The Availability Problem:
Imagine you have cancer, or chronic pain, or a progressive degenerative disease of some sort. You have exhausted the traditional treatment options available to you, and none of them have worked. However, there are treatments that are still undergoing clinical trials which might help you. They are not fully approved yet, but your situation is dire and you don’t have time to wait another 10 years for the trials to finish. Can you access those treatments?
In theory yes, you can access unapproved treatments through federal laws like the 2018 Right to Try bill, or through FDA pathways like “Expanded Access”. However these laws don’t mandate that the company making the drug gives it to you. And what you will find when you try to use your Right to Try, or Expanded Access, is that there are almost no treatments available for use.
That’s why despite there being somewhere in the neighborhood of 13,000,000 Americans with terminal or serious illness, the FDA only grants about 2,000 Expanded Access requests per year, even though they approve 99% of all requests, typically within 24 hours. There just aren’t enough companies even bothering to apply.
No one really knows for sure how many patients have been treated under Federal Right to Try laws. What we do know is how many companies with drugs going through the clinical pipeline have used data from treating patients with RTT, when submitting data for their treatments to the FDA. Even if we assume the usage numbers are 2-3X higher, they are still pretty abyssmal.
Risk and Reward:
But what is it about these pathways that makes companies avoid them like the plague? The answer is three words: Terrible Risk/Reward.
The companies who own the rights to the treatment you want to access are called “Biotechs”. Now Biotechs are not like the big pharma companies you think of, they don’t make billions of dollars. In fact, they usually don’t make any money at all. They’re the small companies that do the research to get the drug approved. This approval process costs somewhere in the neighborhood of 1-2 billion dollars, and takes somewhere in the neighborhood of 10 years.
Biotechs can’t sell their drug pre-approval, so the only way they can fund this process is by raising money. But they don’t get this money all at once. It’s given to them one chunk at a time, as investors say “Okay do this first round of trials, if it goes well we might fund the next one”. This means that just to stay alive as a company and keep the treatment moving through the process, Biotechs must be able to raise money.
And competition is fierce, there’s a lot of Biotechs competing over a small pool of capital. So to raise successfully, you need to be absolutely flawless. As a result of this the executives who run Biotechs are extremely risk averse. They will inherently stay away from anything that has even a slight chance of jeopardizing their clinical trial.
So what does this have to do with Right to Try? Well, treating you under Right to Try is a risk. If something goes wrong, there's the risk of a lawsuit, there's the risk of other investors whose capital is needed to keep the company alive finding out about the bad outcome, which leads to the biotech not being able to raise the next round which it needs to survive. There's also some risk the FDA will come down on you, though they really only do this in extreme circumstances.
So for a Biotech, treating patients before their drug is approved is enormously high risk. That said, these are humans at the end of the day and typically run by founders that went into medical sciences because they are motivated to save lives. If they can justify the risk to their board, many of them would take it? So what’s the reward for participating in Right to Try?
Nothing. There is no reward. Actually, the Biotech will probably lose money treating you.
Federal Right to Try and Expanded Access both only allow the Biotech to charge “at cost”, basically meaning they can recoup the cost of the drug. There’s a ton of other costs that they will probably not be able to get reimbursed for. The lawyer who had to be hired to check that the company could do this, the hours that the Board spent drawing up plans and debating whether or not to do it, the time someone needed to take to engage the FDA and answer your doctor’s questions, and more. All of that is probably money lost.
So the pathways you want to use only work if there is a company willing to basically risk their reputation, and even their company’s survival, just for the chance to lose money treating you. And that’s why no one uses them.
State Laws Are Addressing The R/R Problem:
In 2025 Montana passed an expanded Right to Try bill, SB 535. This bill was specifically crafted to fix the risk/reward problem from earlier. Among other things, SB535 allows for Biotechs to make a profit for treating you instead of taking a guaranteed loss. The idea behind this was that by fixing the Risk/Reward, Montana could attract companies that wouldn’t otherwise make their treatment available.
And it has worked.
I work sourcing treatments for use under SB535. I am paid to talk to Biotechs whose treatment is not available, and convince them to come to Montana. Patients should start receiving treatment some time in June or July, we may very well have more treatment options available in Montana within the first year than have been used under Federal Right to Try in the last 8 years combined.
Here are two charts showing what will be available through just us in Montana basically as soon as the program launches:
And Montana is not alone in this. New Hampshire has HB701, a similar law but terminal illness only.
However, once again, there is a risk of these laws only working "on paper".
Somehow it's the FDA, Again:
Remember those biotechs I mentioned? Well, whether or not some state law says they can come treat patients, the FDA still has the ultimate say. The FDA could shut down a biotech's clinical trial for coming to Montana, or New Hampshire. This is a power they reserve unto themselves.
As a result, all of the treatments I just mentioned and many more, will only condition their participation in state programs like Montana and New Hampshire's on receiving Safe Harbor. Basically this is where the FDA exercises something called "Enforcement Discretion", and in doing so promises the biotechs that they won't get in trouble for coming to treat patients under state law.
Without this, as nice as these state laws are, only the most risk tolerant providers around will participate. This means there will be some treatments available, but only something like 10% of what the numbers could be, and it means patients will continue to suffer and die from lack of access.
Convincing people in the House and Senate to back up efforts to get the FDA to promise enforcement discretion is what I've spent the last 6 or so months working on.
This actually matters a lot for states other than Montana and New Hampshire.
In Utah, there is a stem cell access bill. There is also a great company called Discgenics making stem cell based therapies which are in late stage clinical trials based in Salt Lake City. You cannot access Discgenics treatment under Utah state law. That's pretty ridiculous! Florida, Texas, New Hampshire, and maybe soon Tennessee, have similar laws. So you can get off label stem cells, but nothing with actual clinical trials backing them.
In 17 states (AZ, NV, LA, MD, MI, NC, AK, TN, KS, SD, IN, GA, CO, IA, TX, NH, and WV) there are Right to Try 2.0 laws, also known as Right to Personalized/Individualized treatment laws. These are laws which allow for you to access treatments based on your personal genetic code, a class of treatments which is widely believed to be the silver bullet for many rare diseases and cancers. Like the other laws I have mentioned, any company that participates in one of these does so at their own risk.
Karma: 32 | Comments: 0 | Author: Stephen Martin
Comments
JohnWittle (karma 22):
I have a few questions that might seem a bit naive, and it's possible that you have answered them before in different places (perhaps even in the links and citations of this very post). If so, I'm sorry for asking rather than doing further reading, and I'm especially sorry for erring towards verbosity over brevity. But I do think it would be useful to have the questions all in one place, to refer back to, since I often find myself trying and failing to understand your perspective.
First, let's say I create a course-grained physics whole-brain-emu simulator, which carefully emulates the function of the EM fields to whatever degree of granularity is necessary to get predictive accuracy. This WBE will now talk about being conscious, about having qualia and phenomenology, right? because it's the causal interaction between the neurons and the EM fields which ends up causing the larynx to wiggle in such a way as to make those noises, right?
but the EM fields that are generated by a digital computer which is emulating such a thing can be arbitrary, and not necessarily isomorphic to the EM fields that are being emulated. so this emulation is not actually related to any phenomenal consciousness in reality, right?
doesn't this run afoul of the generalized anti-zombie principle? i'm confused about what your answer is here, since you say you disbelieve in the possibility of p-zombies. does the WBE actually not talk about consciousness? at what step does the functional causal chain deviate from the real-world counterpart, and why? If it does talk about having phenomenological consciousness despite not having any... isn't that very suspicious?
Second, you mention from the michael johnson paper:
How can we enumerate which computations are occurring in a given physical system? How can we establish that a given computation is not occurring in a physical system? If some computations "count" toward qualia and others don't, what makes them "count"?
I feel like this argument proves a bit too much. For instance, you could make the same argument about the concept of 'addition' or 'subtraction'. We don't really have a firm rule for whether a given computation 'is happening', or whether it 'counts as addition' or not. But this doesn't mean that addition is not a computational process... I know that a half-adder is 'doing' 'addition' even though I can't draw objectively defined borders on the continuum which describe exactly how much you have to change a half-adder before it's 'not' doing addition anymore. I think this is because we've got a functional purpose for addition, and if the functional purpose is satisfied, this tells us that addition was performed. I really can use a half-adder to count my sheep, and it really works, and this fact is part of what I use to define 'addition' to begin with.
I can see why some would say phenomenal consciousness is different from this... addition requires an outside observer like me, to decide if the function is fulfilling my needs. Phenomenal consciousness wouldn't need this, it would be verifiable from inside...? but. This still doesn't feel like the kind of objection that hinges on whether we can even define what a computation is, or whether a given computation strictly is or is not addition. So I don't know that it ought to apply to consciousness either.
Third, I think I have the same objection re: the whole question of mapping specific functional states to specific qualia. I notice that when you go looking for the physical substrate of the phenomenological qualia of vision, you immediately start looking at the function of the visual cortex, the optic nerve, etc. If qualia is substrate dependent... why do you suppose that this is the right place to look? Doesn't the same fundamental issue arise, that you have no principled reason to suspect the qualia of 'red' arises from these systems, compared to (say) arising from your kneecaps, or your armpits? Clearly the computations being performed by your visual cortex are relevant to your visual qualia, but doesn't this sort of beg the question? Why wouldn't the qualia just be part of the whole functional system, and therefore substrate-independent, replicated by anything that performs the same function?
Those are the questions I keep hovering over every time my friend Herschel tries to explain the physicalist perspective to me, anyway. I'm one of those people who read the 'p-zombie sequence' two decades ago and thought "yup, this is all perfectly obvious and nobody with any sense could possibly disagree with it", and so I can't quite tell if the non-functional theories of consciousness just haven't actually reckoned with those arguments yet (the way it seems to me), or if actually by ignoring the discussions I missed out on a bunch of new, more advanced material that moved past the original sequences. But these questions are definitely sorta straight out of orthodox 2008-era Yudkowsky, and I feel like I still don't understand what the responses are despite having people confidently try to explain them to me.
uugr (karma 12):
For what it's worth, I'd like to offer you a data point. I was working a miserable software job nearly identical to the one you describe in the comments (including the absurd priority system, excess of meaningless notifications, and constant deferral of decision-making to later meetings). I had the same opinion you did: the idea that this wretched place is "necessary" for my life to be "meaningful" is absurd and insulting. I'm trying my best to find meaning in the hours outside of work, given that my time spent inside could have been equally productively spent staring at the wall. To just have the same money without needing to work for it would be a dream, as I could focus all my attention on the people and hobbies I care about.
So, I decided to test it. I saved up enough to live off of for ~18 months, then quit my job, intending to just do more of the other things I was already doing with the extra time.
I am now 5 months into this sabbatical, and results have been mixed. To be sure, I do feel much more free now that I am not working a bullshit software job. I am, especially, much more socially active than I used to be, and I have more room to care about the people around me. This is very nice. I also like that I can spend long periods of time uninterrupted on things, instead of fitting them into isolated fragments of time.
However, I've also found the experience stressful and disorienting, which I did not expect. Even a meaningless bullshit job still serves as an anchoring point around one's life in a way that's difficult to replace. Another commenter points out that some people who live off benefit programs fall into unhappy, passive media consumption, and while this hasn't happened to me, I can feel myself constantly fighting to make sure it stays that way. There's no buffer between me and staring-at-the-wall-doing-nothing, so if I start feeling like I don't want to leave the house, or that hobbyist work doesn't seem like much fun today, why not?
I expected some amount of this, but assumed that once I'd started filling the time with meaningful things, momentum and inertia would do the rest of the work for me. Maybe, but if so, the momentum takes longer to build than I thought. It may also be that UBI-world would be better, since I'd be one among many people trying to anchor themselves in the world without a job, rather than an isolated individual going against the grain. Or, maybe I'm still just stuck in the mindset of the employed, and a relatively passive lifestyle wouldn't be so bad in a culture less focused on work and productivity.
Any of these might be true, and I'm certainly not saying having a bullshit job made me any happier. But, I'm less confident now that UBI-life is straightforwardly good. It seems more likely to me that there is a problem of structuring life without work, but it's a solvable one, and worth trying to solve.
Viliam (karma 5):
Sometimes I have a free day and I waste it reading Reddit, so I can imagine a possible future where I do this every day, and then regret it at the end of every day. (I mean, not just free from the job, because that would be almost every weekend, but sometimes my wife decides to take the kids for some all-day activity and suddenly I am left home alone.)
That said, if I take the worst possible day and imagine a future consisting only of days like this, that sounds like motivated thinking. I mean, if I took the best day instead and imagined a future consisting only of such days, people would remind me that it is an obvious fallacy.
Another argument is, how do we expect people to manage their own free time, if they never had the opportunity to practice it? I mean, sometimes when I have free time, it's an experience so much out of the ordinary, that it leaves me confused. Suddenly there is an enormous burden of responsibility -- this is the moment you were waiting for so long! make absolutely sure that you won't waste it! who knows when you get a similar opportunity again? -- that it paralyzes me, and makes me feel guilty before I even started doing something.
Maybe it's the other way round: if I had more free time, I would start working on some project, and then the obvious action each day would be to continue on the project. Instead, if I only get free time when I am too tired to do something meaningful, of course I associate free time with meaningless things, and then when I get a free day the habit pulls me towards them.
And if my friends had free time too, then we could meet and do something together. Heck, we might even do something job-like together, but the difference would be that it would be meaningful, without arbitrary pressures and deadlines, and with the people I like.
EDIT:
Uh, this reply was a little incoherent, like I said a few unrelated things, most of them not really addressing your comment. The connecting point is this:
In the past, my activities were usually connected to my social life. For example, I tried to write science fiction stories, and I also attended various sci-fi conventions and clubs; one thing reinforced the other. But what was back then when I was at school. These days, I don't care about sci-fi that much, but if I did, I would have to choose whether to spend my free time trying to write it, or talking to other sci-fi fans, but I wouldn't have enough time to do both meaningfully.
What social activities do you have during your sabbatical? Have you even tried to bring more of them to your life? If we assume that other people mostly work during the day and are free in the evenings, it would make sense to organize your days so that you work on something during the day, and do the related social activity in the evening. And during the social activity, write the to-do list for the next day.
(And if we both had a sabbatical at the same time, and lived next to each other, we could meet tomorrow and spend the day brainstorming about how to solve the problem of being productive during the sabbatical.)
ClaireZabel (karma 9):
Some random thoughts about historical colonization conflicts
Aztec Empire
I read Aztec, by Gary Jennings, a retelling of (among other things) the encounter between Europeans and the Aztecs (note that they didn't call themselves Aztecs, they generally called themselves the Mexica). Though the book is fiction, a lot of the dynamics it talks about were real (warning for potential readers that the book doesn’t just focus on those dynamics and has a lot of disturbing sex content). I was partly interested because of the potential elements of AI, though there are, of course, many important disanalogies.
Before the conquest, emperor Moctezuma II and his advisors faced a really hard problem. There were strange white soldiers with new animals and technology entering their lands. They did not know exactly who the Spaniards were, how many might follow, how their weapons worked, what political authority they represented, or how to weigh the new potential threat against existing enemies and tributary tensions in the empire.
The Aztec Empire was overthrown, its people disempowered or killed (many by disease), and much of its culture was lost. There's a lot of debate about Moctezuma II’s strength as a leader. But what struck me most is that even with the benefit of hundreds of years of hindsight, it is super hard to say what the best response would have been.
Succeed in killing Cortés and his men and perhaps you buy time, but how valuable is that time, and will worse retribution follow (plus, how good do you feel about attacking mysterious strangers you encounter whose political and cultural significance you don't yet understand?)? Resist longer even if you think you’ll lose, and perhaps you preserve dignity or independence for a moment, and perhaps in history, but maybe at catastrophic cost? Ally quickly and perhaps you preserve more lives, as the Tlaxcala (another group in the region that were historical enemies of the Mexica) may have done? The Tlaxcala earned meaningful wins from the alliance (e.g. somewhat better jobs after colonization, tribute exceptions, being allowed to keep their original names, the right to bear arms) relative to other groups; was that a zero-sum game among different indigenous groups, or could everyone have been a bit better off if they followed the strategy? Demonstrate your martial skills to the best of your ability with early skirmishes; then sue for peace and hope that you've increased their willingness to pay? But maybe more violent reprisal will follow.
The Aztec prospects for long-run resistance to European domination seem very slim, especially given pathogen vulnerability asymmetry, regardless of whether they can broker a peace treaty with Cortés. If they’d rebuffed the initial invasion and were very skilled, perhaps in the intervening time the Mexica would have gained a valuable understanding of Spanish and European culture and would have been able to enter trade relations with the Europeans as somewhat less junior partners (albeit still ravaged by smallpox and other diseases brought inadvertently by the Europeans). Or maybe not (again, seems really unclear). Also, they didn't know this, but the original invasion was not initially sanctioned by King Carlos of Spain — Cortés acted unilaterally. As a result, perhaps if they had rebuffed Cortés, the next invading force would have had a pretty different character.
Perhaps people with a much deeper knowledge of this history have somewhat more sophisticated opinions, and I'm not saying that there's no way to gain more clarity. It's just pretty striking how little hindsight helps a layperson (or lay-LLM I asked).
Indigenous people of New Zealand and Australia
Reading about the Mexica made me curious about the British settlement of New Zealand and Australia, so I read a bit about the history there and talked to the AIs about it for a while (I read a lot less about this than about the Aztec Empire).
Both involved catastrophic violence, dispossession, and population collapse of the people living in Australia and New Zealand at the time. But my sense is that, while they were both extremely bad, the situation in Australia was noticeably worse. The Maori were able to remain a somewhat legally recognized and politically and culturally cohesive group and they retained more of their land and culture (though again, they still lost much of what they started with, including the vast majority of their land), most famously in the Treaty of Waitangi signed between the British Crown and many Maori chiefs, making the Maori British citizens with a British governor overseeing New Zealand, but preserving some land right for Maori. There were important discrepancies between the English and Maori versions of the Treaty; most notably, the wording of the English version involved a much more profound ceding of sovereignty, but it seems like it had some meaningful effect. In contrast, the British considered Australia terra nullius (nobody’s land), and indigenous lands and cultures had even less legal representation.
The Māori military was more formidable by the relevant time: they had rapidly adopted firearms through trade, fielded larger forces, and built sophisticated fortifications, probably partly as a result of being an agriculture civilization (but rich natural resources make you more of a target) with a denser population. They had clearer hierarchies and rulers who could be negotiated with, whereas most Australian Aborigines were in much smaller nomadic and (often) less hierarchical bands. Because of the above, they were more valuable as trading partners for the British. In several battles in the New Zealand Wars, a small number of Māori warriors held off a larger number of British soldiers, making a full-on fight visibly costly.
Also, New Zealand was settled by the British about 50 years later than they settled Australia. By then, the treatment of Australian Aboriginals was somewhat of a scandal that had embarrassed the British and that they didn't want to replicate; slavery had ended in the British Empire and there was a wave of moral squeamishness about colonization represented by a religiously-inflected humanitarian movement.
Takeaways
These were three examples that I delved into briefly; it would be cool for actual historians and other people who know more about this to share their views. But I guess my sense is if you're going to encounter a stronger power, it's better for you if:
The delta in technological capabilities between you and them is as small as possible
You rapidly adapt to/take on as much of their technology as possible, reducing the delta quickly
You are as well coordinated as possible
If you have the capability to impose meaningful costs on your conquerors, you make those capabilities clear so that they're incentivized to negotiate with you and there’s common knowledge of your leverage, at least if you can do so without violence that might provoke retribution (with violence, you risk retribution; reprisals in response to Aboriginal Tasmanian resistance seemed like it contributed to the ~ genocide they experienced). Similarly, if you'd be more valuable left intact as a trading partner, that's helpful too.
Understanding your opponents is huge. Knowing the language, norms, systems of governance, different factions, etc. can make a big difference to your ability to intervene on behalf of your interests. Take prisoners, study artifacts, try to reproduce what you can. This seems like among the more robust interventions that are (somewhat) within your control.
Cultural / ideological factors. Your opponents self-identify as and genuinely are pacifistic and culturally pluralistic and don't have a culture of expansionism and ruthlessness. Missionaries were less prone to violence but more motivated to stamp out other religions. Military forces might have been more prone to violent domination but less to eradicate other religious and cultural beliefs.
Outcomes were probably particularly debilitating when the following two bad factors aligned:
Early intense contact: they come to settle or conquer rather than to trade or visit (with few opportunities to gain information, trade, adopt new technology, etc)
Vulnerability to disease
These are mostly obvious in retrospect. But that said, probably my biggest takeaway is that not only can the weaker party in these situations be in an extremely tough situation (obvious) where most trajectories are very bad, but often it remains very unclear what strategy would serve them best.
leogao (karma 8):
why are malaria nets 9-23x more efficient than direct cash transfers? when in theory direct cash transfers can be used to purchase nets
some hypotheses
people are irrational and don't spend money on nets because they underestimate the risks, are not educated, etc
people don't value spending a few days wages to reduce mortality by 0.1 percentage points
Jay Bailey (karma 5):
I think part of it is what you said. Even in Western countries where people have way more education and slack, people often underinvest in preventative health like flu shots, so it makes sense that people in third-world countries would fall prey to this too, and many more probably don't even know about the benefits of nets or how to get them.
Another pair is economies of scale and spillover effects. IIRC it's cheaper per net to protect a whole village at once, and because malaria nets are treated with insecticide, nets kill mosquitos and so they protect other people as well. And people tend to underinvest in things with positive externalities like that - again we go back to the flu shot example.
There's probably other reasons, but these are the ones I know of.
Mo Putera (karma 5):
I liked Ada Palmer on Dwarkesh a lot, but the LLMs pushed back without me even asking to fact-check, including on some of my favorite passages:
Opus 4.7's take: "good for vibes, mediocre for facts, useful for a couple of structural reframes"
It's a fun listen, but I think it's substantially less reliable than it sounds, and the gap between confidence-of-delivery and quality-of-evidence is the most interesting thing about it for someone in your position.
The strongest moves are structural rather than factual. The "Petrarch wanted philosopher-kings, got vaccines instead" frame is genuinely useful — it generalizes the lesson that you mostly don't get to choose how your inputs metabolize, only whether you put inputs in. The "censors are always wrong about what to censor in hindsight" point (Jansenism vs Voltaire, astrology vs anti-monarchical Satan in Paradise Lost) is a good epistemic prior — and a humbling one for anyone trying to anticipate which threads from current AI discourse will matter in 30 years. The point that history always feels fast when you zoom in, and that we've been telling ourselves a Civ-shaped lie about a slow medieval period that wasn't slow, is the kind of reframe I'll actually carry. And the Florence-tyrant-walks-around-the-Mannelli-tower vignette as an argument for "even failed resistance ratchets the equilibrium" is a real point, well made.
But the texture of the interview is vivid specificity standing in for evidentiary support, and once you notice it, it's everywhere.
The headline anecdote — Gutenberg printing 300 Bibles in a German town where only priests could read them — is wrong in at least three ways, and the top comment (Don) actually documents the corrections from primary sources: print run was ~160–185, the Bibles weren't unsold (Pius II's 1455 letter says buyers were lined up at Frankfurt before production finished), and the Latin Vulgate was perfectly legal for any layperson literate in Latin to own. Gutenberg lost a lawsuit to Fust, who then ran a profitable printing business for a decade. The "Gutenberg goes bankrupt because distribution networks didn't exist yet" story is doing enormous load-bearing work for her thesis about successive technology revolutions, and the load-bearing beam turns out to be a beautifully painted styrofoam prop.
Once you've spotted that, other set-pieces start looking shakier. "Florence had 90% male literacy in the 12th century" — the standard estimate, from Villani's famous schooling figures and downstream work, is more like 25–35% for 14th-century Florence, and it's a city much-cited because it was an outlier. 90% in the 1100s would be a sensational claim, and it isn't a sensation in the literature because it isn't right. The "Inquisition invented peer review" line, which Dwarkesh promotes to the writeup, is what one of the commenters caught: Palmer is describing experimental replication, not peer review (gatekeeping prior to publication). Distinct mechanisms, distinct epistemic functions, conflated for the meme.
The Leonardo-as-saboteur framing is performative provocation that gets undergraduates to wake up but doesn't survive scrutiny — most pre-modern artisans kept trade secrets, mirror writing was partly a left-handed practical convenience, and "didn't share systematically" is just not the same thing as "deliberately sabotaged human progress." It's the kind of move that's optimized for the classroom and not for being true.
And the cumulative Petrarch → libraries → printing → med students reading Lucretius → germ theory → vaccines → cure for the Black Death chain is exactly the great-man-with-a-library intellectual history that historians beat each other up over when other historians do it. It silently routes around the Needham question (China had cheap paper and big libraries earlier — and didn't get a scientific revolution; this should at minimum embarrass her own model, but it's not engaged), routes around Islamic medicine and Chinese variolation as germ-theory inputs, and treats a 400-year string of contingent events as if it had a tendency.
When Dwarkesh explicitly tees up the AI parallel — "people think they'll make AI go well by doing X, but historically nobody has a good track record of steering" — Palmer's response is "go well vs go your way" and the implication that worrying about values-loading is the wrong frame because Petrarch's Christianity didn't survive but his world got penicillin anyway. That's a comforting story and I think it's load-bearing for the optimistic-history priors of her audience, but it's potentially complacent in a way I'd want to push on. Petrarch wasn't trying to build something with sharp capability gradients and adversarial dynamics. The "trust the long-run, the metabolism of ideas tends toward good" inference is doing a lot of work that the reference class doesn't obviously support when the artifact you're making isn't a library. The honest version of her lesson is narrower: you can't control which of your downstream effects dominate, which is true and important and also an argument for working harder on the things you can control rather than relaxing about it.
Net: file under "good for vibes, mediocre for facts, useful for a couple of structural reframes." If you're going to mine it for building blocks for future Claudes, I'd lift the censorship-blind-spot point, the partial-victory-still-ratchets point, and the multi-stage-information-revolution frame. I would not lift the Gutenberg anecdote, the Florence literacy stat, the Petrarch-to-vaccines chain, or the "Inquisition invented peer review" line without flagging them.
GPT-5.5's take: "excellent for generating better questions and dangerous for generating confident cached facts; steal the models, verify the anecdotes, distrust the numbers"
Verdict: I loved it, and I don’t fully trust it.
Ada Palmer is doing something rare and valuable: she makes the Renaissance feel politically, materially, institutionally alive. Not “great men rediscovered Plato and painted pretty ceilings,” but “merchant oligarchs, propaganda, fragile legitimacy, book logistics, censorship failure, plague trauma, and weird little institutional hacks collided for centuries.” That is excellent public history. The interview’s central move, from Petrarch’s failed moral-political project to libraries, print, scientific method, and unintended civilizational consequences, is genuinely illuminating. It is also sometimes too gorgeous to be safe.
My main criticism: Palmer is a world-class anecdote engine, and the engine sometimes outruns the evidentiary road. She compresses complicated historiography into punchy claims so well that you can forget to ask whether the claim is literally true. Dwarkesh notices this at points, especially when he pushes on monocausal stories of the Scientific Revolution, but he should have pushed harder on the numbers and “wait, is that literally true?” moments.
The transcript you shared and the official podcast page frame the episode around Florence’s weird republic, Gutenberg’s failure, print as an information revolution, the Inquisition as accidental peer review, and Petrarch unintentionally helping create a world very unlike the one he wanted. The official episode also identifies Palmer as a Renaissance historian, novelist, composer, and University of Chicago academic discussing her book Inventing the Renaissance. (Dwarkesh) Her credentials are real: UChicago lists her as an associate professor in history, working on science, religion, heresy, censorship, printing, books, and European intellectual history. (arthistory.uchicago.edu) So this is not “charismatic internet person free-associates about the Renaissance.” She knows the terrain. That makes the slippage more interesting, and more dangerous.
What I think the interview gets deeply right
The strongest part is the information-infrastructure story. Palmer’s best point is that ideas do not matter just because someone thinks them. They matter when there are libraries, readers, distribution channels, teachers, glosses, translations, arguments, patrons, institutions, and enough people bumping into the same material from different angles. That is exactly the kind of causal story people in AI, EA, policy, and forecasting should absorb. It is anti-great-man in the right way: Gutenberg does not “cause modernity”; Gutenberg plus paper, book demand, Venice, fairs, pamphlets, religious controversy, and mobile printers cause a new information ecology.
Her Florence material is also mostly great. Florence really was an odd republic by European standards: the Signoria was made up of nine priors drawn from guild members, rotating every two months, and the Ordinances of Justice excluded magnate families from formal political power. (Encyclopedia Britannica) Palmer’s reminder that “republic” did not mean “democracy” is especially important. When she says the Florentine popolo is an oligarchic merchant class rather than “the people” in our sense, that is the kind of corrective that actually changes how you read Machiavelli. The exact “top 4%” figure I could not independently verify from the quick public sources I found, but the conceptual point is right. (Dwarkesh)
The “go my way” versus “go well” distinction is probably the most important idea in the episode. Palmer’s Petrarch story says: people try to shape the future according to their values, but the durable effects often come through infrastructure they accidentally create. Petrarch wanted moralized elite rule by classically educated princes; what survived was manuscript recovery, libraries, philology, textual culture, and eventually new ways of using old texts. (Dwarkesh) This is not a cute historical irony. It is a serious warning for anyone trying to “make AI go well” by controlling the values of a future civilization. The thing you build may matter more than the thing you intend.
Where I think Palmer overreaches
The Gutenberg segment is the biggest offender. The interview’s version says Gutenberg prints 300 Bibles, sells maybe seven in a small German town where only priests can read the Bible, goes bankrupt, then the bank that forecloses on him also goes bankrupt, then the apprentices go bankrupt, and only Venice makes print commercially work. (Dwarkesh) The true version is messier. Gutenberg appears to have printed about 180 Bibles, not 300. The financier who sued him, Johann Fust, was a goldsmith/lender, not simply “the bank.” Fust sued Gutenberg in 1455, won, took over equipment, and with Peter Schoeffer created one of the first commercially successful printing firms. (Encyclopedia Britannica) So the line “the bank went bankrupt too” looks dubious, or at least badly compressed.
The “only priests were allowed to read the Bible” claim is also too strong. Medieval access to biblical texts was constrained by literacy, language, cost, clerical control, and region-specific censorship, but the blanket claim that only priests could read the Bible is a common misconception. Vernacular Bible reading existed in parts of late medieval Europe, with restrictions varying by place and time. (Cambridge University Press & Assessment) Palmer’s deeper point still survives: early printed books needed distribution networks, and Venice was superbly placed for that. Venice really did become the leading fifteenth-century center of printing and book distribution, with far more editions than any rival. (Encyclopedia Britannica) But the anecdote as told is too neat.
The Florence literacy claim also smells inflated. Palmer says Florence had 90% male literacy as of the twelfth century. The better-supported version is: later medieval Florence had unusually high schooling and practical literacy by European standards. Giovanni Villani’s fourteenth-century figures imply very high male schooling, perhaps around 67% to 83% by one interpretation, and later catasto evidence broadly supports unusual literacy. (Cambridge University Press & Assessment) But “90% male literacy in the twelfth century” is the sort of number that should make your inner spreadsheet cough blood. Maybe she has a source in the book. In the interview, it lands as overconfident.
The Roman Senate claim is worse. Palmer says the Roman Senate kept meeting until 1200 AD. The classical Western Roman Senate seems to disappear from the historical record around the late sixth century, with Britannica saying its last mention is in AD 580. (Encyclopedia Britannica) There was a medieval revival of a Roman senate in the twelfth-century commune of Rome, but that is not the same as continuous institutional survival from the ancient Senate. (Cambridge University Press & Assessment) This is exactly the kind of Palmer move that makes me both delighted and suspicious. It is a killer line. It is also, unless carefully qualified, misleading.
The life expectancy claim is another one I would not casually repeat. The episode summary says European life expectancy decreased from 35 in the medieval period to 18 during the Renaissance. (Dwarkesh) Palmer has elsewhere been quoted saying Renaissance Florence had an average life expectancy of 18. (The University of Chicago Magazine) But recent demographic work on medieval Italy emphasizes how sporadic the data are and estimates life expectancy at birth around 20 years in medieval Italy, with recurrent plague causing stagnation and demographic pressure from the fourteenth to sixteenth centuries. (EconPapers) A clean “35 to 18” Europe-wide story is too tidy. Also, life expectancy at birth is a brutal statistic dominated by infant and child mortality; it should not be heard as “adults normally died at 18.” I would treat this claim as rhetorically powerful and empirically fragile.
The Inquisition bit is my favorite and least favorite. Palmer says the Inquisition accidentally invented peer review, had a huge experimental lab, and executed only one person for doing science. (Dwarkesh) The good version of this point is: the Catholic Church’s relationship to science was much stranger than the cartoon “priests hated science.” Macuglia’s work, which Palmer invokes, argues that Church information-control systems in Rome could paradoxically help reshape and disseminate scientific practice, including Newtonianism in early modern Italy. (PubMed) That is fascinating. But “invented peer review” is branding, not a literal institutional genealogy. “Only one person executed for doing science” is also slippery. Giordano Bruno was executed for heresy, with cosmological claims among a much wider theological package; Galileo was tried and punished but not executed. (Cambridge University Press & Assessment) The clean scorekeeping category “executed for science” is itself anachronistic.
The Leonardo “saboteur” line is a terrific classroom grenade and a bad final judgment. Palmer’s point is that Leonardo hoarded knowledge, wrote in mirror script, and did not publish into a scientific community, so calling him a scientist in the modern sense is misleading. Fine. But “saboteur” is too cute. The reason for Leonardo’s mirror writing is uncertain; plausible explanations include secrecy, but also practical left-handed writing that avoided smudging. (Museum of Science) And judging Renaissance workshop secrecy by modern scientific publication norms is unfair unless you explicitly mark the category shift.
Claim-by-claim fact-check
Claim from the interview
My verdict
Why
Florence was a weird guild-based oligarchic republic, not a democracy
Basically right
Signoria of nine priors, guild basis, magnates excluded. Good corrective. (Encyclopedia Britannica)
The popolo was a narrow elite, not “the people” in our sense
Right in spirit
The exact “top 4%” may be Palmer’s own framing, but the oligarchic point is correct. (Dwarkesh)
Florence was infamous for sodomy
Broadly right
Michael Rocke’s work supports Florence’s extraordinary reputation and prosecution record; the specific French-law anecdote I could not verify from open sources. (OUP Academic)
Gutenberg printed 300 Bibles and sold seven
Probably wrong in details
The usual estimate is about 180 Bibles; I found no good support for the “seven” figure. (The Morgan Library & Museum)
Fust/the bank foreclosed and then went bankrupt
Looks wrong or at least very misleading
Fust was a financier/goldsmith, sued Gutenberg, took over equipment, and with Schoeffer built a successful press. (Encyclopedia Britannica)
Venice was crucial to making print economically powerful
Strongly right
Venice became the leading fifteenth-century printing and distribution hub. (Encyclopedia Britannica)
Only priests could read the Bible
Too strong
Vernacular Bible access varied by region and period; blanket clergy-only framing is a misconception. (Cambridge University Press & Assessment)
Florence had 90% male literacy in the twelfth century
Doubtful
Later medieval Florence was highly literate, but the best quick check supports high fourteenth/fifteenth-century schooling, not a clean twelfth-century 90%. (Cambridge University Press & Assessment)
The Roman Senate kept meeting until 1200
Misleading
Ancient Western Senate disappears around the late sixth century; the twelfth-century Roman commune revived senatorial forms. (Encyclopedia Britannica)
Renaissance life expectancy fell from 35 to 18
Highly suspicious
Florence may have had horrifying mortality, but the Europe-wide 35-to-18 line is too neat and clashes with broader medieval Italy estimates around 20 at birth. (EconPapers)
The Inquisition accidentally invented peer review
Great metaphor, weak literal claim
Church censorship and Roman scientific institutions were more complex than the myth, but “invented peer review” needs heavy qualification. (Dwarkesh)
Leonardo was “not a scientist” / a saboteur
Useful provocation, unfair if literal
He did not operate like a modern publishing scientist, but mirror writing and secrecy are not enough to make him anti-scientific. (Museum of Science)
My actual take
This interview is excellent for generating better questions and dangerous for generating confident cached facts.
Palmer’s superpower is that she de-kitsches the Renaissance. She strips away the museum-poster version, where everything is genius and marble and golden light, and gives you a world of fragile states, illegitimate rulers, patronage networks, sexual policing, mercenary violence, plague trauma, paper costs, book distribution, censorship logistics, and institutional improvisation. That is the right direction. The New Yorker’s review of Inventing the Renaissance makes a related point: Palmer’s Renaissance is full of poverty, violence, and yearning for a lost antiquity, though the reviewer also criticizes her voice and argues she sometimes mishandles evidence and underplays visual art. (The New Yorker) That sounds exactly right to me.
But she sometimes replaces one myth with another. The old myth is “Renaissance equals golden age of genius.” Her counter-myth is “Renaissance equals violent cosplay plus information infrastructure plus unintended consequences.” The counter-myth is much smarter. It is still a myth when squeezed into podcast form.
The best way to use this episode is: steal the models, verify the anecdotes, distrust the numbers. The models are excellent. Print as an infrastructure stack, legitimacy as theater, republics as oligarchic machinery, censorship as a speed-and-enforcement problem, intellectual revolutions as delayed consequences of earlier failed projects. These are portable and powerful. The anecdotes are often directionally right but served with too much theatrical certainty. The numbers are where I’d be most cautious.
My grade: A for intellectual electricity, A- for historical imagination, B for causal architecture, C+ for numerical discipline. Watch it. Think with it. Do not quote the sexiest lines without checking them first.
Raemon (karma 17):
For things like this, it's not very useful if you don't include the prompt.
Eye You (karma 5):
I think I found two more BIG problems with the eval.
First: I looked into the tests a little more. Every task test suite I saw has many ignoredtests for "reason: goldfail". Which apparently means that the reference solution itself fails the test. This one has 79 tests ignored due to goldfail, which is ~10% of its total tests.
This seems really bad! It makes me think that there is something bad about the way they are generating tests and that the tests don't really correspond to the program being "correct". Epistemic status: this is my first time learning about this "goldfail" and I am not a professional software engineer.
Second:
Opus 4.7 scores 2.9% but Sonnet 4.6 scores 71.5%? No way. Something has gotta be broken here.