Interesting. So basically an individual out in the sticks can genuinely get by with Internet but not plumbing, but urban life would be impossible at scale without plumbing, and without urban civilization at scale we probably wouldn’t be able to maintain the internet at scale?
Correct. At the risk of stating the obvious, indoor plumbing (and public sanitation in general) is not something required for you as an individual. It's something required for society as a whole to sustain value added activities that require dense urban areas without debilitating epidemics wiping out productivity (and any other measure of well-being) in those urban areas.
Always how it shows up too: someone says "I've been camping and it was fine".
That's not what a lack of indoor plumbing is like though. In fact going camping when indoor plumbing exists isn't even the same: when it's a few enthusiasts digging holes sparsely is very different to when the entire population is doing it.
The first city to really hit this wall was London in 1858. When the river level dropped, the sewage in the Thames remained, resulting in "the great stink". Construction of a proper sewage system began the following year in 1859. In 1865 it was complete enough to begin operation. It wasn't considered complete until a decade later, in 1875.
The role of sewage in spreading cholera was first hypothesized in 1849 by John Snowe. He'd put together a pretty convincing case by 1854, and the actual bacteria was discovered in the same year. But the proof that finally convinced the medical establishment didn't come about until 1883.
If this makes you suspect that the medical establishment had their collective heads up their collective asses, I'm not about to disagree.
Reasoning is hard, and the medical establishment didn't consist of biologists, any more than the computer-programming establishment consists of computer scientists. It still doesn't today.
The main reasoning challenge here is that doctors are slow to accept evidence that what they've always done is not what they should do.
See the prolonged acceptance of bloodletting, resistance to handwashing, and on and on to the slow adoption in the present day of evidence based medicine.
I guess that's plausible, and I have occasionally observed doctors behaving that way, but I don't have enough evidence to independently confirm that it's especially common among doctors.
Also, I've seen people do amazingly dumb things because of disbelieving their doctors, so maybe a certain amount of overconfidence would be protective?
There is a lot of research in psychology on this. ChatGPT will happily refer you to various books written over the decades on how the strong hierarchical structure of medicine makes it particularly prone to cognitive dissonance, with lots of concrete examples of doctors behaving that way.
I asked GPT-5 Mini and it said, in part, "some studies find clinicians update more when evidence is clear and actionable (better calibration), others show clinicians exhibit the same biases as laypeople (e.g., positivity bias, anchoring). Results depend on task design, sample, and how “evidence” is presented. (...) Experimental psychology and related fields show measurable differences in how some doctors update beliefs—many update appropriately to clear, high‑quality evidence and some update better than average—but there is no simple universal claim that all doctors are more willing than the average person to change their minds. The evidence supports a nuanced conclusion: clinicians can be more evidence‑responsive in domain‑relevant tasks, but updating varies widely and is strongly shaped by task framing, institutional context, performance level, and incentives."
But that's because GPT-5 Mini's responses are strongly shaped by task framing and context. You can get it to say just about anything as long as you stay away from taboo areas.
It did refer me to a lot of books, and the ones I looked up did in fact actually exist, but none of them seemed to be relevant.
No worries. I was sort of poking fun at your bringing up ChatGPT as a source (especially in a discussion about epistemic hygiene), but I probably shouldn't have done that.
Yeah, "would you, personally, forgo this" is a very different value proposition vs. "would you delete this from civilization".
A single person might choose the internet over plumbing because at worst they have to compost and use an outhouse, which is less inconvenient than being locked out of most web services.
But while giving up the internet globally sends you to the 1980s, giving up plumbing globally sends you to the 1780s. YouTube and Amazon ain't worth chamberpots, dessicated skyscrapers, and regular cholera outbreaks that would reduce most cities into dysfunctional public health disasters.
As in "lacks running water," meaning you have to dispose of a building's worth of piss and shit at street level multiple times per day. And if it's a residential building, that means no water for bathing, cooking, drinking, etc. (You could ship in thousands of gallon jugs per day, but that's a logistical nightmare.)
Like a world without elevators, urban life without plumbing very quickly becomes unsustainable in buildings above a certain size.
The piss and shit problem is real, but not nearly as bad as you're imagining; I've written a bit based on my extensive shit-related experience and shit-related human history in https://news.ycombinator.com/item?id=45908441.
Burning Man recommends 6 liters of water per day per person for bathing, cooking, drinking, etc.: https://burningman.org/event/preparation/playa-living/water/ But that can generally be cut in half when you're anywhere other than one of the world's driest deserts in the middle of summer. This means you need to bring in your own weight in water roughly once a month; if there's no elevator, and you can safely lift 25% of your own weight, you can lug it up the stairs once a week. If there's an elevator, you can probably bring the water up the elevator every month or two.
About a third of that water has to eventually go back down in the form of piss, which is not a major problem if you have sealable plastic bottles to store it in. There's always the risk of an unpleasant accident with that approach, of course, but that's rare.
So I don't think there's ever a building size where a lack of indoor plumbing makes urban life unsustainable. If you're strong enough to walk up and down the stairs every day, you're strong enough to carry water up the stairs once a week. If there's an elevator that you can ride carrying two children, you can also ride it carrying water, once a month. Throughout history, and today in poor rural areas, most people have always had to carry their water much farther than that.
