risk of death
  • A 25 year old man with asthma has a 4.2% risk of hospitalization, and <0.1% risk of death
  • A 40 year old woman with obesity has a 6.5% risk of hospitalization, and 0.1% risk of death.
  • Risk of hospitalization rises steadily with age but the risk of death doesn’t really take off until 50, at which point our healthy man has a death risk of 0.4% and our health woman has a risk of 0.2%

If you’d like, you can use your own numbers in this guesstimate sheet.

And again, that’s only for officially diagnosed and registered cases. If you assume ⅓ of infections in that age group are asymptomatic, the risk drops by ⅓.

If you are hospitalized, your risk of being ventilated is currently very, very low even if you’re in a high risk category. The overall average percent of hospitalized patients who were ventilated was 2.0% in the last week for which data was available (2021-03-24), after dropping steadily for most of the plague. We can assume that’s disproportionately among the elderly and people with severe comorbidities, so if that’s not you your odds are better still. I’m going to count the risk of intubation for our cohort as 0.5%, although that’s likely still an overestimate.

How do vaccines change these odds? According to CDC data from a time period ending 2021-05-01 (so before delta took off), 27% of breakthrough infections that reached the attention of the CDC were asymptomatic, and only 7% were hospitalized due to covid (another 3% were hospitalized for non-covid reasons). It’s very likely that the CDC is undercounting asymptomatic cases, so we’ll continue using our ⅓ number for now. The minimum age of reported breakthrough infection deaths was 71, so we’ll continue to treat the risk of death as 0% for our sample subjects. Additionally, given the timing most vaccinated participants would be elderly or front line workers, raising their risk considerably. A CDC press release goes much farther, saying vaccinated people > 65 had 7% of the hospitalizations of age-matched controls. 

How does delta change these odds? A Scottish study estimated delta had 2x the risk of hospitalization as alpha, which a Danish study estimated as having 1.42x the risk of hospitalization as baseline covid. So very roughly, we’re looking at 3x the risk of hospitalization from delta, relative to baseline.

So for our sample cases above, we have the following odds (note I updated these on the night it was posted, due to a math error. Thanks to Rob Bensinger for catching it):

Risk given vaccine, deltaHospitalizedIntubated
Healthy 30yo man0.38% = 2.7*.07*3*2/3.002% = 0.38*.005
Healthy 30yo woman0.24% = 1.7*.07*3*2/3.002% = 0.24*.005
Asthmatic 25yo man0.58% = 4.2*.07*3*2/3.003% = 0.58*.005
Obese 40yo woman0.92% = 6.5*.07*3*2/3.005% = 0.92*.005

That’s not so far from the rate of hospitalization in that age range for the flu (0.6%), with some caveats (the CDC sample includes unvaccinated people and the bucket is 18-49 years old, with the higher end presumably carrying more of the disease burden).

There is concern that vaccine effectiveness wanes over time, which I haven’t incorporated here.

Odds of long term outcomes

In general I ignored studies that merely tracked number of persistent sequelae but not their severity or type, which made it impossible to distinguish between “sense of smell still iffy” from “permanent intellectual crippling”, and studies that didn’t track how long the sequelae persisted. This was, unfortunately, most of them.

We talked about the Great British Intelligence Test above. I initially found this study quite scary. The study used its own tests rather than IQ, but if you assume a standard deviation in their tests is equivalent to a standard deviation in an IQ test, the worst category (ventilation) is equivalent to a 7 point IQ loss. That’s twice as bad as a stroke in this study (although I suspect sampling bias). I suspect the truth is worse still, because the worse your recently acquired cognitive and health issues are, the less likely you are to take a fun internet test advertised as measuring your intellectual strengths. However as I noted above, you are extremely unlikely to be put on a ventilator. 

For people with “symptoms, but not respiratory symptoms”, the cognitive damage is ~equivalent to 0.6 IQ points. For “medical assistance at home”, it’s 1.8 points. These are both likely to be overestimates given that the study only included known (although not necessarily formally diagnosed) cases. Additionally, while the paper claims to control for education, income, etc, bad things are more likely to happen to people in worse environments, and it’s impossible to entirely back that out.

Taquet et al used electronic health records to get a relatively unbiased six figure sample size, and found unhospitalized diagnosed covid patients (pre-Delta, pre-vaccine) had a 11% likelihood of a new neuro or psych diagnosis after their covid diagnosis, hospitalized patients had a 15% likelihood, and ICU patients had 26% likelihood. The majority of these were mood disorders (3.86%/4.49%/5.82% for home/hospitalized/ICU) and anxiety (6.81%/6.91%/9.79%). This seems quite bad, until you compare it to the overall numbers for depression in the time period, a naive reading of which suggests that covid had a protective effect

These numbers aren’t directly comparable. The second study is much lower quality and includes rediagnoses (although the total depression diagnosis numbers for the covid patients are 13.10%/14.69%/15.43%- still under the total increase in depression in the general population study). 

Overall this seems well within what you’d expect from getting a scary disease at a scary time, and not evidence of widespread neuro or psych impact of covid. Even if you take the numbers at face value, they exclude most people who were asymptomatic or treated at home without a formal diagnosis.

A UK metareview found the prevalence at 12 weeks of symptoms affecting daily life ranged from 1.2% (average age: 20, minimum 18) to 4.8% (average age: 63). The cohort with average age 31 had a mean prevalence of 2.8%., which is is well within the Lizardman Constant. This is based on self-reports on survey data, which will again exclude asymptomatic cases, so even if you treat it as real, you need to discount it down to 2.8%.

On the other hand, medicine is notoriously bad at measuring persistent, low-level, amorphous-yet-real effects. The Lizardman Constant doesn’t mean prevalences below 4% don’t exist, it means they’re impossible to measure using naive tools.

Comparison to other diseases

The Taquet study did compare covid patients to those with other respiratory diseases (including the flu, not controlling for disease severity or patient age), and found covid to be modestly worse except for myoneural junction and other muscular diseases, where covid 5xed the risk (although it’s still quite low in absolute terms). Dementia risk is also doubled, presumably mostly among the elderly.

Additionally, cognitive impairment following critical illness, and especially following intubation, is a well known phenomenon. This puts the Great British Intelligence Test numbers in perspective- being/needed to be ventilated is quite bad, but it’s always been that bad, there doesn’t appear to be any unique-to-covid badness.

Conclusion

My tentative conclusion is that the risks to me of cognitive, mood, or fatigue side effects lasting >12 weeks from long covid are small relative to risks I was already taking, including the risk of similar long term issues from other common infectious diseases. Being hospitalized would create a risk of noticeable side effects, but is very unlikely post-vaccine (although immunity persistence is a major unresolved concern).

I want to emphasize again that “small relative to risks you were already taking” doesn’t necessarily mean “too small to worry about”. For comparison, Josh Jacobson did a quick survey of the risks of driving and came to roughly the same conclusion: the risks are very small compared to the overall riskiness of life for people in their 30s. Josh isn’t stupid, so he obviously doesn’t mean “car accidents don’t happen” or “car accidents aren’t dangerous when they happen”. What he means is that if you’re 35 with 15 years driving experience and not currently impaired, the marginal returns to improvements are minor. 

And yet. I have a close friend who somehow got in three or four moderate car accidents in < 7 years, giving her maybe-permanent soft tissue damage (to answer the obvious question: no, the accidents weren’t her fault. Sometimes she wasn’t even driving). Statistically, that friend doesn’t exist. No one gets in that many car accidents that quickly without it being their fault. And yet the law of large numbers has to catch up with someone. Too small to measure can be very large.


What this means is not that covid is safe, but that you should think about covid in the context of your overall risk portfolio. Depending on who you are that could include other contagious diseases, driving, drugs-n-alcohol, skydiving, camping, poor diet, insufficient exercise, too much exercise, and breathing outside. If you decide your current risk level is too high, or are suddenly realizing you were too risk-tolerant in the past, reducing covid risk in particular might not be the best bang for your buck. Paying for a personal trainer, higher quality food, or a HEPA filter should be on your radar as much as reducing social contact, although for all I know that will end up being the best choice for you personally. 

Change my mind

My own behavior and plans have changed a lot based on this research, so I’m extremely interested in counterarguments. To make that easy, here’s a non-exhaustive list of things that would change my mind:

  1. Evidence that long covid gets worse over time, rather than slowly improving (note that I did look at data from SARS 1 and failed to find this).
  2. New variants increase the risk to what it was or was feared to be in April 2020
  3. Evidence of more severe vaccine attenuation than we’re currently seeing.
  4. Credible paths through which the risk could drop sharply in the next six months.

Thanks to LessWrong and Redwood Research for funding this research, Connor Flexman and Ray Arnold for comments on drafts, and Rob Bensinger and Lanrian for catching errors post-publication that did not affect my overall conclusion.

Exercise Trade Offs

Woman Exercise Bike - Free vector graphic on Pixabay

Update 9/2: A friend pointed out that I was ignoring the time costs of exercise, which ended up being pretty significant. See new numbers here. I then double checked the math on the microlife numbers and the news is not good.

Tl;dr: under my current conditions, outdoor exercise is slightly safer than indoor for me, but the risks of both are dwarfed by the benefits of exercise.

Recently I’ve been weighing trade offs around exercise. At the gym I’m risking covid exposure. I can reduce that by wearing a mask, at the cost of making the exercise less effective or enjoyable. I could use my friend’s outdoor gym, but it’s fire season here in California so there are prolonged periods where I don’t want to be sucking in all that unfiltered air. This is also addressable with a mask, but at the same cost. I could exercise indoors in my own home, but I do not have that much space and it gets miserable really fast. I could not exercise until conditions improve, but that has its own health costs. So I did some math.

Wikipedia says 10 minutes of exercise = 1 micromort lost (as in, you live longer). That’s obviously going to depend a lot on the type of exercise but we’ll use it.

This calculator translates time * AQI into cigarette equivalents. At 50 AQI, it takes 12 minutes to generate .01 cigarettes. I’m going to treat that as 10 minutes because exercising is slightly worse than merely existing out doors and it makes the math much easier.

Wikipedia lists an equivalent of 1.4 cigarettes = 1 micromort.

N95 masks block 95% of PM2.5 particles (which is what the AQI is based on). I couldn’t immediately find a translation of that to micromorts so let’s assume it’s linear discounting. EDIT: On Twitter Divia Eden points out that 95% assumes a perfect seal, which you probably don’t have. This isn’t material at my current air quality; I did this whole thing without including masks at all and then added them in afterwords, but when you do your own math you should include that.

That means that 10 minutes unmasked outdoor cardio, at 50 AQI = .01/1.4 = .007 micromorts, which is clearly dwarfed by the 1 micromort lost from exercise (even if you assume it’s 10x worse for me due to the existing chest congestion, and don’t give the exercise a corresponding impact bump). If I wear a mask the risk is probably below the significant figures I’m allowed. It’s so negligible compared to the benefits that if allowing myself to go outside increases total exercise by any amount at all, it’s obviously worth it.

How about covid risk?

My gym is personal training focused with a single cardio machine, which you must schedule in advance. If I’m doing cardio there will be at most two clients doing weight training and two trainers in the room, plus me, all > 10 feet away, in a large room with filtration they claim is good. If I’m doing weight training there’s me, my trainer (fairly nearby), and potentially a farther away client and trainer pair. In theory there could be an additional person on the cardio machine but I’ve yet to see it happen.

Under an excessively conservative set of assumptions (City-average vaccination, no mask, constant talking), my cardio scenario is 7 microcovids. If I give everyone masks it’s 0.5. My weight training scenario is <=10 microcovids (7 for the other pair, which may or may not exist, and 3 for my trainer. Note that weight training is 2.5x as long as cardio). But microcovids are not micromorts. The Economist calculator (pre-delta, pre-vaccine) has the risk of dying of acute covid at my age and sex as immeasurably low, despite it being prone to overestimate because its denominator is only diagnosed cases. Long covid is a concern (although I’ve tentatively concluded its overblown: more on that soon hopefully), but lack of exercise is bad for long covid in particular. If we generously use my age/sex hospitalization rate as the discount factor (2.6%), the micromorts from my indoor cardio are <=0.16, and my weight training is <=0.23. These are not quite as negligible as the pollution, but still very safely under the benefits of exercising.

Some caveats: I didn’t examine any of these numbers that closely because the verdict was so overwhelmingly clear; the values would need to be off by orders of magnitude to change my conclusion. But that is always an option, and when I tried to follow up on the 0.1 micromort/minute of exercise number, I hit a dead end.

I’ve made a very crude spreadsheet with sources linked in comments so you can make a copy and play around with your own numbers, based on your local air quality, covid prevalence, etc.

Follow Up: Predictions as a Substitute For Reviews

In August I wrote about using PredictionBook as a substitute for weekly reviews. Several months later, I am rather predictably not using it, for the same reason weekly reviews stop working: it reminded me of something I endorsed doing but didn’t finish, and that put an ugh field around the whole thing.

Weirdly, I re-picked-up that thing a week ago. This was completely independent: I haven’t looked at PredictionBook since September. I don’t think this has any bearing on the viability of predictions substituting for reviews, it’s just a cute coincidence.

Breaking Questions Down

Previously I talked about discovering that my basic unit of inquiry should be questions, not books. But what I didn’t talk about was how to generate those questions, and how to separate good questions from bad. That’s because I don’t know yet; my own process is mysterious and implicit to me. But I can give a few examples.

For any given question, your goal is to disambiguate it into smaller questions that, if an oracle gave you the answers to all of them, would allow you to answer the original question. Best case scenario, you repeat this process and hit bedrock, an empirical question for which you can find accurate data. You feed that answer into the parent question, and eventually it bubbles up to answering your original question.

That does not always happen. Sometimes the question is one of values, not facts. Sometimes sufficient accurate information is not available, and you’re forced to use a range- an uncertainty that will bubble up through parent answers. But just having the questions will clarify your thoughts and allow you to move more of your attention to the most important things.

Here are a few examples.  First, a reconstructed mind map of my process that led to several covid+economics posts. In the interests of being as informative as possible, this one is kind of stylized and uses developments I didn’t have at the time I actually did the research.

Vague covid panic@2x.png

If you’re curious about the results of this, the regular recession post is here and the oil crisis post is here.

Second, a map I created but have not yet researched, on the cost/benefit profile of a dental cleaning while covid is present.

Risk model of dental cleanings in particular@2x.png

Aside: Do people prefer the horizontal or vertical displays? Vertical would be my preference, but Whimsical does weird things with spacing so the tree ends up with a huge width either way.

Honestly this post isn’t really done; I have a lot more to figure out when it comes to how to create good questions. But I wanted to have something out before I published v0.1 of my Grand List of Steps, so here we are.

Many thanks to Rosie Campbell for inspiration and discussion on this idea.

How to Find Sources in an Unreliable World

I spent a long time stalling on this post because I was framing the problem as “how to choose a book (or paper. Whatever)?”. The point of my project is to be able to get to correct models even from bad starting places, and part of the reason for that goal is that assessing a work often requires the same skills/knowledge you were hoping to get from said work. You can’t identify a good book in a field until you’ve read several. But improving your starting place does save time, so I should talk about how to choose a starting place.

One difficulty is that this process is heavily adversarial. A lot of people want you to believe a particular thing, and a larger set don’t care what you believe as long as you find your truth via their amazon affiliate link (full disclosure: I use amazon affiliate links on this blog). The latter group fills me with anger and sadness; at least the people trying to convert you believe in something (maybe even the thing they’re trying to convince you of). The link farmers are just polluting the commons.

With those difficulties in mind, here are some heuristics for finding good starting places.

  • Search “best book TOPIC” on google
    • Most of what you find will be useless listicles. If you want to save time, ignore everything on a dedicated recommendation site that isn’t five books.
    • If you want to evaluate a list, look for a list author with deep models on both the problem they are trying to address, and why each book in particular helps educate on that problem.  Examples:
    • A bad list will typically have a topic rather than a question they are trying to answer, and will talk about why books they recommend are generically good, rather than how they address a particular issue. Quoting consumer reviews is an extremely bad sign and I’ve never seen it done without being content farming.
  • Search for your topic on Google Scholar
    • Look at highly cited papers. Even if they’re wrong, they’re probably important for understanding what else you read.
    • Look at what they cite or are cited by
    • Especially keep an eye out for review articles
  • Search for web forums on your topic (easy mode: just check reddit). Sometimes these will have intro guides with recommendations, sometimes they will have where-to-start posts, and sometimes you can ask them directly for recommendations. Examples:
  • Search Amazon for books on your topic. Check related books as well.
  • Ask your followers on social media. Better, announce what you are going to read and wait for people to tell you why you are wrong (appreciate it, Ian). Admittedly there’s a lot of prep work that goes into having friends/a following that makes this work, but it has a lot of other benefits so if it sounds fun to you I do recommend it. Example:
  • Ask an expert. If you already know an expert, great. If you don’t, this won’t necessarily save you any time, because you have to search for and assess the quality of the expert.
  • Follow interesting people on social media and squirrel away their recommendations as they make them, whether they’re relevant to your current projects or not.

Types of Knowledge

This is a system for sorting types of knowledge. There are many like it, but this one is mine.

First, there is knowledge you could regurgitate on a test. In any sane world this wouldn’t be called knowledge, but the school system sure looks enthusiastic about it, so I had to mention it. Examples:

  • Reciting the symptoms of childbed fever on command 
  • Reciting Newton’s first law of motion
  • Reciting a list of medications’ scientific and brand names
  • Reciting historical growth rate of the stock market
  • Reciting that acceleration due to gravity on Earth is 9.807 m/s²

 

Second, there is engineering knowledge- something you can repeat and get reasonably consistent results. It also lets you hill climb to local improvements. Examples:

  • Knowing how to wash your hands to prevent childbed fever and doing so
  • Driving without crashing
  • Making bread from a memorized recipe.
  • What are the average benefits and side effects from this antidepressant?
  • Knowing how much a mask will limit covid’s spread
  • Investing in index funds
  • Knowing that if you shoot a cannon ball of a certain weight at a certain speed, it will go X far.
  • Knowing people are nicer to me when I say “please” and “thank you”

 

Third, there is scientific knowledge. This is knowledge that lets you generate predictions for how a new thing will work, or how an old thing will work in a new environment, without any empirical knowledge.

Examples: 

  • Understanding germ theory of disease so you can take procedures that prevent gangrene and apply them to childbed fever.
  • Knowing the science of baking so you can create novel edible creations on your first try.
  • Knowing enough about engines and batteries to invent hybrid cars.
  • Actually understanding why any of those antidepressants works, in a mechanistic way, such that you can predict who they will and won’t work for.
  • A model of how covid is spread through aerosols, and how that is affected by properties of covid and the environment.
  • Having a model of economic change that allows you to make money off the stock market in excess of its growth rate, or know when to pull out of stocks and into crypto.
  • A model of gravity that lets you shoot a rocket into orbit on the first try.
  • A deep understanding of why certain people’s “please”s and “thank you”s get better results than others.

 

Engineering knowledge is a lot cheaper to get and maintain than scientific knowledge, and most of the time it works out. Maybe I pay more than I needed to for a car repair; I’ll live (although for some people the difference is very significant). You need scientific knowledge to do new things, which either means you’re trying something genuinely new, or you’re trying to maintain an existing system in a new environment.

I don’t know if you’ve noticed, but our environment was changing pretty rapidly before a highly contagious, somewhat deadly virus was released on the entire world, and while that had made things simpler in certain ways (such as my daily wardrobe), it has ultimately made it harder to maintain existing systems. This requires scientific knowledge to fix; engineering won’t cut it.

And it requires a lot of scientific knowledge at that- far more than I have time to generate. I could trust other people’s answers, but credentials and authority have never looked more useless, and identifying people I trust on any given subject is almost as time consuming as generating the answers myself.  And I don’t know what to do about that.

 

Where to Start Research?

When I began what I called the knowledge bootstrapping project, my ultimate goal was “Learn how to learn a subject from scratch, without deference to credentialed authorities”. That was too large and unpredictable for a single grant, so when I applied to LTFF, my stated goal was “learn how to study a single book”, on the theory that books are the natural subcomponents of learning (discounting papers because they’re too small). This turned out to have a flawed assumption baked into it.

As will be described in a forthcoming post, the method I eventually landed upon involves starting with a question, not a book. If I start with a book and investigate the questions it brings up (you know, like I’ve been doing for the last 3-6 years), the book is controlling which questions get brought up. That’s a lot of power to give to something I have explicitly decided not to trust yet. 

Examples:

  • When reading The Unbound Prometheus, I took the book’s word that a lower European birth rate would prove Europeans were more rational than Asians and focused on determining whether Europe’s birth rates were in fact lower (answer: it’s complicated), when on reflection it’s not at all clear to me that lower birth rates are evidence of rationality.
  • “Do humans have exactly 4 hours of work per day in them?” is not actually a very useful question. What I really wanted to know is “when can I stop beating myself up for not working?“, and the answer to the former doesn’t really help me with the latter. Even if humans on average have 4 hours, that doesn’t mean I do, and of course it varies by circumstances and type of work… and even “when can I stop beating myself up?” has some pretty problematic assumptions built into it, such as “beating myself up will produce more work, which is good.” The real question is something like “how can I approach my day to get the most out of it?”, and the research I did on verifying a paper on average daily work capacity didn’t inform the real question one way or the other.

 

What would have been better is if I’d started with the actual question I wanted to answer, and then looked for books that had information bearing on that question (including indirectly, including very indirectly). This is what I’ve started doing.

This can look very different depending on what type of research I’m doing. When I started doing covid research, I generated a long list of  fairly shallow questions.  Most of these questions were designed to inform specific choices, like “when should I wear what kind of mask?” and “how paranoid should I be about people without current symptoms?”, but some of them were broader and designed to inform multiple more specific questions, such as “what is the basic science of coronavirus?”. These broader, more basic questions helped me judge the information I used to inform the more specific, actionable questions (e.g., I saw a claim that covid lasted forever in your body the same way HIV does, which I could immediately dismiss because I knew HIV inserted itself your DNA and coronaviruses never enter the nucleus).

 


 

I used to read a lot of nonfiction for leisure. Then I started doing epistemic spot checks– taking selected claims from a book and investigating them for truth value, to assess the book’s overall credibility- and stopped being able to read nonfiction without doing that, unless it was one of a very short list of authors who’d made it onto my trust list. I couldn’t take the risk that I was reading something false and would absorb it as if it were true (or true but unrepresentative, and absorb it as representative). My time spent reading nonfiction went way down.

About 9 months ago I started taking really rigorous notes when I read nonfiction. The gap in quality of learning between rigorous notes and my previous mediocre notes was about the same as the gap between doing an epistemic spot check and not. My time spent reading nonfiction went way up (in part because I was studying the process of doing so), but my volume of words read dropped precipitously.

And then three months ago I shifted from my unit of inquiry being “a book”, to being “a question”. I’m sure you can guess where this is going- I read fewer words, but gained more understanding per word, and especially more core (as opposed to shell or test) understanding. 

The first two shifts happened naturally, and while I missed reading nonfiction for fun and with less effort, I didn’t feel any pull towards the old way after I discovered the new way. Giving up book-centered reading has been hard. Especially after five weeks of frantic covid research, all I wanted to do was to be sat down and told what questions were important, and perhaps be walked through some plausible answers. I labeled this a desire to learn, but when I compared it to question-centered research, it became clear that’s not what it was. Or maybe it was a desire to go through the act of learning something, but it was not a desire to answer a question I had and was not prioritized by the importance of a question. It was best classified as leisure in the form of learning, not resolving a curiosity I had.  And if I wanted leisure, better to consume something easier and less likely to lead me astray, so I started reading more fiction, and the rare non-fiction of a type that did not risk polluting my pool of data. And honestly I’m not sure that’s so safe: humans are built to extract lessons from fiction too.

Put another way: I goal factored (figured out what I actually wanted from) reading a nonfiction book, and the goal was almost never best served by using a nonfiction book as a starting point. Investigating a question I cared about was almost always better for learning (even if it did eventually cash out in reading a book), and fiction was almost always better for leisure, in part because it was less tiring, and thus left more energy for question-centered learning when that was what I wanted.

 

Turns Out Interruptions Are Bad, Who Knew?

I’ve been known to accuse people who say open offices are “fine with a few mitigations” of not paying attention to the cost of their mitigations. I believed they shrunk their thoughts down to the point that not much was lost from an interruption, at the cost of only being able to think the thoughts that fit in that interval. Any thought that would take too long to process could not be conceived of.

I’ve also been known to accuse people who advocate for deep, uninterrupted work without the distractions of social media of “not understanding how valuable social media is to me”. And  besides, my workflow works best with frequent breaks (that I choose the timing of) because I “background process”.

*Cough*

I maintained this illusion until, inspired by a stupidly expensive device that only does one thing, I taped my old phone to a bluetooth keyboard* and began to write in offline mode. It was immediately a magical experience. It was so *quiet*. I could go on my porch and write and it was quiet. My thoughts got much larger because I wasn’t subconsciously afraid I’d interrupt them. I began to feel angry at my laptop. Why did it insist on hurting me so much? Why couldn’t it be pure like the offline phone/keyboard experience? Why couldn’t I just create things?

[* I only found two bluetooth keyboards with an inlay for phones/tablets. The other one lacks a built in battery, and shipped with a broken key]

Locally, this lasted for about 10 minutes before the social media cravings kicked in. But that was enough. I deeply resented work for taking me away from my magic writing device and making everything so noisy

Since I started, my desire for using the quiet device has waxed and waned. At first I thought this was reflective of some deep pathology, but after two weeks it looks a lot more like “sometimes the benefits of quiet outweighs the benefits of being able to look stuff up, sometimes they don’t’”.  I’ve also changed how I interact on a connected device- I’m more likely to close Signal, less likely to open Twitter. This is less due to a utilitarian calculation of the costs and benefits of Twitter, and more that once I’m in a good state, I can notice how switching to Twitter is almost physically painful.

The problem is that I wasn’t wrong that social media was genuinely very valuable to me, and that was before we were all locked inside. But I definitely was wrong that getting those benefits were costless, in a way very analogous to mistakes I accused others of making. I’m glad I have the information now, but I haven’t figured out what to do with it yet.

The Oil Crisis of 1973

Last month I investigated commonalities between recessions of the last 50 years or so. But of course this recession will be different, because (among other things) we will simultaneously have a labor shortage and a lot of people out of work. That’s really weird, and there’s almost no historical precedent- the 1918 pandemic took place during a war, and neither 1957 nor 1968 left enough of an impression to have a single book dedicated to them.

So I expanded out from pandemics, and started looking for recessions that were caused by any kind of exogenous shock. The best one I found was the 1973 Oil Crisis. That was kicked off by Arab nations refusing to ship oil to allies who had assisted Israel during the Yom Kippur war- as close as you can get to an economic impact without an economic cause. I started to investigate the 1973 crisis as the one example I could find of a recession caused by a sudden decrease in a basic component of production, for reasons other than economic games.

Spoiler alert: that recession was not caused by a sudden decrease in a basic component of production either.

Why am I so sure of this? Here’s a short list of little things,

 

But here’s the big one: we measure the price of oil in USD. That’s understandable, since oil sales are legally required to be denominated in dollars. But the US dollar underwent a massive overhaul in 1971, when America decided it was tired of some parts of the Bretton Woods Agreement. Previously, the US, Japan, Canada, Australia and many European countries maintained peg (set exchange rate)  between all other currencies and USD, which was itself pegged to gold. In 1971 the US decided not to bother with the gold part anymore, causing other countries to break their peg. I’m sure why we did this is also an interesting story, but I haven’t dug into it yet, because what came after 1971 is interesting enough.  The currency of several countries appreciated noticeably (Germany, Switzerland, Japan, France, Belgium, Holland, and Sweden)…

 

(I apologize for the inconsistent axes, they’re the best I could do)

 

 

…but as I keep harping on, oil prices were denominated in dollars. This meant that oil producing countries, from their own perspective, were constantly taking a pay cut. Denominated in USD, 1/1/74 saw a huge increase in the price of oil. Denominated in gold, 1/1/74 saw a return to the historic average after an unprecedented low.

 

 

 

(apologies for these axes too- the spike in this graph means oil was was worth less, because you could buy more with the same amount of gold)

 

This is a little confusing, so here’s a timeline:

  • 1956: Failed attempt at oil embargo
  • 1967: Failed attempt at oil embargo
  • 1971, August: US leaves the gold standard
  • 1972: Oil prices begin to fall, relative to gold
  • 1972, December: US food prices begin to increase the rate of price increases.
  • 1973, January: US Stock market begins 2-year crash
  • 1973, August: US food prices begin to go up *really* fast
  • 1973, October, 6: Several nearby countries invade Israel
  • 1973, October, 17: Several Arab oil producing countries declare an embargo against Israeli allies, and a production decrease. Price of oil goes up a little (in USD).
  • 1974, January, 1: Effective date of declared price increase from $5.12 to $11.65/barrel. Oil returns to historically normal price measured in gold.

This is not the timeline you’d expect to see if the Yom Kippur war caused a supply shock in oil, leading to a recession.

My best guess is that something was going wrong in the US and world economy well before 1971, but the market was not being allowed to adjust. Breaking Bretton Woods took the finger out of the dyke and everything fluctuated wildly for a few years until the world reached a new equilibrium (including some new and different economic games).The Yom Kippur war was a catalyst or excuse for raising the price of oil, but not the cause.

 

Thanks to my Patreon subscribers for funding this research, and several reviewers for checking my research and writing.

 

Negative Feedback and Simulacra

Part 1: Examples

There’s a thing I want to talk about but it’s pretty nebulous so I’m going to start with examples. Feel free to skip ahead to part 2 if you prefer.

Example 1: Hot sauce

In this r/AmITheAsshole post, a person tries some food their their girlfriend cooked, likes it, but tries another bite with hot sauce. Girlfriend says this “…insults her cooking and insinuates that she doesn’t know how to cook”. 

As objective people not in this fight, we can notice that her cooking is exactly as good as it is whether or not he adds hot sauce. Adding hot sauce reveals information (maybe about him, maybe about the food), but cannot change the facts on the ground. Yet she is treating him like he retroactively made her cooking worse in a way that somehow reflects on her, or made a deliberate attempt to hurt her.

 

Example 2: Giving a CD back to the library

Back when I would get books on CD I would sometimes forget the last one in my drive or car. Since I didn’t use CDs that often, I would find the last CD sometimes months later. To solve this, I would drop the CD in the library book return slot, which, uh, no longer looks like a good solution to me, in part because of the time I did this in front of a friend and she questioned it. Not rudely or anything, just “are you sure that’s safe? Couldn’t the CD snap if something lands wrong?.” I got pretty angry about this, but couldn’t actually deny she had a point, so settled for thinking that if she had violated a friend code by not pretending my action was harmless. I was not dumb enough to say this out loud, but I radiated the vibe and she dropped it.

 

Example 3: Elizabeth fails to fit in at martial arts 

A long time ago I went to a martial arts studio. The general classes (as opposed to specialized classes like grappling) were preceded by an optional 45 minute warm up class. Missing the warm up was fine, even if you took a class before and after. Showing up 10 minutes before the general class and doing your own warm ups on the adjacent mats was fine too. What was not fine was doing the specialized class, doing your own warm ups on adjacent maps for the full 45 minutes while the instructor led regular warm ups, and then rejoining for the general class. That was “very insulting to the instructor”.

This was a problem for me because the regular warm ups hurt, in ways that clearly meant they were bad for me (and this is at a place I regularly let people hit me in the head). Theoretically I could have asked the instructor to give me something different, but that is not free and the replacements wouldn’t have been any better, which is not surprising because no one there had the slightest qualification to do personal training or physical therapy. So basically the school wanted me to pretend I was in a world where they were competent to create exercise routines, more competent than I despite having no feedback from my body, and considered not pretending disrespectful to the person leading warm ups.

Like the hot sauce example, the warm ups were as good as they were regardless of my participation – and they knew that, because they didn’t demand I participate. But me doing my own warm ups broke the illusion of competence they were trying to maintain.

 

Example 4: Imaginary Self-Help Guru

I listened to an interview where the guest was a former self-help guru who had recently shut down his school. Well, I say listened, but I’ve only done the first 25% so far. For that reason this should be viewed less as “this specific real person believes these specific things” and more like  “a character Elizabeth made up in her head inspired by things a real person said…” and. For that reason, I won’t be using his name or linking to the podcast.

Anyways, the actual person talked about how being a leader put a target on his back and his followers were never happy.  There are indeed a lot of burdens of leadership that are worthy of empathy, but there was an… entitled… vibe to the complaint. Like his work as a leader gave him a right to a life free of criticism.

If I was going to steel- man him, I’d say that there are lots of demands people place on leaders that they shouldn’t, such as “Stop reminding me of my abusive father” or “I’m sad that trade offs exist, fix it”. But I got a vibe that the imaginary guru was going farther than that; he felt like he was entitled to have his advice work, and people telling him it didn’t was taking that away from him, which made it an attack.

 

Example 5: Do I owe MAPLE space for their response?

A friend of mine (who has some skin in the meditation game) said things I interpreted as feeling very strongly that:

  1. My post on MAPLE was important and great and should be widely shared.
  2. I owed MAPLE an opportunity to read my post ahead of time and give me a response to publish alongside it (although I could have declined to publish it if I felt it was sufficiently bad).

Their argument, as I understood it at the time, was that even if I linked to a response MAPLE made later, N days worth of people would have read the post and not the response, and that was unfair.

I think this is sometimes correct- I took an example out of this post even though it required substantial rewrites, because I checked in with the people in question, found they had a different view, and that I didn’t feel sure enough of mine to defend it (full disclosure: I also have more social and financial ties to the group in question than I do to MAPLE).

I had in fact already reached out to my original contact there to let him know the post was coming and would be negative, and he passed my comment on to the head of the monastery. I didn’t offer to let him see it or respond, but he had an opportunity to ask (what he did suggest is a post in and of itself). This wasn’t enough for my friend- what if my contact was misrepresenting me to the head, or vice versa? I had an obligation to reach out directly to the head (which I had no way of doing beyond the info@ e-mail on their website) and explicitly offer him a pre-read and to read his response.

[Note: I’m compressing timelines a little. Some of this argument and clarification came in arguments about the principle of the matter after I had already published the post. I did share this with my friend, and changed some things based on their requests. On others I decided to leave it as my impression at the time we argued, on the theory that “if I didn’t understand it after 10 hours of arguing, the chances this correction actually improves my accuracy are slim”. I showed them a near-final draft and they were happy with it]

I thought about this very seriously. I even tentatively agreed (to my friend) that I would do it. But I sat with it for a day, and it just didn’t feel right. What I eventually identified as the problem was this: MAPLE wasn’t going to be appending my criticism to any of their promotional material. I would be shocked if they linked to me at all. And even if they did it wouldn’t be the equivalent, because my friend was insisting that I proactively seek out their response, where they had never sought out mine, or to the best of my knowledge any of their critics. As far as I know they’ve never included anything negative in their public facing material, despite at least one person making criticism extremely available to them. 

If my friend were being consistent (which is not a synonym for “good”) they would insist that MAPLE seek out people’s feedback and post a representative sample somewhere, at a minimum. The good news is: my friend says they’re going to do that next time they’re in touch. What they describe wanting MAPLE to create sounds acceptable to me. Hurray! Balance is restored to The Force! Except… assuming it does happen, why was my post necessary to kickstart this conversation?  My friend could have noticed the absence of critical content on MAPLE’s website at any time. The fact that negative reports trigger a reflex to look for a response and positive self-reports do not is itself a product of treating negative reports as overt antagonism and positive reports as neutral information.

[If MAPLE does link to my experience in a findable way on their website, I will append whatever they want to my post (clearly marked as coming from them). If they share a link on Twitter or something else transient, I will do the same] 

 

Part 2: Simulacrum

My friend Ben Hoffman talks about simulacra a lot, with this rough definition:

1. First, words were used to maintain shared accounting. We described reality intersubjectively in order to build shared maps, the better to navigate our environment. I say that the food source is over there, so that our band can move towards or away from it when situationally appropriate, or so people can make other inferences based on this knowledge.

2. The breakdown of naive intersubjectivity – people start taking the shared map as an object to be manipulated, rather than part of their own subjectivity. For instance, I might say there’s a lion over somewhere where I know there’s food, in order to hoard access to that resource for idiosyncratic advantage. Thus, the map drifts from reality, and we start dissociating from the maps we make.

3. When maps drift far enough from reality, in some cases people aren’t even parsing it as though it had a literal specific objective meaning that grounds out in some verifiable external test outside of social reality. Instead, the map becomes a sort of command language for coordinating actions and feelings. “There’s food over there” is perhaps construed as a bid to move in that direction, and evaluated as though it were that call to action. Any argument for or against the implied call to action is conflated with an argument for or against the proposition literally asserted. This is how arguments become soldiers. Any attempt to simply investigate the literal truth of the proposition is considered at best naive and at worst politically irresponsible.
But since this usage is parasitic on the old map structure that was meant to describe something outside the system of describers, language is still structured in terms of reification and objectivity, so it substantively resembles something with descriptive power, or “aboutness.” For instance, while you cannot acquire a physician’s privileges and social role simply by providing clear evidence of your ability to heal others, those privileges are still justified in terms of pseudo-consequentialist arguments about expertise in healing.

4. Finally, the pseudostructure itself becomes perceptible as an object that can be manipulated, the pseudocorrespondence breaks down, and all assertions are nothing but moves in an ever-shifting game where you’re trying to think a bit ahead of the others (for positional advantage), but not too far ahead.

If that doesn’t make sense, try this anonymous comment on the post

Level 1: “There’s a lion across the river.” = There’s a lion across the river.
Level 2: “There’s a lion across the river.” = I don’t want to go (or have other people go) across the river.
Level 3: “There’s a lion across the river.” = I’m with the popular kids who are too cool to go across the river.
Level 4: “There’s a lion across the river.” = A firm stance against trans-river expansionism focus grouped well with undecided voters in my constituency.

In all five of my examples, people were given information (I like this better with hot sauce, you might break the library’s CD, these exercises hurt me and you are not qualified to fix it, your advice did not fix my problem, I had a miserable time at your retreat), and treated it as a social attack. This is most obvious in the first four, where someone literally says some version of “I feel under attack”, but is equally true in the last one, even though the enforcer was different than the ~victim and was attempting merely to tax criticism, not suppress it entirely. All five have the effect that there is either more conflict or less information in the world.

 

Part 3: But…

When I started thinking about this, I wanted a button I could push to make everyone go to level one all the time. It’s not clear that that’s actually a good idea, but even if it was, there is no button, and choosing/pretending to cut off your awareness of higher levels in order to maintain moral purity does you no good. If you refuse to conceive of why someone would tell you things other than to give you information, you leave yourself open to “I’m only telling you this to make you better” abuse. If you refuse to believe that people would lie except out of ignorance, you’ll trust when you shouldn’t. If you refuse to notice how people are communicating with others, you will be blindsided when they coordinate on levels you don’t see. 

But beating them at their own game doesn’t work either, because the enemy was never them, it was the game, which you are still playing. You can’t socially maneuver your way into a less political world. In particular, it’s a recent development that I would have noticed my friend’s unilateral demand for fairness as in fact tilted towards MAPLE. In a world where no one notices things like that, positive reviews of programs become overrepresented.

I don’t have a solution to this.  The best I can do right now is try to feed systems where level one is valued and higher levels are discussed openly.  “How do I find those?” you might ask. I don’t know. If you do, my email address is elizabeth – at – this domain name and I’d love to hear from you. You can also book a time to talk to me for an hour. What I have are a handful of 1:1 relationships where we have spent years building trust to get to the point where “I think you’re being a coward” is treated as genuine information, not a social threat, and mostly the other person has made the first move. 

The pieces of advice I do have are:

  1. If someone says they want honest feedback, err on the side of giving it to them. They are probably lying, but that’s their problem (unless they’re in a position to make it yours, in which case think harder about this).
  2. Figure out what you need to feel secure as someone confirms your worst fears about yourself and ask for it, even if it’s weird, even if it seems like an impossibly big ask. People you are compatible with will want to build towards that (not everyone who doesn’t is abusive or even operating in bad faith- but if you can’t start negotiations on this I’d be very surprised if you’re compatible).
  3. Be prepared for some sacrifices, especially in the congeniality department. People who are good at honesty under a climate that punishes it are not going to come out unscathed.