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self_made_human

amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi

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joined 2022 September 05 05:31:00 UTC

I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.

At any rate, I intend to live forever or die trying. See you at Heat Death!

Friends:

A friend to everyone is a friend to no one.


				
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self_made_human


								

								

								
								
									
								
								
								
								

								
							
					
 
				


				
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi

				
				
				

				

					16 followers  

					follows 0 users  

					joined 2022 September 05 05:31:00 UTC
				


				
					

					
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.


At any rate, I intend to live forever or die trying. See you at Heat Death!



				

				
					
Friends:

					
A friend to everyone is a friend to no one.


				

				

				

				

					

					

					
					
					

					
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				Small-Scale Question Sunday for May 17, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I have a very realistic looking houseplant. The fact that I haven't watered it since I moved in a year ago suggests that it's probably plastic. (Or that I've stumbled onto a hardy new species of Scottish cactus.)


Back home? A Labrador and a Golden. The former has two brain cells, both currently on lunch break. The latter is too smart for his own good. I adore them both, and I look forward to being settled enough to justify getting a dog here. I grew up with more dogs than I can count, which is unsurprising given that we also had more parrots than I could count, or that my grandfather once owned a tiger. (Yes, a tiger. A different time, a different country, very different ideas about what constitutes a reasonable household animal.) I think my kids should enjoy that same privilege, even if I've concluded that a single animal is perfectly adequate. This is probably the consequence of a serial injection of pragmatic genes into the family. The men in my ancestry tend toward pleasant eccentricity, the women toward laudable sanity. I'm not sure where I land.


My personal benchmark for canine intelligence is the ability to open doors. The Golden could do it from the moment he was tall enough to reach the handle on his hind legs. My Lab can't, and just stares at them mournfully until someone takes pity. An earlier German Shepherd managed it too, though less consistently than his mother. She was a rescue (so is the Golden), and she came into our house with a profound distrust of menfolk. It took over a year for her to accept that I wasn't going to hurt her, and then assent to scritches behind the ears. She'd graduated to begrudgingly accepting belly rubs a year or so before she passed. Her son, and every dog since, seems to gravitate toward me. Maybe it's because I'm unusually considerate of their needs, while my younger brother has been known to wield a chancla when they misbehave. My father is the living archetype of the "we are absolutely not getting more dogs" to "I cannot live without them" pipeline. My mother is usually the one who talks us into the original transgression.


Honestly, I'm glad that most of my dogs passed away suddenly, and painlessly. I support euthanasia in principle, but taking an animal I love to the vet with full knowledge that they aren't coming back with me would break parts of me I'd prefer to keep intact. Dogs live unfortunately short lives. Parrots live far too long.


Some say we don't deserve dogs. I find that farcical. They're one of humanity's greatest achievements: without anything resembling a modern understanding of genetics, we managed to turn a ravenous pack predator into a creature that will, more often than not, lay down its life for you. We made dogs. We deserve them. (If anything, the dogs got the better end of the bargain, though I doubt they'd phrase it that way.)


Cats? I don't mind them. I'm slightly fond of them. Some can be cute, and they seem to like me in particular because I don't go out of my way to fuss over them. I've irritated quite a few of my female cat-loving friends by being the lap of choice. While renting elsewhere, I once had a stake in a kitten who would always climb up into my bedsheets and snooze on my feet. I'd wake up every morning, and before I could panic-dress and run off to catch the bus, I had to make sure she was safely disentangled. I could have stepped on her without noticing, which is probably also why she enjoyed sleeping inside my shoes. I felt awful the one time I forgot to let her out of the bedroom, coming back from work to see her practically leap ten times her body length over my shoulder to escape. Oh well, at least she kept coming back. I wonder how she's doing these days. She was on the smaller side, and lived a semi-outdoor lifestyle in an area where cats go missing with distressing frequency. I hope she's fine, and that she has kittens who've found smaller shoes to fill.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


My own case for it, without reference to fiction and with reference to real science, would lead me to write a book about dynastic aristocracies with supermen who control technology instead of letting technology control them.




I wish to note that I put serious weight on an oligarchic future where a few elites control AGI, and thus the rest of us. I am far more skeptical of genetic engineering being the primary driver behind the creation of a permanent underclass, for the same reason that cars went from being something that were the playthings of the rich to available to most. Everything I've described has gotten cheaper over time, often drastically so.




We spend way too much on healthcare and it really doesn't improve human happiness much. These medicines have pros and cons. You seem to fixate on the pros without acknowledging any cons. Why is that?




This is more reflective of your unfamiliarity with me. I mean that without insult. I've written on exactly that topic at length, multiple times, over years. I have very long effort-posts on the importance of using metrics like QALY/DALY and cost-benefit/cost-utility when it comes to dictating policy on medical care. If that weren't true, that would be a fair critique, but this is one of the rare occasions where I genuinely can't afford to be as thorough as I'd desire. I am not writing a policy white paper, I am crunched for time because of exams, and in all honesty, I shouldn't even be here in the first place. I have not pretended to have done a comprehensive cost-benefit analysis here, but I have linked to the work of people who have.


But considering my own output:


https://www.themotte.org/post/2899/culture-war-roundup-for-the-week/359026?context=8#context




I'll run the numbers on grandma, even if I already know the answer. A $300,000 treatment (roughly £240,000) for a 60% chance at two months (0.16 years) of very low-quality life (let's generously say 0.2 QALYs) results in a cost per QALY that is astronomically high. The answer from the system is a clear, predictable no. Conversely, a treatment with the same price tag for a teenager that offers a high chance of fifty more years of healthy life would be approved without a second thought. The system is explicitly utilitarian. It prioritizes maximizing the total amount of healthy life across the population. It can and will spend millions on a child, but it will counsel a family against a futile and painful intervention for a demented octogenarian. This isn't some big secret either. I have had such discussions with dozens of families, and not a single one has had a problem with it, or withdrawn their relative to go elsewhere, as they are at full liberty to do.






For those who find this calculus unsettling (I do not know why the standard approach to handling scarce resources unsettles anyone) the system provides an escape hatch. The existence of the NHS does not preclude private medicine. The wealthy, or anyone with good private insurance, can opt out of the public queue and pay for the treatment the state has denied. You can, in effect, disagree with the state’s valuation of a life year and substitute your own. The state provides a robust, free baseline for ninety-nine percent of situations, while allowing a private market for those who want more. A similar model exists in India, a country with far fewer resources than the United States (citation available on request) which manages to provide basic care for free while supporting a thriving private sector.




In other words, I am the last person who you should accuse of not considering the diminishing returns to further healthcare expenditure. Also, note that diminishing returns are not the same thing as no returns, let alone negative returns. If you have a billion dollars and want to spend all of it on care that has a negligible chance of healing you, be my guest. I'm more concerned with public policy and public funds.


I am also a transhumanist, so I want medical technology to get even cheaper (which it mostly has), alongside society getting wealthier. The expected result is that we end up with cheaper, better treatments, and can provide them to more people. Be it privately or through public funding.




Anyway, IVF is extremely expensive and basically works to perpetuate people who barely want to reproduce. That attitude correlates positively with other negative behaviors that punish those around them as well. The babies it makes are sicker on average. Why should we have more sick people who hate family life at such a high cost? Who does that benefit? I'm not seeing it pass the pros and cons audit.




There is very, very good reason that I advocated for embryo selection above and beyond subsidized IVF. Consider that that cuts down the majority of your arguments at the knee. The "sicker IVF babies" finding is largely driven by maternal age, multiple-embryo transfers (now declining as standard practice), and underlying parental subfertility rather than the IVF procedure itself. You can't accuse me of not acknowledging that, when I have already offered a solution.


I also do not particularly care about whether people "barely want to reproduce", as long as the answer is more yes than it is no. I'm not a gynaecologist, but in general, if someone tells me that they want children, I support them. Even if it would be easy to scold them for being irrational or indecisive and making things harder for themselves. In psychiatry, it's all too common for depressed people to not want to be helped, because depression strongly correlates with reduced self-esteem and a sense of being unworthy of care. Many people show up in front of me who just care enough to get out of bed and see a psychiatrist. I treat them nonetheless, and I am happy doing so.


The IVF population is overwhelmingly composed of couples who want children intensely (often more than the median fertile couple) and whose biology has betrayed them, and that conflating them with "people who barely want to reproduce" is incorrect.


Humans are fallible, non-omniscient and imperfectly rational actors, and society should make some concession to those unfortunate facts.


If you disagree with this on moral grounds, be my guest. I am on Scott's side, in the sense that Society is fixed, Biology is mutable.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


Have you read Dune? It makes a compelling case that's the opposite of true.




The Logical Fallacy of Generalization from Fictional Evidence


You know what, maybe we shouldn't have invented treatments for malaria, chemotherapy for aggressive cancers, ozempic for the obesity epidemic. Maybe reducing infant-and-child mortality rates from the ~50% they hovered around for most of human history to the rounding error they are today was deeply misguided. Maybe doctors should all retire en masse and society should return to the state of nature, however we're defining that this Sunday.


If you disagree, then I think the arguments for trying to fix demographic collapse write themselves. If you don't, then we're not going to get anywhere.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


Guys, have you ever spoken to any women about how many kids they want to have, if they want to have kids, and why don't they want ten kids like their grandmothers' generation?




Why yes, I've had this conversation with my serious partners. The answer ranged between 0 and 3, with the modal value being 2.




Would you undergo circumcision for any money if it was a repeated operation?




Any money? Like, how much money we talking about here? I'd do it for $250k, maybe even $100k. Hell, if they were pretty reasonable and made sure I was well anesthesized, I'd do for it much less. Presuming the foreskin grew back, and this isn't just the equivalent of removing my dick with a cheese grater. I would charge at least a few hundred million dollars for that.


Sadly this must remain a hypothetical, since I was circumcised for medical reasons, and I didn't even get paid for it.


The biggest problem with the rest of your arguments is that they're emotive/rhetorical, not numerate or quantitative.




Men will leave because "you pay more attention to the kids than me".




How many men? How often? Ballpark figures, even? Because lurid anecdotes are not a good argument.


At the end of the day, I'm a weak policy pro-natalist. I do not make it a general point of going around ordering women to have kids. I think the government should encourage people to have more kids, for a form of encouragement that is closer to an anti-smoking campaign than it is to a breeding camp. Personally? I simply wouldn't marry a lady who didn't want to have kids, and I am perfectly willing to make the sacrifices necessary to support them. No hypocrisy here.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Friday Fun Thread for May 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
British psychiatry trainees like me almost universally rely on a paid resource and question bank called SPMM for our written exams. It's very expensive for the entry level package, doubly so if you want their paid mocks, triply if you want a statistics crash course.


Why? Because the nominal syllabus is... everything. Or at least so large that it's completely impractical for even the best trainee to read the official reading list/syllabus and then understand whats relevant to the test. We have to rely on SPMM (or lesser known alternatives) to make things manageable.


You would think that the dedicated teaching we get during our training itself, or the Royal College's free online material would help right? Oh no, that's unwarranted optimism. Like it or not, you need SPMM.




Who is writing these questions and who is grading the responses?




SPMM claims to have unusual, perhaps questionably legal levels of insight into the actual questions that come on the exam (they probably ask the people who just gave it to jot down as much as they can from memory). That's alongside their doctors hand-crafting what they imagine are representative questions to pad things out. What kind of doctors? From what I can tell, ones just a few years senior to me. Which is not necessarily a bad thing, since they would have given the same exams recently.


I presume the same people choose the correct answer for the questions they wrote, and then the answer stem too. But once that's set in stone, the grading is automated. I can't even flag things to the attention of a human within the company. They don't care.




Assuming your situation is similar, it wouldn't surprise me if the mocks are being graded by non-practicing doctors who may not be doing the best job, especially, if like me, you went with a less expensive option than the industry standard.




Are they non-practicing? I hope not. They're probably just cash-strapped and asked to shit out a ton of output for not very much money. QC seems inadequate. Even their teaching material is riddled with errors. And this is the best money can buy!


I passed my earlier exam with a different version of the paid material, and I can tell you that the overall quality of things was grossly superior. This time, they're borderline scamming me. By the time I realized, it's too late to simply give up and read the primary sources, or even to switch to a competitor. Literally every other resident I know is in the same boat, and it's rapidly sinking.


The good news is that the actual exam, or at least the last one I gave, was mostly sane. Mostly. There was a question about the mechanism of action of a new antidepressant, where the real answer was "nobody knows", but I had to choose something else anyway. Praying that's the case here, but bad study material and bad mocks are driving me nuts.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I've had the displeasure of seeing that Reddit thread. The takes in it are so bad that they're known to the state of California to cause cancer.


Fortunate, the people chimping out in public are not the same people who make mods. I don't know about the VIC 3 modding community, but the CE discord is chill. My mod didn't get much backlash while published, and there are plenty of mostly AI made mods that do way more in terms of mechanics of depth, all without popular outcry. The people on the subreddit can cry away, they have no real power over things.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Friday Fun Thread for May 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
From a psychiatric perspective, I must discourage self-harm and adjacent practices.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I wish to note that my proposal is not mutually exclusive with anything you've said.


What differentiates $10k for egg-harvesting from a direct reward for natality?


    

  1. It particularly helps the middle class and UMC, who are the most likely to postpone fertility till it falls off a cliff.
    2. 

  2. You get the eggs in hand, and the demographic that is most likely to experience severe hindsight regret gets optionality later.
    3. 

  3. An actual child is much more inconvenient to produce. My recollection is there's strong empirical evidence that comparable cash awards for actual child birth have barely done anything at all, though I don't have the time to go digging right now. Exams.
    4. 



So the real target for my proposal are people who want kids, but have a tendency to postpone things till it's way too late. At that point, having eggs preserved (preferably from way earlier) would be an absolute godsend. To contrast, if they wanted to get the $10k for the child then, it's far more likely that it's too late. That's true regardless of how badly they want the kids.


The benefit of the wider embryo-selection policy is that avoids or minimizes dysgenic effects. Even if $10k means a lot more to the poor, you can still screen and select for the higher quality potential children. Conveniently, the same markers that promise general good health also correlate positively with IQ. Follow the LW link for a better exploration of that point. You don't even need to do the politically difficult thing of actively selecting for IQ, you can just say you want healthier kids (by pretty standard definitions of health) and get IQ points as a happy little accident.


And even if there's no embryo selection? Well, at least we have good eggs for the IVF. That should make a difference. There's plenty of other things you could reasonably try, but I'm not writing a policy whitepaper here.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


How many times has one particular poster here been accused of using AI, denying it, and then sheepishly admitting that he "polished" it with AI?




On the off-chance that you're referring to me, I'd appreciate evidence that I've ever denied using AI when asked (when I've actually used it, which isn't most of the time).  Au contraire, I make it a point to admit that I have, if asked, including being painfully specific with proof-of-work when I have it.


Here is a specific example:


https://www.themotte.org/post/3690/culture-war-roundup-for-the-week/434542?context=8#context


I can't think of who else you might be referring to, barring perhaps our dear friend @BurdensomeCount, and even he had the grace to admit to it when specifically challenged. By me. With my mod hat on. I suppose we have had our share of bad-actors who try to get away with AI spam, but that's the kind of thing that gets caught by the moderation filter or explicitly warned/banned.


If you mean someone else entirely, then please disregard, though preferably not before you clarify things.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


Suppose you made IVF 100% subsidized and free, you still have to convince young women to undergo an invasive surgical procedure.




Young women, the demographic known to be particularly fond of cosmetic surgery? Hmm..


The easiest answer is to bribe pay them. I expect plenty of takers if it's a $10k one-off, with heavy government encouragement.


As far as I can tell, my proposal involves less demanding all-encompassing public propaganda or government intervention than any alternative I can name. Is it a perfect solution? Of course not, but praying away cratering TFRs might be cheap and also wouldn't work.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Friday Fun Thread for May 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
"Patient displays dimished insight into condition"


(That's a joke)


I would bet good money on you having Aspergers (or high functioning ASD, as we'd call it these days). This is mostly a gestalt clinical impression on the basis of significant familiarity/fond perplexity. It's not a formal diagnosis. I haven't had the pleasure of meeting you (I am sadly not invited to the party), which is the bare minimum for a formal diagnosis. Or actually, below the bare minimum, because the GMC would disbar me if that was my standard practice.


Man... Where would I even begin to answer that question? That's a serious statement.


A written house warming invite is perfectly fine. The specific format and terminology you've used is... unusual. Please note that I'm not assigning any negative connotations here at all. Never have. It's friendly riffing on the internet with a kernel of truth in it. It is abundantly clear that you are high-functioning and a productive member of society, even after retirement. You should probably get that depression properly checked out, if you haven't already. You clearly know where to find a PHQ-9 form.




Come on, you're exaggerating here.




To be clear, I don't think any degree of autism, by itself, can get a human being ITAR restricted. Nor do I actually believe you can manage to build a space elevator, at least not with a reasonable budget. Megastructural engineering is probably not your area of expertise as a civil engineer, but then again, you probably know the specs of elevator-planning, and what is a space elevator but a very, very tall elevator?


Okay. I'm burnt out on exam prep right now, so I will take a half-hearted crack at identifying supportive elements from the textual evidence provided:


The autism is that your housewarming invitation opens like a government form, proceeds by FAQ, and invokes 2024 International Fire Code 1004.5 to explain why invitees may bring one pet but no household members. You cite the occupant load factor for "assembly without fixed seats, unconcentrated (tables and chairs)," derives a 14-person cap, concedes the IFC isn't actually applicable to private residences, and then independently re-derives the same number from your floor plan geometry. Three justifications, in order, for the guest cap on a sixteen-person gathering.


A five-level wellness rubric with columns for Willpower, 24/7 headache, Enjoyment of life, and Rough time period, with your current 2-to-3-out-of-5 rating disclosed in a public appendix circulating to your former colleagues and your brother. I am genuinely glad you are not still at 1/5. Late 2025 sounds rough. Your coworkers from the retirement job, though, probably did not show up looking for a quarterly state-of-the-soul report. I mean, I can't rule that out either, maybe all civil engineers are like this?


Capitalized WILL in "Entry WILL be refused to anything beyond that," where "anything" rather than "anyone" is appropriate because pets are grammatically inanimate. The same all-caps treatment on "My plan for the future is to RELAX." Consistent signature style throughout. Your mother parenthetically identified as "the renter of a bedroom in the house" rather than as your mother, because... I genuinely don't know. I am the wrong flavor of neurodiverse for that.


I must reiterate: no negative connotation. I'm saying this with sincere affection and anthropological awe. You are clearly high-functioning, productive, technically competent, conscientious, and capable of producing documents that make normal people look like chimps poking at drywall with a stick. When you ask "what exactly about this is autistic?", you so while standing inside a two-page exhibit titled Invitation to Housewarming Party with appendices A through D.


People like you are probably responsible for 90% of human civilization, especially the boring but important bits. That's also my approximate level of confidence in the autism diagnosis.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I'm not going to get into the whole cultural debate around declining TFR or putative causes. I am painfully pragmatic, and what I intend to demonstrate is that there is a technological solution to the problem (the best kind of solution, mwah):


A country as wealthy as Sweden can circumvent the dysgenic concerns raised by @sleepyegg through embryo selection. The primary costs are the IVF itself, which should be in the realm of affordability for the middle class and above (who suffer disproportionately from reduced TFR). If not, I think any sane government should be willing to spend enormous sums of money to prevent population collapse.


You can screen for a lot of things, including strong proxies for health/mutational load. The screening itself is a trivial fraction of the cost compared to the egg extraction, freezing and IVF, and as mentioned it's the IVF that's the costly part.


Further, implantation success rates are remarkably stable even for older women. It's the age of the ova itself that matters, someone using eggs they harvested at 25 when they're in their late 30s is way more likely to succeed (for a given number of cycles) than that person using recently harvested eggs.


In other words, the uterus can handle things just fine for a very long time. The eggs continue to degrade the longer they stay in the ovary.  You're already born with all the eggs you'll ever have if you're a woman, or as man, though that depends on when you last went to the supermarket. The success rate for implantation or the dysgenic effects of mutational load on the viability or overall health of the eggs/children increase precipitously once you're in your 30s. It's no coincidence that the risk of Down syndrome shoots up with increasing maternal age around that time.


The problem is, of course, that few governments have crossed the minimum sanity threshold to do these things. The fruit couldn't hang much lower without already being in the dirt.


Recommended reading:


https://www.lesswrong.com/posts/dxffBxGqt2eidxwRR/the-optimal-age-to-freeze-eggs-is-19


As a matter of fact, I would strongly recommend everything GeneSmith has ever written on the topic. I'd trust him to smith my genes, or those of my children.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Friday Fun Thread for May 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
https://open.substack.com/pub/rawandferal/p/norman-polycule?r=a71by


Funniest thing I've seen all year. That's my honest assessment, I was there from the start, before it was officially disclosed as satire (that was obvious to me, but apparently not to millions of people).


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Friday Fun Thread for May 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Such a shame. I wish I had an invite, but if you thought trying to attend Inkhaven was hard, imagine me trying to explain to the American embassy staff that I want to attend the house warming party of an online acquaintance with weapons-grade autism.


I dare say that your autism is so strong it would be ITAR-restricted. Imagine if you resettled in China: they'd have a working space elevator in two weeks, built to code handed down retrocausally by the Singleton at the end of time.


I don't even know man. I think that there's only like a 5% chance that this is satire only matched by that fake Bay Area polycule invite from a month back. The rest of my probability mass is mostly on you playing this straight, with perhaps some degree of self-awareness/attempted humor (which works).


Please share the final form when you're done. I might do a case study on it, or at least a funny essay. And good luck with the actual housewarming, even if it involves inviting your uncool brother.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


since they need to be great at them to get anywhere inside India, and if I were in their position I'd 100% do the same thing




This is incorrect, I'm afraid. You can't use that kind of identity politics to get ahead the way you can in the States. When do you get the tangible benefits in the form of reservations and quotas for being lower caste? When you have a certificate from the government that says your ancestors were lower caste.


Can you get a fake one? Technically yes, but you'd be spending a lot of money on bribes, and you'd be rather screwed if you were caught. I don't know anyone who did this, though I'm sure it does happen (as I always say, India is a big country, with many Indians).


No, the sad reality of it is that the kind of person you spoke to learned to play that game in the States, or were intelligent and unprincipled enough to be well prepared before they got there.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for May 13, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


    

  • In psychiatry most problems are fixed by an SSRI or an antipsychotic - who cares if they have schizophrenia, schizoaffective, or bipolar disorder if the solution is the same.
    • 





You're giving me exam PTSD, and I haven't even given the exam. SSRIs are not just what you'd rely on for BPAD, there's a ton of context for when they're actively harmful, or when you need antipsychotics and mood stabilizers. Good to know that the exam prep prepares me for discussions on this underwater basket weaving forum.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for May 13, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Thanks for showing up. I suppose you can still sympathize with an early-career sod like me, and I'm grateful for that. Now all we need is @reo for the senior psychiatrist take. Don't let the team down dawg!


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Wellness Wednesday for May 13, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Thank you for advice, I do appreciate it. But I will say that my Motte use is a hobby and, in a very real sense, a coping mechanism.


Let's say I've had a really, really bad time before my exams. I've been taking more stimulants than I can tolerate. They're wearing off, and my focus is gone. Or I'm waiting for the next dose to kick back in. This is dead time. I can't study. Instead, I could be using Twitter or Discord. I'd rather be here. I get to talk about interesting things with interesting people. I write about what's going on, which is in part a letter to ny future self. I hope that pain and suffering converts to some degree of amusement for my readers, someone ought to be laughing after all.


And guess what? Half of what I write about is psychiatry. I love psychiatry. I just don't like the way it's taught or trained in the UK. This gives me a small fig leaf. I can pretend that I'm being semi-productive. Maybe some if it is genuinely productive


But without truly draconian steps, being on the Motte is good for me. It's where the people cheering me on live.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
A slight tangent. About a year back, I made a Rimworld mod. Minuscule in scope: a handful of infantry-grade railguns, designed to work exclusively with Combat Extended, a popular and (depending on who you ask) deeply contentious mod.


CE is something I refuse to play without. It transforms vanilla Rimworld's ranged combat from "two blind, drunk, concussed gangbangers shooting airsoft pistols at each other" into something resembling tactical depth and realism. Every self-respecting gun nut has it installed.


(Sorry Zorba. Rimworld combat is dogshit. I've been on CE since at least Alpha 14.)


The trouble with adding weapons is that they require art. Sprites, at the bare minimum. I am not an artist. For years, going back to early Stable Diffusion, I had been trying to coax AI image generators into producing decent guns in the Rimworld style, with results ranging from "comically bad" to "merely embarrassing". I gave up several times. That changed with GPT Image 1 and Nano Banana, which, after a fair bit of prompting and selection, finally produced passable output.


I should specify that the vanilla artwork for Rimworld is also awful. Nobody plays it for the graphics. The guns are particularly egregious; they look like plastic goop, especially if you use mods that let you zoom the camera in. Most self-respecting modders make their art to substantially higher standards, even if the game itself doesn't reward photorealism.


(Sorry again Zorba, but it's true.)


What I ended up with was decent. Probably well above the average amateur human artist-modder, though not as good as the best.


I also tried to get the AI of the day to write the code for me. This did not go well. Rimworld code is niche, Combat Extended code is niche-squared, and the available models simply weren't up to the task. It also might have been a skill issue on my end.


In the end, I wrote the code myself, asking for guidance on the Discord and lifting scaffolding from open-source and permissively licensed mods. The result wasn't perfect, but it worked.


Then came the part I was actually dreading. I posted the finished product, AI-generated art included, for feedback. I expected a shitstorm and I got one, though smaller than feared, and largely confined to one reasonably famous modder. He is best known (or most notorious) for using what can be charitably described as fetish art for the thumbnails of his mods, regardless of their actual content. To my pleasant surprise, the majority of the other modders were either neutral or supportive (one of them, I believe, lurks here, hi). I told him to get bent and stick to the fetish art. I explained that I was making free content, in my spare time, and that his gatekeeping was somewhere between unwarranted and retarded. I even said that I fully expect my own profession, the one that pays the bills, to get automated eventually. I can't stop that. I'm just enjoying the newfound ability to work around my utter lack of talent at the visual arts. The reception of this position was, again, better than I had any right to expect. Most Rimworld modders work for free, and they understand that even a small mod represents real opportunity cost.


The mod went up. It was unabashedly niche, but over a hundred people downloaded it and a dozen favorited it.


That was almost a year ago. Recently, bored, I considered making a better version with the new tools at my disposal. In hindsight, I should have used my Claude Max plan for the code, but I now know enough to bumble through. I made new art assets and posted them for feedback. Enough time had passed that most people had forgotten the original controversy and were appreciative. Then, on cue, that same jerk-off showed up, and we had our usual sparring match. I was expecting it. What I wasn't expecting was that, even after the AI-generated nature of the new assets was disclosed, the majority continued being supportive.


That included some seriously talented modders, ones known for producing high quality art. It warms the cockles of my heart to see people being reasonable, or at least on my side. Their verdict was that the art was now better than average, up to the standards of the best human work being done in Rimworld. The guns even made sense from a design/realism standpoint, GPT-Image 2 in particular is remarkably intelligent, and it knows what distinguishes a near future but plausible railgun from a standard firearm in Hollywood furniture. Prompting it is a piece of cake.


I'll probably get to a proper version after my exam. The interesting thing is the trajectory: making the art itself went from impossible, to a PITA, to nearly trivial. Maybe I'll tackle something more ambitious. I have thoughts about Rimworld's medical system and its approach to mental health and psychology. I've helped on a mod that fixes some of the issues, though my role there is best described as "local doctor you can ping for advice on trauma medicine". I've done freelance consulting on much larger projects, including some tactical shooters. A few systems in Gray Zone Warfare (a Tarkov competitor) made it in on my recommendation. Good times.


The best part of the anti-AI controversy is how easy it is to ignore the detractors, particularly when you aren't trying to make money off any of this. All I want is the opportunity to make cool things, for my own enjoyment and that of others. If someone isn't cool with that, that is their problem.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
You made specific factual claims about my views and motivations across four replies now. You have produced no quotes from me supporting any of them. The syllogism you've finally offered, even if it worked, would not establish that I "see caste as natural and correct," that my emigration is "opportunistic," or that I'm "chasing status among peers back home." Those were the accusations. They remain unsubstantiated.


Even granting some form of statistical discrimination as efficient on some specific measure, a caste system is not just any discrimination.


Why? Because it's hereditary, hierarchical, totalizing across social, economic, marital, and religious domains, and self-perpetuating across generations independent of individual merit. That is literally what caste means.


You're skipped roughly the entire content of what makes a caste system a caste system, and now you're calling the missing steps "from first principles." Perhaps you'd like to examine my debate with @2rafa where I advocate for meritocracy as pure as can be feasible? I'd like to see you reconcile that with accusations of casteism. Group differences, even if real, require additional values being injected to decide what to do about them. Balanced standardized testing would be the strongest form of Bayesian evidence against any accusations of inferiority wrt background. I'm all for it.


"Correct" not being normative? Pure sophistry, poor sophistry. Calling a social arrangement "correct" is necessarily a judgment that it is a proper way to organize society. There is no descriptive sense in which a social system itself can be "correct" or "incorrect." You can describe whether it exists, whether it produces certain outcomes, whether participants endorse it. The moment you call the system itself "correct," you have endorsed it as proper. And worse? This isn't just something you're doing yourself, it's something you've accused me of doing.


I'm out. I've asked for receipts multiple times. You've produced none, and have instead built impressively rickety scaffolding around the original claims while refusing to retract a word of them. Anyone reading this thread can decide for themselves what that pattern indicates. I have an exam to study for.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Friday Fun Thread for May 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
This is probably my last opportunity to waste time complaining about the upcoming exam, and the study material for it in particular.


The second last mock (150 questions, 3 hour timer) I did? Oh fucking hell man. I don't deserve this. Let me illustrate.


[RCT trial findings for agomelatine vs placebo, including a forest plot]


My answer was marked wrong, despite the fact that I was extremely confident in it. I was nonplussed by the claimed "correct" answer. I took it to ChatGPT with a screenshot.




How am I reasonably expected to tackle this one?








You are not reasonably expected to get this from the marked answer, because the marked answer is almost certainly wrong.






Exhibit 2:


A survival chart/graph comparing different doses of disulfiram vs placebo against cumulative probability of remaining abstinent from alcohol.


(It didn't look good for the disulfiram)


My answer was marked incorrect. Why?




They refer to information provided in the text to support their answer. What fucking text???








Yeah, that line is bad. In the screenshot, there is no supporting text except the graph and the answer options.






Final exhibit:


Some bullshit summary of qualitative research on the challenges of handling dementia patients overnight at a care home.




Where can I get myself some risperidone? Unrelated, what about this one?




(The request for an antipsychotic wasn't unrelated, dear reader)






Risperidone: from a lawful prescriber, ideally not as prophylaxis against SPMM-induced psychosis.
On the actual question: your answer is very defensible.
The stem literally begins:




“To explore the current practices and challenges in night-time care for people with dementia living in care homes…”
Your selected answer:
“To clarify the challenges that exist for night-time care of people with dementia living in care homes”
is basically a paraphrase of that.








I started losing it.




Right. This mock has left me mildly homicidal. To amuse me, please evaluate what proportion of the questions I've shared for review are sane, dubious, or written by someone who should be an in-patient in a psych ward.








Sane /exam-legitimate: 7 questions
Dubious/badly-worded: 5
Containment level broken: 4










So the mock’s sanity index is about:
44% sane, 31% dodgy, 25% cursed.






What do I even say? What do I even do? ChatGPT gently dissuaded me from actually killing anyone, and even filing a GDPR request so I could track down whoever wrote this paper and egg their house. All I can do is come here and vent about it.




Bonus question, copied verbatim:




Mrs. Patterson is a 66-year-old woman who has presented with evidence of dementia. She has a personal history of severe migraine and a strong family history of stroke and early onset dementia. Which of the following is the most likely diagnosis? Mrs. Patterson is a 66-year-old woman who has presented with evidence of dementia. She has a personal history of severe migraine and a strong family history of stroke and early onset dementia. Which of the following is the most likely diagnosis? Mrs. Patterson is a 66-year-old woman who has presented with evidence of dementia. She has a personal history of severe migraine and a strong family history of stroke and early onset dementia. Which of the following is the most likely diagnosis?




Unfortunately, diagnosing the exam writer with dementia was not included in the list of options. Shame.




Anyway. Enough kvetching. Back on the grind. An estimated 75% chance of passing, which I'm going to take with gratitude.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Friday Fun Thread for May 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Getting it to hold my hand while I try not to have a nervous breakdown. Exam pressure is bad enough, trying to parse which of the "correct" answers on my mocks make actual sense and which ones are subtly or not so carefully wrong, in a manner designed to make me walk off a bridge? I'd be rather screwed if I couldn't use AI to double-check my suspicions.


To my pleasant surprise, OpenAI has managed to inject some degree of personality into 5.5. It's dry and pedantic, but not as dry or pedantic as the versions that came before. I use it for this because it's more scrupulous than Claude, which doesn't follow instructions as carefully.


Other than that? I've offloaded most of my executive function to it for the rest of the week. I didn't book hotels or trains without running everything by multiple models. God knows that when I'm exhausted, depressed and flagging hard, I wouldn't trust myself to make those decisions without an unacceptable risk of fucking something up.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
You've offered three rationales for the original accusations in three consecutive replies. First they stood on their own. When I asked for evidence, none came. Then it became "some readers might come away with that impression," which is the motte-and-bailey I already called you on. Now: if I agree to a proposition you've just invented, the accusations were "far from baseless."


This is what bad faith looks like when it's trying oh-so-hard to stay within the realm of what won't be moderated on this forum. Impressive work, law school must have helped.


Pick a position. Defend it properly. Or retract. Don't waste my time by manufacturing new justifications until one of them sticks.


The "demographic factors determine individual outcomes" question is empirical, and the real answer is "it depends." For caste-correlated outcomes in India specifically, I think genetics likely plays some role. I said so openly upthread. That is a descriptive claim about how the world is. Endorsing caste as "natural" and "correct" is a prescriptive claim about how the world should be. These are not the same thing and you're not getting away with laundering one into the other through sleight of hand.


You now want credit for "very purposefully side stepping" whether caste is good, in order to focus on whether it's "correct" or "natural." Please examine what you've just said. "Correct" is straightforwardly normative. "Natural," deployed in defense of a social arrangement under attack, is also normative. You picked loaded words, fired them at me, and are now claiming a neutral reading was always available. Nope.


You're claiming I implied "the US also has a caste system." That paragraph is about American pre-med admissions and the difference between rank-ordered exam grinds and "holistic" admissions weighted with extracurriculars. The "it" in "more legible and crueler about it" refers to the selection function of education, which I had just spent several thousand words describing. Reading "caste" into a sentence about MCAT prep is a failure of your reading comprehension. It does even worse as an argument.




bigotry of low expectations




You found a phrase that sounded adjacent to something you wanted to say, linked it without explanation, and are now reverse-engineering a rationale rather than concede the link wasn't doing what you needed it to.


Yeah. Right. Being against Indian affirmative action or the US focus on "holistic" admission criteria is "the soft bigotry of low expectations". Sorry, I'd say it's the opposite. Eschewing explicit AA or  putting primacy on standardized testing, without lowering the bar for certain demographics? That is called having the same expectations of everyone. Words have meanings, whether you like them or not.


Now, I specify (with rapidly diminishing patience): you made specific claims about my views and my motivations. That I see caste as "natural" and "correct." That my emigration is opportunistic. That I am chasing status among peers back home. Three replies in, you have produced zero quotes from me supporting any of these and have shifted the goalposts twice without retracting an inch. Substantiate the claims with what I actually wrote, or withdraw them. I am not here to argue whichever question you'd prefer to be answering instead.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
That is an utter non-apology after serious, unfounded accusations.


"It was not my intention to offend you, and if did i apologize." Your intent is not my primary concern. The factuality (or lack thereof) of what you said about me is. An acknowledgement that your accusations are baseless would be an improvement. If you wish to persist in that mischaracterization, then provide evidence in proportion to how inflammatory it is. In this case, a simple search on the index for this site should suffice.


I am not sure what linking to an ancient press release from GW Bush is supposed to help with. It's a 2006 address about Republican outreach to African American voters, the Voting Rights Act, HBCU funding, and the legacy of slavery. It does not mention Indian immigrants, the caste system, or any framework for distinguishing "good" from "opportunistic" immigrants.


It certainly doesn't help with misrepresenting me as having made claims I have literally never made, and then not walking them back.


Look around, my man. Do you see any of the other Americans in this forum full of Americans accusing me of endorsing the Indian caste system? No? Not surprising at all.


You have the gall to make a clear Motte-and-Bailey argument on the Motte?  You didn't "intend" to be offensive, but 'oh, some readers might come away with that impression'. I wasn't born yesterday.


				

				

						

							

								
							

						


						
					

				
			


			
			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of May 11, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


The first sort is people like yourself and certain other users here who see the caste system as simply "natural" and "correct". (Note that I am purposefully side-stepping the question of whether it is "good"). Thier reasons for leaving the subcontinent and coming to the West are ultimately opportunitistic, they're chasing a better job or a better school that they can leverage to raise thier status amongst thier peers back home.




To be very brief: the fuck?


No, seriously, I invite you to find any evidence of me arguing that the caste system is "natural" and "correct". Please. Take all the time you need.


I am incredibly impressed by the sheer chutzpah on display here. Apparently I've moved to the UK, and want to move to the States to "raise thier status amongst thier peers back home"? That's news to me. I should take notes.


Anyone who knows me would find your accusations laughable. Anyone who doesn't know me should at least check before saying something this remarkably, fractally incorrect.




The second sort are the ones who leave the subcontinent explicitly to escape the system.




It's astounding that you can read that whole-ass essay and decide that this isn't a working description of me. I really want to know the chain of logic that lead you to that conclusion.


To be painfully specific:


    

  1. I don't know how anyone can say I'm not remarkably Westernized for an Indian, even before leaving the country. I mostly prefer Western culture over my native one, even if I say that both have their strengths and weaknesses.
    2. 

  2. I do not endorse the caste system. In fact, I'm not even upper-caste. I'm one step away from the threshold where I would have been so lower-caste that I'd qualify for strong affirmative action.
    3. 

  3. I think that it is quite plausible that there do exist significant differences between castes, possible due to genetic factors, with measurable differences in outcome even after affirmative action. This is not self-aggrandizement, because I am not upper caste. Whatever genetic factors are at play do not apply to me, because my ancestors were rural peasants or minor bureaucrats.
    4. 

  4. My primary dissatisfaction with the caste system in India is because of the ridiculous levels of affirmative action, which amounts to discrimination against me. I know doctors with worse grades who got into better med schools because of their caste, while the reality of it was they were as wealthy as I was. I get none of the putative benefits of being upper caste, nor the far more tangible benefits of being lower caste.
    5. 

  5. I am remarkably caste blind, and cannot recall a single instance of discriminating against anyone on the basis of caste in India, let alone the West.
    6. 



It would be too much to hope for an apology from you, so I'll settle for receipts.