MetaMed

MetaMed was a medical consultancy started by Michael Vassar (who called himself Michael Arc for a while), a LessWronger and former President of the Singularity Institute, on the basis that superior rationality skills as taught by Eliezer Yudkowsky would make them obviously better at medical research than mere medical school and applicable scientific experience could. MetaMed was founded in 2012,Bloomberg company database started operations in 2013 and went broke by 2015, because it turned out rich hypochondriacs weren't dumb enough.
MetaMed was an instructive example on the value of experience and knowledge versus assuming one's own general brilliance and reasoning from first principles — and why people who think they're too smart to bother acquiring actual domain knowledge are potentially dangerous idiots. The people behind MetaMed seriously believed that LessWrong training was all one needed to out-doctor doctors reliably enough to base a business on it.
Medically speaking, MetaMed's rapid failure was probably the least worst outcome, and it didn't have time to rack up a body count.
The key thought everyone involved seemed to have was: "everything I don't know the tedious details of is simple because I am smart and radical in my thinking and know the One Weird Trick™!" Perhaps you are and do! But it's overwhelmingly likely you aren't and don't.
==Origins==
Vassar had been the President of Yudkowsky's Singularity Institute (now MIRI) and left to try his superior Yudkowskian rationality against the real world. He was very strong on the general applicability of skills gained from arguing on an amateur philosophy forum:
Yudkowsky helped market it to LessWrongers.Eliezer Yudkowsky, MetaMed: Evidence-Based Healthcare. LessWrong, 5 March 2013. He was a big fan, as they had helped him resolve his sleep disorder.Author’s Note Ch. 98. hpmor.com, 27 August 2013.
Vassar got together with Jaan Tallinn (a programmer, who had previously made it big with Skype and Kazaa, and started reading LessWrong in 2009 when sidelined by a lawsuit between Skype and eBayAaron Labaree, Our science-fiction apocalypse: Meet the scientists trying to predict the end of the world. Salon, 5 October 2014.) and Zvi Mowshowitz (previously a professional Magic: The Gathering player, who is also worried about Roko's basiliskNitasha Tiku, Faith, Hope, and Singularity: Entering the Matrix with New York’s Futurist Set. Archived from betabeat.com, 6 September 2012.). They also scored $500,000 in venture funding from Peter Thiel.Peter Thiel-backed MetaMed thinks you should have your own on-demand medical research team. thenextweb.com, 1 March 2013.
Vassar explained to Harper's how MetaMed would leverage this to change the world, and serve as incontrovertible evidence of the power of Yudkowsky's philosophy:
==The plan==
Vassar explained the plan to Bloomberg:
The actual working model was: you paid Metamed $5000 (for the starting package), then someone who'd just heard of the disorders involved for the first time in their lives, but was experienced in arguing on LessWrong, would enter your symptoms into various scientific journal databases and give you their rational advice in return, e.g.:
Their doctors would review the reports first, at least.
MetaMed's target market was rich hypochondriacs — the "worried well", the perennial favourite targets of quacks and alternative medicine scammers — who they could convince of their ability to beat the system:
For Vassar, MetaMed was all about fighting the power:
They also aimed to aid doctors with advanced artificial intelligence and data from information experts. This, despite Vassar's complete lack of experience in any real-world AI development — only in talking about the risk of AI dooming humanity.
Scott Alexander worked for them early on (his day job is as a medical doctor), and was very excited about the possibilities the MetaMed model offered.MetaMed Launch Day. Archived from slatestarcodex.com, 7 March 2013.
At least one of the doctors involved, Hank Gardstein (Henry F. Gardstein, Jr.), turned out to have been struck off for writing online pharmacy prescriptions.Hacker News by ceejayoz (28 February 2013) Ycombinator.Physician Information: Gardstein, Jr, Henry F New York State Department of Health. License surrender… "The physician did not contest the charges of practicing fraudulently and negligence on more than one occasion involving prescribing via the internet." MetaMed did fire him quickly once others had pointed it out, though it indicates a serious lack of due diligence at MetaMed.Tyler Cowen, Sarah Constantin replies on MetaMed. marginalrevolution.com, 23 March 2013.
==The hype==
Despite touting their superior Bayesian statistics and research skills, their main promotional page "Vital Facts and Statistics",Vital Facts and Statistics. Archived from metamed.com, 2013. a collection of scary claims about the failings of the medical field in general, had a number of problems. One of them was a lack of hyperlinks, despite it being a web page and many of the cited references being online.
Unsurprisingly, it's full of vagueness, weasel wording, and references that simply don't back the claims. Even if you thought MetaMed fundamentally had the right approach, the claims on this page showed worrying deficiencies in understanding basic statistical reasoning and researching and assessing scientific sources. Just a few examples:
===CT scanning and radiation===
The claim:
…but if you examine their own linked reference, what it actually says is:
That is, it is not a warning that a CT scan exposes you to atomic bomb radiation levels — but is a passing note that some atomic bomb survivors got doses as low as a CT scan (this is almost a certainty, since radiation exposure decreases with approximately distance-squared from the source).
Giving someone excessive CT scans can in fact cause cancer, and this is a risk that actual CT operators know all about and keep careful track of, where the risk from the X-rays is balanced against the risk of not having the test done;Patient dose information: guidance. Public Health England. but the comparison to Hiroshima and Nagasaki is purely for radiophobic scaremongering.
One should note that lifespan studies — performed regularly since the 1950s onwards on the survivors of the aforementioned atomic bombings — actually fail to show an increase in cancer rates, even at radiation levels greatly surpassing that of the low-exposure survivors which MetaMed invoke for their flawed comparison to CT scans.Yehoshua Socol and Ludwik Dobrzyński, Atomic Bomb Survivors Life-Span Study: Insufficient Statistical Power to Select Radiation Carcinogenesis Model. PubMed Central, 4 May 2015.
===98,000 deaths per year from medical errors===
The claim:
This is cited from the 2000 book To Err Is Human: Building a Safer Health System by Linda T. Kohn et al. which actually says:To Err Is Human: Building a Safer Health System by Linda T. Kohn et al. (2000) National Academy Press. ISBN 0309261740.
That is: from two single studies, one sees 0.2% errors leading to deaths in Colorado and Utah, 0.8% in New York, which could have been halved with more attention. That's potentially important, but it's not clear how medical amateurs doing their own research could be applicable to this problem. Not to mention hyping the larger number.
It is also important to note two responses regarding this "44,000-98,000" number:
* The journal article by Harold C. Sox, Jr. and Steven Woloshin, "How Many Deaths Are Due to Medical Error? Getting the Number Right" in 2000 shows that the numbers are derived via a long chain of extrapolation, with very wide error bars that aren't noted by MetaMed:
* The 2000 American College of Clinical Pharmacology response to the report, particularly the bogus nature of the 44,000-98,000 claim.American College of Clinical Pharmacology Response to the Institute of Medicine Report "To Err Is Human: Building a Safer Health System" (2000) The Journal of Clinical Pharmacology, 40:1075-1078. doi:10.1177/009127000004001001.
Surely MetaMed's research skills had found these as well, and surely people who literally bragged about their "statistical literacy" would have spotted these problems in the material they were citing.
==="Deaths caused by medicine itself total 225,000 per year in the US"===
The claim:
This claim is not substantiated by the references:
*The first citation is not to a scientific finding, but to an article in a law journal, which is actually a lecture transcript,Legal Alchemy: The Use and Misuse of Science in the Law by David L. Faigman (1999) Yale Journal of Law and Technology. Edited transcript of remarks delivered to the Yale Law and Technology Society on October 12, 1999. the text of which at no point backs a claim of "225,000".
*The second citation is to a JAMA article titled, "Defensive medicine among high-risk specialist physicians in a volatile malpractice environment", but does not at any point contain the claimed numbers.David M. Studdert, Michelle M. Mello, and William M. Sage, Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment by David M. Studdert et al. (June 1, 2005) JAMA 293(21):2609-2617. doi:10.1001/jama.293.21.2609.
==Memento mori==
By about April 2015, MetaMed had gone to its richly deserved fate, because its original idea (LessWrong rationalists are automatically smarter than domain experts!) was stupid, and its pivoted idea (concierge medicine to the rich worried well!) didn't have much of a market.
Tallinn attributed MetaMed's failure to the difficulty of producing research results — they were actually surprised when medical research turned out to be harder than they'd thought — and the limited interest from consumers.Liuat Clark, The solution to saving healthcare systems? New feedback loops. Wired, 24 April 2015. Of course, he was still all about fixing medicine with One Weird Trick™ — the horrifyingly dysfunctional US health care system apparently being the only example he could think of in the world.
Zvi Mowshowitz blogged about why they went down. His take was that everyone else was too irrational and signaling-obsessed to understand that they ought to pay large sums of money for Metamed's advice:
This raises the question of how they understood marketing, where the job is literally to promote the sizzle in order to shift the sausages. MetaMed VP of research Sarah Constantin details that they were really quite bad at this, with a list of mistakes that are actually not unusual for failed startups (i.e., lessons not learned); she considers they could have had a viable business had they made less retrospectively-obvious errors.Lessons Learned from MetaMed. docs.google.com.
Of course, they spent early 2015 stiffing people...am preparing a complaint to be filed with the Federal Court for the Northern District of Texas against MetaMed… by Joseph Martin III (20 March 2015) Twitter (archived from 25 Nov 2023 19:03:04 UTC).Yesterday I sent my lawsuit to MetaMed's registered attorney for service of process by priority certified mail… by Joseph Martin III (1 April 2015) Twitter (archived from ).Just delivered proof of delivery of service of my lawsuit against MetaMed to the courthouse...they have until… by Joseph Martin III (20 April 2015) Twitter (archived from 25 Nov 2023 19:11:11 UTC).
==After MetaMed==
Michael Vassar started another company, BayesCraft. That's "Bayes" in the special sense of "talks transhumanist bafflegab but doesn't seem to understand actual statistics."
BayesCraft is:
#Another medical startup (though what it actually does, the internet does not reveal);
#that has "Bayes" in the name.
From this, we can presume that Vassar really does want to make a difference in medicine in particular, and considers his LessWrong-trained rationalist skills ideally suited to the task, without all that tedious mucking about with training as a doctor, scientist, or both.
It is quite possible he will attain fame for this — though the Bayesian likelihood from prior probabilities is that it will be the sort of fame that results in FDA warning letters, and writeups in Respectful Insolence, Science-Based Medicine, Edzard Ernst's blog, Quackwatch, and the very wiki you're reading right now.
Fortunately for potential patients, this endeavor seems to have gone nowhere, with no web presence, and the only indication of its existence being Vassar's old Twitter profile.Michael Vassar Twitter (archived from December 19, 2015).Michael Vassar Twitter (archived from May 17, 2023).
==See also==
*Dunning-Kruger effect
==Notes==
==References==
Category:LessWrong
Category:Alternative medicine
Category:Living people
Category:Medicine
Category:Thielsphere