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naraburns  nihil supernum  1yr ago (text post)   Edited 1yr ago   34391 thread views

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.

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.

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.

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