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Culture War Roundup for the week of November 14, 2022

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Scott has a piece up on SBF's drug use. Unsurprisingly, the writing is clear and informative. It's Scott doing Scott things - go read it!

That said, I can barely get through it. This latest bout of examining SBF and his crew just fills me with a sense of absolute disgust and contempt. I rarely feel what people are talking about when they see some public figure do something they don't like and refer to it as "gross", but this has to be what that sensation is. We're talking about a guy that essentially committed fraud to collect billions of dollars, funneled tons of money to preferred political causes, played dress-up as being highly altruistic, and still might well get away with the whole thing. But none of that really triggered the disgust reaction, all of that just seems like the sort of thing that I predict the scions of Harvard finance law professors get up to - scamming money in maybe-legal fashion just seems incredibly on brand for such families, even if the specifics of effective altruism spice the story up.

Against the odds of anything that I would have thought years ago, the part I'm disgusted by is the drug use and treating it as just a bit of biochemical calculus to work out whether it's a good idea. I cannot even begin to relate to the idea of thinking about things like this:

Milky Eggs reports a claim by an employee that Sam was on “a patch for designer stimulants that mainlined them into his blood to give him a constant buzz at all times”. This is a hyperbolic description of Emsam, a patch form of the antidepressant/antiparkinsonian agent selegiline.

...

Everyone wants “magic bullets” - drugs that can increase dopamine in one of these ways, but not any of the others. Treat attention problems without causing hallucinations. Cure tremors without causing hypersexuality. But it’s tough. There are dozens of dopamine-based drugs, and all of them succeed in some ways and fail in others. Adderall mostly helps attention but sometimes causes a little paranoia on the side. Antipsychotics mostly prevent hallucinations and delusions, but also cause anhedonia. If a good doctor carefully chooses the right drug and dose, you’ll mostly get what you want. Otherwise, choose 2d4 random side effects from the appropriate side of the table.

Using things like this when you don't actually have anything wrong with you, when you just wish your mind worked differently viscerally disgusts me. I'm not exactly a Mormon over here - I start the day with coffee and often finish it with whiskey. I don't care if people smoke weed or even have the occasional bump of cocaine. Something about this though, medicalizing your very existence and taking psychoactive drugs all day, every day. Of course, Scott gets more into the pros and cons of the drug, whether it induces compulsive gambling, and so on, but I keep returning to the simple prescription to just not pump yourself full of psychoactive drugs in your quest to embezzle more money to send it to "good" causes.

I'd drifted away from rationalism, effective altruism, utilitarianism, and other ideas in the same constellation over the years, but nothing really quite put a bow on it like this SBF story in its full ridiculous caricature of how utterly bankrupt of basic morality and humanity the whole suite is. Scott closes with:

If I were one of the psychiatrists who will one day buy second houses from the money they make as expert witnesses on this case (DON’T EVEN THINK ABOUT ASKING ME TO DO THIS9), I would focus on what doses were involved. Adderall 10 mg will help treat ADHD and give you a nice motivational boost. Adderall 200 mg will cause paranoia and sometimes hallucinations. There are similar considerations for modafinil and Emsam. All of these drugs are compatible with “probably didn’t matter” or “probably the main cause of everything” depending on what doses we’re talking about.

(and of course there could be other drugs I don’t know about)

The other free advice I would give these witnesses is to think about sleep. The most common way stimulants cause psychosis (this is my personal opinion, I haven’t checked if the literature agrees with me) isn’t by some kind of direct dopaminergic agonism. It’s by making it feel possible to operate on two hours of sleep a night. This is not actually possible and will land you into some kind of very exotic and maladaptive mental state. Someone who takes lots of stimulants during the day and then manages to sleep fine at night might do better than someone who takes the same amount of stimulants in order to work 130 hour weeks.

As someone that's not a credentialed psychiatrist, I have free advice that has served me and people close to me well - just don't do any of this. If you're ever having to consider whether you had a psychotic break because of meth or the lack of sleep caused by the meth, and the putative reason was so that you could work really long hours moving financial chips around while creating absolutely nothing of any value, you're doing everything wrong. These shouldn't be critiques on the margins, they should be wholesale repudiation of such a lifestyle. If I were part of the EA community, I'd be getting out in front of this and rejecting everything about how these people behaved, not saying that maybe they should have just used lower doses of their drugs.

Using things like this when you don't actually have anything wrong with you, when you just wish your mind worked differently viscerally disgusts me. I'm not exactly a Mormon over here - I start the day with coffee and often finish it with whiskey. I don't care if people smoke weed or even have the occasional bump of cocaine. Something about this though, medicalizing your very existence and taking psychoactive drugs all day, every day.

I found this to be the most interesting part of your post to me: I feel the opposite way about alcohol/weed. I find myself disgusted at the idea of taking alcohol/weed and when others take them, but would be happy to take (less exotic concoctions than whatever SBF was using) strong nootropics.

My intuition for the disgust I have for alcohol/weed is: Why take something that lessens your ability to think? Why slow yourself down? I'd choose improving my abilities to do what I enjoy over inducing relaxation / euphoria.

But none of that really triggered the disgust reaction, all of that just seems like the sort of thing that I predict the scions of Harvard finance law professors get up to - scamming money in maybe-legal fashion just seems incredibly on brand for such families, even if the specifics of effective altruism spice the story up.

Darren Beattie claims coming crypto crashes will make FTX look like small potatoes. He's probably unusually smart for a journo, so there might be something to it.

Also, yeah, SBF might get away with it, or more likely suffer mysterious heart failure. Dude was on so many stimulants, not weird at all.

Apparently, FTX seems to look like a BCCI like situation - a fraudulent bank that operated for far, far longer than made sense because it was useful to spooks.

Coinbase and Binance are the two big ones. If those start to fail, sparks are gonna fly.

Nouriel Roubini attacked Binance recently, but it's unclear what it's about - whether Binance is really insolvent, or Feds are trying to punish it for some reason..

(I don't trust Kim Dotcom further than I can throw him, and he's a heavy mofo. )

Brains already regulate their neurochemistry. How is this not just more of brains regulating their neurochemistry, via a much longer control loop?

To be clear, I can see the pragmatic argument of "your biology is a lot better at it than your cognition". I don't see where the aesthetic argument comes from.

How is this not just more of brains regulating their neurochemistry, via a much longer control loop?

This reasoning applies not only to phamaceuticals, but also to lobotomies and to shooting yourself in the head.

There's an implicit "by an evolutionary process which would result in failures being selected out of existence".

I mean, yes. Sometimes we commit suicide, sometimes cells commit cancer. I didn't say it was good, I'm saying it's not unusual. It's the sort of thing the brain does, just by a longer path.

So tired of seeing this guy's greasy hair and face everywhere. Not that it matters much, but I don't we can conclude this early that he enriched himself with billions of FTX customers proceeds. His wealth was entirely based hypothetical holdings that for reasons that have yet to be understood, evaporated. It says that $1 billion is missing but the presumption of innocence means a very high burden of proof must be cleared , even if to some of us it seems obvious he stole the money. It hasn't even led to an indictment yet, yet we're confident in casting aspersions.

But self-serving , pretend altruists are not unheard of. Megachurch pastor fraud is a dime a dozen. https://www.google.com/search?q=Megachurch+pastors+fraud

I don’t think we can conclude this early that he enriched himself with billions of FTX customers proceeds

It’s even dumber than that. He didn’t use customer funds to enrich himself. He used customer funds to bail out his girlfriend’s hedge fund so she could keep trading shitcoins on margin.

his latest defence is FTX didn't have a bank account so customers were transferring money to Alemeda and then OOPSY DAISY the money was never transferred from Alemeda to FTX. (https://www.vox.com/future-perfect/23462333/sam-bankman-fried-ftx-cryptocurrency-effective-altruism-crypto-bahamas-philanthropy) I'm not sure how that covers all the deposits because presumably you could transfer crypto as well.

there is a bunch of interesting DMS between the reporter and SBF including this:

REPORTER: you were really good about talking about ethics, for someone who kind of saw it all as a game with winners and losers

SBF: hehe

SBF: i had to be

SBF: it's what reputations are made of, to some extent

SBF: I feel bad by those who get fucked by it

SBF: by this dumb game we woke westerners play where we say all the right shibboleths and so everyone likes us

SBF--secretly based? Were people wrong about him being a Democratic operative hoping to advance globalist interests?

I think he is an operative of a single interest, himself.

This is what’s so interesting about the whole thing. Sam and Caroline aren’t ordinary your everyday scammers. These are batman villains. It’s not enough simply to stop them, they must be refuted.

I wonder how crypto prices going to zero would affect his his punishment. Would the damages be assessed at 2021 prices or hypnotical much lower prices?

Wild article. I wonder if he is speaking freely because he is oblivious to his legal jeopardy, because he has already resigned himself to spending the rest of his life in prison, or because he is already living in a cave in some non-extradition jurisdiction.

He posted on Twitter that he didn't think the convo would be published.

Prosecutors aren't limited to reviewing what has been published...

He seems to just be very chill. Maybe it was the drugs making him jittery, after all. https://twitter.com/psyopcop/status/1592977107281666049

Fair... but the interview seems pretty likely to be quoted back to him by prosecutors, and I don't understand how he couldn't foresee that, especially with two law professors as his parents.

No one can resist the siren call of #ThingsIWillRegretWriting, especially when it seems like their only chance to get their side of the story out there. And especially especially in a live interview where you don't have time to think.

My thoughts more or less exactly.

“SV venture capitalist detonates spectacularly”...isn’t really newsworthy. Not to me, out here in Texas. I’m sure it’s absolutely miserable for those who lost everything, and rather unpleasant even if one was tangentially involved, but most of us are neither. So—my sympathies to the victims, and I wish everyone could shut up about it so I can stop defending EA from the Worst Argument in the World.

Most Silly Valley blowups are not banks. FTX was, in reality, a bank (although it fraudulently claimed not to be, by saying that customer deposits were fully backed by cash and crypto reserves in specie). Bank blowups cause a lot of innocent third parties to lose money - FTX/Alameda didn't just lose all of Sequoia and Softbank's money - it also lost $8 billion of customer money.

In the sane world, we don't let people run a bank the way they run a Silly Valley juice startup.

Someone making earnest attempts that go bad isn't the same thing as intentionally misleading depositors and taking their money without their knowledge for various speculative bets. I think people who wish to whitewash what he did haven't frankly read up enough on the details.

I don’t want to whitewash him. It sure seems like he was negligent, if not predatory.

“Spectacular detonation” was intended to include massive fraud and other happenings which are not normal, not okay...but not unprecedented. EA critics have been eager to jump on SBF’s weird extremism and blame EA. Never mind the amount of crypto and finance meltdowns under similar circumstances.

… Two elderly superhumans were competing for the presidency of the planet's foremost nation, USA: a 70-year-old schemer with obvious signs of sexual-pharmacological degeneration, and a 70-year-old demagogue, showman and professional bankrupt who had never been in politics before. […]

For a European, any medicine is poison: an evil which treats an even greater evil. This has been the basis of European medicine since antiquity. It is clear that no Europeans will take pills without a great and pressing need, especially if those pills affect the inner sanctum of man - his psyche.

Americans gobble up drugs by the handful, since for them they are not poisons but enhancers and dietary supplements. By the age of 50 an average American has enhanced himself to the stage of psychopathy, and then it gets worse and worse.

t. Galkovsky

Sick burns. We're all living in America, though.

I've heard it asserted that European boxers were disgusted upon learning that Anglos do weight training to prepare for competitions. Those are supposed to be games, vigorous festivals of bodily perfection, causes for joy – the opposite of dreary displays of a peasant's work ethic or a merchant's cold numerate chase after marginal returns. Or something. Well you know how it turned out, and the role performance enhancing drugs play in competitive sports now. Moloch whose dumbbells are (mumble mumble), I guess. But don't the stunts of modern champions look positively superhuman? Don't those playful Chads of the all-natural era seem scrawny next to the optimized contemporary giants?

This jealous amazement underlies general American obsession with finding some edge, and specifically Silicon Valley fads like mindfulness meditation, diets and training routines, ADHD medication, microdosing LSD and now weirder prescription stuff. (A guy called Sam doing EMSAM, seriously?) The most egregious case was probably Serge Faguet. Like Sam, only on a much smaller scale, he crashed and burned thanks to his miracle enhancements (he had the bright idea of visiting Russia with LSD and amphetamine in his luggage). The most incredible bit of his story wasn't drugs – it was using fancy hearing aids without indications. To hear more than others.

All that being ridiculous enough, what is your actual objection? I may be wrong, but it seems you'd take issue with PEDs whether they work or not, regardless of their safety profile and side effects; they disgust you viscerally due to their inherent effect.

My hypothesis is that this is your lack of chutzpah talking. Fair play, equivalent exchange, no weird tricks, not trying to get something for nothing, not getting carried away with hypothetical astronomic returns, not gambling, not doing crazy drugs – those are reasonable defaults to avoid failure modes like St. Petersburging oneself, setting the community on fire or summoning Cthulhu. But like I've argued recently, chutzpah, the brazen rejection of those defaults, and pursuit of narrow unorthodox openings, can be instrumental for actually transcending the status quo. Sometimes it works, and works so well we've come to depend on it with all of our engineering and science and finance; it is reasonable, then, to ask if practicing it in a certain manner is justified in a specific case. This is a question of specifics.

Unfortunately, the specifics with current psychoactive drugs are pretty dismal even if they don't make you outright crazy. The brain is… complex; effects of any molecule peppered onto its mechanism are crude and untargeted. Using drugs to improve one's already healthy cognition is equivalent to using Curves in a graphical editor to «enhance» a picture, or naive transformations of sound: good enough if you have shit taste or sensory deficits, but it only destroys available information; wipes out subtle differences of pixel values by banding them; clips audio tones; reduces precision of inference; discretizes and roughens your thoughts. Across the multidimensional space of mental contents it erases the lion's share of possibilities and, may Allah forgive me for such mawkishness, the depth of human soul. It may work well enough in a predictable environment like school or the workspace of a linear worker, where prioritizing the few legible, measurable features the Boss cares about is a sensible trade-off. If you make high-uncertainty decisions, you may find that «production velocity» isn't as valuable as seeing clearly the road your'e on.

Drug enhancement does not disgust me any more than the normal condition. It is more noble to struggle against the limitations of human condition than to accept it. «Baseline humans aren't that cool» is something any transhumanist feels viscerally and seeks to remedy.

It is, however, prudent to acknowledge when you're being greedy and petulant in denying that the tech isn't there yet.

Or, well, that your scam is going tits up and you'd do well to liquidate it before collapsing the entire market.

It may work well enough in a predictable environment like school or the workspace of a linear worker, where prioritizing the few legible, measurable features the Boss cares about is a sensible trade-off.

In fairness it worked pretty well for Paul Erdös and Francis Crick too.

If performance-enhancing drugs actually had zero side effects, there would be no need to worry about fair play. It's not a fair play problem when an athlete has to wear shoes to participate in most sports, even though shoes give athletes an unearned advantage over athletes who don't wear shoes.

Drug enhancement does not disgust me any more than the normal condition. It is more noble to struggle against the limitations of human condition than to accept it. «Baseline humans aren't that cool» is something any transhumanist feels viscerally and seeks to remedy.

Some people can tolerate drugs well; for others it destroys them and even those around them. It's like a coin toss as to how someone will respond. With alcohol there is not as much variability compared to the more serious stuff, but it can still be pretty bad.

All that being ridiculous enough, what is your actual objection? I may be wrong, but it seems you'd take issue with PEDs whether they work or not, regardless of their safety profile and side effects; they disgust you viscerally due to their inherent effect.

As I mention in another reply, I'm actually still trying to parse exactly why I'm disgusted, which means that any answer is likely to be more rationalization than reality. I suspect that if there was truly no side effect, I wouldn't much care. In the case of these psychoactive drugs though, there always seems to be a side effect - in this case, there's video of SBF jittering in his chair like a crackhead. Worse still, the use of PEDs in this case isn't to some noble end, it's to spend more time running a harebrained financial scheme. I'm not disgusted by a cyclist taking EPO (even though it's cheating, I don't feel disgust), but I am disgusted by the inhuman looking freaks in bodybuilding taking steroids to make themselves that much more inhuman. Likewise, a caffeinated scientist doesn't disgust me, but a finance scammer on designer drugs does.

there's video of SBF jittering in his chair like a crackhead

maybe he's autistic?

In the case of these psychoactive drugs though, there always seems to be a side effect - in this case, there's video of SBF jittering in his chair like a crackhead.

IF you have a link handy, please give. I've got my treasured video of Hitler & George Floyd rhytmically jittering like crackheads, were I to add in Bankman the whole thing would be somewhat improved.

best I can do is a deepfake of Xi Jinping pulling his eyebrows out with tweezers, take it or leave it

LOL, are you curating a Stereotype Paragon of the Race collection?

No, but well, now that you've suggested it..

there's video of SBF jittering in his chair like a crackhead

Honestly I think a big part of that is Sam knowing his accounting is fraudulent and he's about to be fried, and desperately putting up a front of a weird whiz kid who's got it all under control.

It is part of the branding. If he looked like some boring guy in suit he probably would not have gotten as much media coverage.

I dunno, seems like he rode this horse into the ground, and seems to have had a pretty good time until now.

Using things like this when you don't actually have anything wrong with you, when you just wish your mind worked differently viscerally disgusts me. I'm not exactly a Mormon over here - I start the day with coffee and often finish it with whiskey. I don't care if people smoke weed or even have the occasional bump of cocaine.

I'm largely in the same boat as you, philosophically -- I go cold turkey on caffeine regularly to make sure I can, don't and can't take more than a single serving of alcohols at a time, have a bit of internal resistance to even prescribed non-psychoactive drugs, and think people are too quick to dismiss the psychoactive risks of 'soft' drugs -- but I'm gonna push back a little bit, here.

I don't like the existing drugs, but I also don't think there's some particularly holy nature of the unaltered biochemistry. The snarky side is that we're already doing a lot of alterations to it, for better or worse: people worried about fluoride in water stealing their essence are probably a little nuts but it also probably does have some minor neurological impact, removing lead from everything is probably overstated but also not trivial, the amount of taurine you get in your diet probably effects memory even if you can separately synthesize it internally.

But the deeper part is that I'm extremely skeptical that even if the modern natural brain biochemistry was once well-optimized for the ancestral environment, that it currently is for our current one. Depression and obesity are popping up at ranges that are simply nonsensical from an evolutionary perspective. A significant portion of the male population can't successfully initiate sex to completion with any partner, nevermind one they can reproduce with. Modifications should be met with extreme skepticism because they're so hard to evaluate from the inside, and shouldn't be exploited for stupid or valueless reasons, and if there are available non-pharmaceutical interventions that work even moderately well I'd favor them.

But shit's broke already.

But the deeper part is that I'm extremely skeptical that even if the modern natural brain biochemistry was once well-optimized for the ancestral environment, that it currently is for our current one

Agree strongly here. For all the benefits of modernity it is clearly driving us 'crazy' in large numbers.

I don't like the existing drugs, but I also don't think there's some particularly holy nature of the unaltered biochemistry

There clearly isn't in a broad sense - genetic differences between humans that lead to great differences in intelligence or some other traits are themselves biochemical. But the particular mechanisms of psychoactive drugs are strong enough that they aren't doing the kind of thing that, like, a gradient descent of fine modifications would, but more just 'making you focus really hard on some specific thing' (stimulants, bad because - naturally - you'd be considering if you should do that thing and how you should do it in relation to larger-scale structures), or 'kinda feeling good or having crazy insights while actually just being dumb' (alcohol, weed, psychoactives). In the particular case of stimulants for 'not being able to focus', I really do think it's just a 'natural' lack of desire to engage in various aspects of school, work, modern life that is in great part justified, but poorly developed, rationalized, and then treated with the drug

The ironclad rule is that there is always going to be a cost associated with the benefit of a drug. When you’re dealing with pharmaceutical drugs that are not totally tested in normal humans, the cost is likely much greater than the benefit. But it’s easy to feel an immediate benefit, and much less easy to feel the longterm benefit that has imperceptibly small differences day by day.

If SBF were actually serious about maximizing his mind, and not just looking for an easy solution, he would go on a fasting regimen to lose weight, hire a personal chef to give him nutritious meals, start training for a marathon, quit league of legends, and never sleep on a bean bag chair. But really, he just wanted to get high. He was motivated by the same desire as meth addicts.

"The ironclad rule is that there is always going to be a cost." I'd have ended the sentence there. TANSTAAFL.

fasting is a bad way to lose weight, from what I have read. It causes metabolism to crash, hence rapid regain. Better to do it slowly.

However it is very good for brain health and reversing diabetes

This is why I was never a rationalist. Not because I'm smart or perceptive, I've just been alive long enough to see the fads that smart people go through to convince themselves that their own rapacious greed and obsessive status competition is really "altruism". All these movements have some good ideas. They all have bad ones. And in time, they all fall victim to the humanity of their believers. Altruism is not a human trait. It's an ideal, failed in 100% of cases by the people who believe in it. When someone tells me about their pure intentions and desire to better the world, I check my wallet and my weapon.

To paraphrase the great mind of the 20th century: All intellectual movements start as a cause, become a business and end up as a racket. If this was your first, buckle up sunshine. It only gets dumber the longer you live. Smart people are morons.

If human traits are normally distributed and to some degree innate, it's reasonable to assume that some people are probably more altruistic than others. But altruism is conveyed through actions, not a label.

I would say some people feel the need to find an altruistic explanation for their base motives more than others, but perhaps we're talking about the same thing.

I'm disgusted by is the drug use and treating it as just a bit of biochemical calculus to work out whether it's a good idea

Why? Humans have been experimenting with drugs like alcohol for tens of thousands of years. Many argue that civilization, language, art, etc would be impossible without these substances. What makes it so viscerally disgusting to you?

SBF story in its full ridiculous caricature of how utterly bankrupt of basic morality and humanity the whole suite is

Not to pull a No True Scotsman, but do you really think that one bad actor makes all of rationality/EA/utlitiarianism bad? If that's the case wouldn't virtue ethics or deontology be bad 10,000x times over by all the bad actors those ethical systems have produced over the centuries?

Seems to me as if you're just ranting based on feelings here, which is fine, but you literally admit to drinking caffeine and alcohol daily. Seems to me like this is not really a rational position, just you hating on your outgroup because they do different substances than you.

Not to pull a No True Scotsman, but do you really think that one bad actor makes all of rationality/EA/utlitiarianism bad?

No, but I'm not convinced that this is an issue of "one bad actor". This is rationality/utlitiarianism going wrong in exactly the way it's critics keep predicting it will, and not for the first time. This is the "uncharitable strawman" of the EA movement as a bunch of drug-addled sociopaths and grifters selling secular indulgences to their drug-addled tech-bro friends being revealed as not a strawman at all.

Why? Humans have been experimenting with drugs like alcohol for tens of thousands of years. Many argue that civilization, language, art, etc would be impossible without these substances. What makes it so viscerally disgusting to you?

Yeah, drug use was surprinsgly common in the 18-20th century America, such as opiates. Medicine was quite rudimentary and to ease pain of untreated chronic conditions and pass the time, drugs were often used, which would be considered illicit today

Why? Humans have been experimenting with drugs like alcohol for tens of thousands of years. Many argue that civilization, language, art, etc would be impossible without these substances. What makes it so viscerally disgusting to you?

I don't know. My intention was to speak frankly about something that I'm still trying to parse. As noted, I'm not a pure abstainer, but I am a skeptic of synthetic pharmacology. I cannot presently articulate the moral difference, but I have a very strong feeling that coffee and beer are quite different from whatever the SBF crew was doing.

Not to pull a No True Scotsman, but do you really think that one bad actor makes all of rationality/EA/utlitiarianism bad?

I don't and that's what I was trying to get at in my last sentence.

Do you feel like regular use of Tylenol is wrong?

I suspect that people transpose a dislike for the medical system onto the things the system controls. If you had to cajole an ethanol prescription from your PCP every 3 months your relationship to booze would seem craven and desperate, even holding the quantity and quality constant. If you could pick up amphetamines at your local gas station, would it still feel so gross?

Got it! Maybe I didn't see some of the nuance. I'm also against the idea of medicating away any issues with your life, but I think modern society errs too far in the other direction at the moment.

Part of the reason that so many have issues with drug use, imo, is that we aren't free enough to experiment with them. So there's a sort of allure to illicit drugs.

What gets me the most is that he prescribes to family members in emergencies. This pisses me off pretty severely. For people who don't know a doctor, getting the drugs they need can be a huge struggle. Rather than try to fix the amount of red tape in the system, doctors what, make sure that it never affects the people they care about, and let the rest of us just deal with it? this ability to avoid the consequences of their own inaction is typical of doctors and part of why the US healthcare system's problems aren't just caused by faceless bureaucrats.

Counterpoint: the obnoxiousness of the medical system is beyond Scott's marginal ability to fix, and in such cases one must tend to one's garden.

But every doctor thinks this way and they're the only group with the collective power to do anything about it.

But no individual doctor actually controls that collective power.

Doctors can prescribe to family members in almost all countries. It's not what's causing the US malaise.

Exactly how should Scott fix the red tape in the system? (Except for running his own experimental shoestring clinic, and talking loudly about the problem to his big and influential audience, both of which he already does.)

I agree, I strongly resent the paternalism of a system that even requires a prescription in the first place (if your concerned about drug abuse a good start would be that prescriptions are required for controlled substances and that insurance doesn’t have to cover drugs purchased without prescriptions)

I didn't say that it was breaking the system, I did say that it was removing their incentive to fix it.

Exactly how should Scott fix the red tape in the system?

Refuse to do business by fax.

I’ll admit that I didn’t read the whole thing, but why would he use an MAOB instead of just taking a stimulant? (Or was he being treated for depression)

Sounds like he was doing both, possibly with the idea that they'd work synergistically.