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I love that the affect of this very naturally inverts the traditional conspiracy theory in that the dark heart of the operation, underneath all of the criss-crossing string and grainy photographs, was money intended for a good cause

Is… is FTX another Metamed?

Metamed had an actual business plan that theoretically could have produced value for some people, they were just bad at their jobs and the market was incredibly small / turns out people don't actually want to pay for concierge medicine as researched by unqualified recent-college-grad rationalists. FTX is more like Theranos, where the whole thing was fraudulent and worth nothing.
FTX is actually worse than Theranos inasmuch as if Theranos had not been fraudulent it would have been addressing something useful. A non-fraudulent version of FTX would essentially just have been a casino. Unless you're well and truly dyed in the rationalist wool and believe that redistributing wealth upwards towards yourself is the most noble cause on Earth, I think it's very hard to justify why a company like FTX needs to exist or what value it provides to humanity, especially when there are already so many other functionally identical services out there. Doubly so when you consider the negative externalities of even a (hypothetical, obviously) non-fraudulent cryptocurrency market. And the value proposition of Alameda (which it appears FTX was created in service of, mostly in order to front run customers' orders and gamble away their money) is arguably even lower. I don't think Sam or other EA leaders even ever tried to dispute that, really, did they?
Metamed would absolutely have racked up a body count if they'd been even slightly sustainable. These are rationalists. There is nothing they can't fuck up at scale.