Oh my god this card is amazing.
Whenever I draw this card I swear I can hear Samuel L. Jackson somewhere in the background saying "Motherfucker" with an approving tone.
The sheer amount of garbage that may pile up in any given scenario is crazy, literally like an ever growing headache. Alter Fate is the pill that makes the headache go away, or perhaps cures the cancer outright! In many scenarios this is the card you save Resourceful for in particular.
Admittedly, I don't think a solo player draws persistent gunk at a speed fast enough to warrant Alter Fate, it's a liability when you dont need it and your deck probably requires other, important, level upped mechanics. In two player or three player the amount of gunk goes up and the sheer usefulness of making the gunk go away is stupid good. I did a little check and every single scenario from the release up to the conclusion of Path to Carcosa and start of Forgotten age had at least a couple perfectly viable targets. Every scenario!
One of these days, if you haven't already, once you've slotted your first 8 XP worth of important XP upgrades, try spending you next 6 on a couple of these. They are great.
Edit, campaign evaluation:
Dunwich and Circle unbound in particular reward playing with Alter Fate.
Forgotten age it can be clutch, but there are less "GOTCHA!" persistent treacheries in this one.
Carcosa has a few good targets, but also an occasional dud scenario. Definitely lower priority due to the deckslot.