Astral Codex Ten

Adderall

59 min read

Adderall

Article

Adderall is a recurring brand in the Astral Codex Ten archive, appearing 16 times across 16 issues between January 25, 2021 and February 18, 2026. The archive places it in contexts such as “They decided to rebrand Obetrol as ” Adderall ” and pitch it as an ADHD cure”; “Adderall entered the market at exactly the right time”; “James et al switch children back and forth between Adderall and Dexedrine”. It most often appears alongside DEA, FDA, US.

Metadata

  • Category: Brands
  • Mention count: 16
  • Issue count: 16
  • First seen: January 25, 2021
  • Last seen: February 18, 2026

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Know Your Amphetamines
January 25, 2021 · Original source
As usual in pharma, someone bought Obetrol Pharmaceuticals, then someone else bought them, and after a few iterations of this, all their intellectual property ended up with a company called Richwood. They decided to rebrand Obetrol as "Adderall" and pitch it as an ADHD cure.
Treating ADHD with amphetamines was hardly a new invention. Psychiatrists had been doing it since the 1930s, albeit with slightly different drugs. Remember, many organic chemicals come in two versions, a "right-handed" or "d" version and a "left-handed" or "l" version. Benzedrine (a 50-50 d/l split) and Dexedrine (pure d-amphetamine) were the treatments of choice throughout the mid-20th century. So why was it Adderall - a weird combination of four different salts selected kind of at random by a sketchy diet pill company - that caught on?
In the early 1990s, psychiatric research, a series of popular self-help books, and the business interests of Richwood Pharmaceuticals all converged on the idea that it was important to get more people diagnosed with ADHD. Adderall entered the market at exactly the right time, and it became everyone's go-to ADHD medication.
WebMD, And The Tragedy Of Legible Expertise
February 05, 2021 · Original source
"You said this drug is occasionally mildly addictive but the risk/benefit calculation is worth it for most people. But my cousin's friend took it and became really addicted and it ruined his life. Maybe you should warn readers about it more emphatically." The particular example I'm thinking of is something exotic, but something like Adderall could equally well be in this category. Still, I get nervous whenever I get emails like this. What if I do ruin somebody's life? Maybe I should just change the wording to "this drug has some benefits but is often addictive, be careful with it"?
Drug Users Use A Lot Of Drugs
June 09, 2021 · Original source
Every so often somebody realizes that there's not much chemical difference between methamphetamine and Adderall. Then they freak out that we give ADHD kids Adderall all the time. Isn't that like giving them crystal meth?
So should we be less concerned about methamphetamine? More concerned about Adderall? Or what?
The average crystal meth addict uses about 500 mg a day. And they snort it, which probably produces about double the peak plasma level as taking it orally. So they're getting the equivalent of 1000 mg oral amphetamine daily. The average Adderall patient takes 20 mg. The most important reason meth makes your teeth fall out and ruins your life but Adderall just makes you study a little harder is that the meth users are taking 50x higher doses (yeah, okay, there are also some pharmacokinetic differences, but those are less important). Drug users really do use a lot of drugs!
Inline links: uses
Peer Review Request: Ketamine
July 19, 2021 · Original source
There are common reports of severe side effects from recreational ketamine users, of which the best known are urinary (eg cystitis) and hepatic. It would be concerning if clinical use caused these at anywhere near the same rate. But we should remember that eg recreational amphetamine abuse produces all sorts of terrible side effects, but essentially none of them carry over to clinical amphetamine use (eg Adderall for ADHD). This is mostly because recreational users take doses orders of magnitude higher; “the dose makes the poison”.
In general, I’m not very concerned about this with most patients, for a few reasons. First are the reports from expert prescribers, who say basically none of their patients ever get addicted. Second is the general experience of using addictive drugs in psychiatry – for example, amphetamine (Adderall), which despite its fearsome reputation as a street drug is rarely abused by patients who get it by prescription. Addiction is a biopsychosocial process and people without genetic and psychological predispositions to addiction are usually able to use these chemicals safely.
In a survey of drug experts, ketamine was ranked as less addictive than tobacco, alcohol, or Adderall, and around the same level as marijuana. If you would feel comfortable going out to a bar a few times without worrying about addiction, or smoking pot a few times without worrying about addiction, probably you also shouldn’t worry about getting a few ketamine infusions.
Highlights From The Comments On "Crazy Like Us"
July 21, 2021 · Original source
Living in Russia, I can say that ADHD (translated as СДВГ) is less recognized by the psychiatry community here because of its unclear aetiology. Doctors usually refuse to treat the patients in the absence of dangerous symptoms, and state the diagnosis as "organic nervous system disorder", "psychoorganic syndrome" or indeed "neurasthenia". Adderall and Ritalin are illegal drugs here. Patients usually get prescribed nootropics (glycine, racetams) and adrenaline reuptake inhibitors (atomoxetine).
At the same time there are some articles in popular online magazines telling stories about children and adults struggling with ADHD in Russia. Some people order illegal drugs from nearby countries. Researchers also are aware of it. At the same time, I see some articles talking about US problems with over-medicalization of ADHD with dangerous narcotics driven by profit-seeking pharma companies.
Inline links: some articles in popular online magazines, some articles
I would be surprised if ADHD was especially culture-bound. Partly this is because it’s much more genetic than most other conditions. But partly it’s because it’s just a really basic deficit. Some people aren’t very smart. Other people aren’t very coordinated. And still other people aren’t very good at concentration / executive function (see my past discussion of this here). There’s no reason why everyone should have the same level of concentration ability, so sure, some people have extremely bad concentration ability (just as some people are really dumb, or really clumsy), and we call that ADHD. This seems much less mysterious than “sometimes people can’t stop dieting and starve themselves to death”.
Inline links: here
The Psychopharmacology Of The FTX Crash
November 16, 2022 · Original source
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.
I don’t think Emsam is vastly worse than other dopaminergic drugs - maybe even including common drugs like Adderall. I think all of these drugs are fine for ordinary people who need antidepressants or stimulants. They might even potentially be fine for people who work with risk as a job, like traders - especially if they’re following an algorithm or having their work checked by other people. But if someone’s making big decisions based on their intuitive risk assessments, they should keep in mind that dopaminergic drugs can shift the way they think about those things - not necessarily to a worse place, just a different place.
A significant fraction of the finance industry is on Adderall - I know because they keep trying to make me prescribe it to them. This hasn’t degraded performance so much that managers have noticed or made rules against it. And for all I know, maybe the medicated mental risk curves are better for trading than the unmedicated ones. Still, I would warn everyone involved to be careful.
Semaglutidonomics
November 24, 2022 · Original source
Semaglutide is now as searched-for on Google as Prozac or Viagra. Even if this is a temporary Musk-related spike, even pre-Musk it was getting a little above half their level. But Google Trends doesn’t exactly track awareness; few people search for Prozac these days precisely because everyone already knows what it is. So all this tells us is that there’s a lot of buzz around semaglutide. Suppose for the sake of argument that 5% of obese people have heard of this drug. Step 2: Prescription Accessibility The FDA says Wegovy is indicated for obesity, defined as BMI ≥ 30, or for people with BMI ≥ 27 and certain medical conditions. Does that mean that if you have that BMI, your doctor will give you a prescription? I think most doctors will want patients to try diet and exercise first. My experience as a doctor is that most obese people have already considered diet and exercise. Sometimes if you have a very compelling reason and a very well-thought out plan you can get them to try again. But usually they are obese because diet and exercise are hard for them, or don’t work for them, or some other reason besides “they never thought of it”. Still, I hear lots of stories about patient-doctor fights here. I assume this will happen with Wegovy too. Every doctor will have their own threshold for what amount of “already tried diet and exercise” is enough to justify a Wegovy prescription, and sometimes patients won’t meet that threshold. The history of medicine includes the following story many times: there’s some condition that doctors recommend lifestyle changes for. Then an exciting new medication comes out that treats the condition effectively. Over a generation or so, doctors go from demanding the lifestyle change, to gesturing at the lifestyle change before prescribing the medication, to mostly just prescribing the medication. We saw this with cholesterol and statins, with hypertension and ACE inhibitors, with depression and SSRIs. You can form your own opinion on whether this is good or bad, but we’re probably in the very beginning of this process with obesity. Opinions will be all over the map for a while before the inevitable pharma company victory makes everyone agree that semaglutide is first-line therapy. …except that this time, Silicon Valley is short-circuiting the process with fly-by-night telemedicine companies that guarantee you’ll get the drugs you want. For example, NextMed charges $138/month ($99 first month only!) for a guaranteed GLP-1 agonist prescription, plus “support and messaging with expert doctors”. The DEA sometimes shuts these groups down when they start playing around with controlled substances (eg addictive drugs like Adderall), but Wegovy isn’t controlled, and the government probably doesn’t care that much here. These services guarantee that people with money will be able to circumvent conservative doctors and access a prescription. Only 75% of Americans have PCPs at all. If we assume half of them will eventually be able to get a Wegovy prescription from their doctor, that’s 37.5%. Step 3: Affordability Semaglutide costs $15,000/year. Well-off people like Elon Musk might be able to pay that out-of-pocket, but most people will probably need insurance coverage. Right now this is spotty. Medicare doesn’t cover obesity drugs. This isn’t a reaction to the threat of semaglutide-related cost explosions - they’re not that smart. I think Medicare laws were just written in the old days when people were less likely to think of obesity as a disease. Is it time for change? Some Congressmen have proposed a very noble-sounding law telling Medicare and Medicaid to start covering weight loss drugs. I‘m sure this is out of deep compassion for America’s obese population and not because it would make pharma companies one billion zillion dollars. One of the Congressmen even has the last name “Kind!” Some pharma lobbyist probably got a bonus for that one. Private insurers mostly have to cover whatever Medicare does, but they can choose whether or not to include extra non-Medicare-covered drugs. Some have chosen to cover semaglutide under some conditions. Others would prefer not to cover it, but can be scared into covering it by the magic words “medical necessity”. Overall I don’t understand the laws here beyond that maybe they’ll cover it and maybe they won’t. Here, too, it might be time for change. The New York Times is publishing articles trying to convince us that private insurances not covering semaglutide is an outrage. Here in the tiny gray text, I want to take a second to complain about this article. It notes that Wegovy (semaglutide for obesity) costs more per prescription than Ozempic (semaglutide for diabetes), and calls this “a gross inequity”, accusing Novo Nordisk of “charg[ing] people more for the same drug because of their obesity”. But the obesity prescription is higher dose than the diabetes prescription! Milligram per milligram, Wegovy costs *less* than Ozempic! A steelmanned version of the NYT might object - don’t most of the costs come from the intellectual property and not the manufacturing, so that dose shouldn’t matter? Yes, but if you made the obesity version cost too much less per milligram than the diabetes version, then diabetics would cheat the system by buying the obesity version and splitting it into smaller doses! Insurances that do cover it may require extra documentation that the patient has tried lots of diet and exercise, maybe including some official diet-and-exercise program like WeightWatchers. They might also want documentation that patients have tried cheaper earlier-generation weight loss drugs without success. Even when insurances do cover semaglutide, copays may be very high. I have a pretty minimal insurance and it looks like if I got semaglutide my copay would be about $500/month until I reach my out of pocket limit. Harsh. People with better insurances might get hit less hard, but I don’t think anyone will be picking this up for cheap. Let’s say only 5% of people who clear all previous hurdles can afford the drug. How Many People Get Semaglutide? 140 million obese Americans * 25% interested * 5% know of semaglutide’s existence * 37.5% can get prescriptions * 5% can afford it = 33,000, which is a pretty good match for the 50,000 estimated prescriptions. I didn’t even fudge the numbers to come out right, it just happened. The Coming Decade As a service to pharma investors, Morgan Stanley modeled the economic future of obesity medications over the next decade. Their headline result: semaglutide and various semaglutide-copycat-drugs will be a $30 billion market by 2030. That’s less than the $500 billion disaster I was afraid of! But still almost 10% of all US drug spending! Here are two core analyses from the report: The first analysis asks “what if doctors medicalized obesity as comprehensively as they’ve medicalized hypertension and high cholesterol?” That is: what if we put in a society-wide effort to get every obese person to a doctor, and after only a little diet and exercise, the doctor puts them on a medication? They find that the US obesity market would multiply by a factor of 25, to about $87 billion/year. The second analysis is a more realistic projection for the next decade. Two things stand out. First, the number of patients on Wegovy or related medications goes from an estimated 46,910 now (pretty close to my 50,000 estimate!) to 11.3 million in 2030. Second, the cost per prescription goes from $15,000/year to about $4,000 year. Let’s look at this second change in more detail. Right now semaglutide is literally in a class of its own for weight loss. But remember, it started as a GLP-1 agonist diabetes drug. And there are other GLP-1 agonists already in use for diabetes. Novo Nordisk’s competitor Eli Lilly owns a closely related molecule, tirzepatide (Mounjaro®). They’ve already done studies showing it also works very well for weight loss - if anything even better than semaglutide - and they’re expected to get FDA approval to market it as a weight loss medication next year. Although capitalism fans might expect the presence of two competing drugs to immediately drive down prices, this is mysteriously not how things work in health care and prices will probably stay the same in the short term. But several other companies are working on semaglutide-like drugs, some will be cheaper to produce than semaglutide, and Morgan Stanley expects that this stronger level of competition will eventually drive costs down to $350/month ($4,000/year) by 2030. “Mounjaro” sounds like the playful animal sidekick in a Disney movie. From a purely economic perspective, semaglutide costs the health system money (because it’s expensive) but also saves the health system money (because we don’t have to pay for obesity consequences like diabetes and heart attacks). Which effect wins out? According to the Institute for Clinical and Economic Review, benefits would outweigh costs if semaglutide cost less than about $8,000/year. Since it costs $15,000 year now, it’s not cost effective. But if Morgan Stanley’s model comes true and it costs $4,000/year in 2030, then it will be cost effective. So at some point, Medicare (and so insurance companies) may start covering it more out of self-interest. I can’t tell whether the model takes this into account or not. (there’s also a third-level effect where it costs the health system money again, because it prevents people from dying of obesity-related complications, and dead people stop needing expensive health care. I think health economists are supposed to ignore this level.) 11.3 million prescriptions at $4,000/year comes to $45 billion, but Morgan Stanley expects that not everyone will fill their prescriptions consistently or stay on the medication the same amount of time, leading to their $31 billion figure. Towards The Glorious Post-Obesity Transhuman Future The Morgan Stanley report shows that even the greediest pharma investors, openly plotting to medicalize obesity, can’t bring themselves to believe in more than 11 million US semaglutide patients by 2030. That’s less than 10% of the US obese population. Isn’t that kind of disappointing? We’ve got > 100 million people dealing with a condition that not only makes them unhealthy, but also causes them psychological distress, and makes lots of people low-grade disappointed in and repulsed by our society. And we’ve got an effective drug that treats the condition. And we’re going to use it on less than 10% of the people involved? In 2032, semaglutide goes off-patent. It will probably take a few years to sort out legal issues and ramp up generic production, but by the mid-2030s, its price will go way down. I don’t think there are technical barriers to getting it down as low as $10 - $100 per month. By then, maybe there will be even more exciting branded weight loss drugs for wealthy people to choose from. But at the very least, semaglutide itself should become much more widely available even to poor or uninsured patients. I’m not sure what will happen. Will there be an inflection point, where so many people use semaglutide that obesity becomes unusual again, and then the remaining obese people start using it just to fit in? Will obesity become an optional fashion statement, like shaving your head or getting a tattoo? Or will semaglutide end up disappointing us in some way, like so many promising drugs have before? I come at semaglutide from a transhumanist perspective. I want to hack genetics and biology until everyone is as tall as they want, as strong as they want, as smart as they want, and whatever gender they want. If you want wings, you should be able to have wings. And yes, part of this vision is everyone having the weight they want. I’m not sure this will happen, but for the first time I can see a clear path to how it might. Postscript 1: Should You Take Semaglutide? I can’t answer this, please ask your doctor. But I do want to add that there are potential side effects I haven’t mentioned in this post, including nausea, gastrointestinal problems, pancreatitis, and kidney problems. Semaglutide has been accused of slightly increasing risk of pancreatic and thyroid cancers. Studies have found trends in this direction, but these conditions are so rare that even over thousands of patients over many years, the increase hasn’t yet reached clear statistical significance. The current consensus position is that it may increase thyroid cancer by a tiny amount not relevant to most patients, and that it probably doesn’t increase pancreatic cancer. I think my father has looked over these data more and is less sure than other people about the lack of pancreatic cancer risk, but he can’t get the resources he needs to prove anything, and I can’t remember his exact argument. More broadly: like all medications, semaglutide has benefits and risks, and you shouldn’t blindly take it after reading one blog article. Postscript 2: Is There A Way To Cheat The System To Get Semaglutide For Lower Cost? Health care is much like airline tickets: everyone pays a different price for everything and there’s usually a secret way to get what you want for much less money. Is this true of semaglutide? Pharma company Novo Nordisk offers a Savings Card that they say brings the price down to as low as $25 per month. I’m a little suspicious of this - pharma company offers are rarely as good as they sound - but I don’t notice any obvious tricks in this one and it should probably be your first bet. This startup claims that they can get insured people semaglutide for a $25/month copay “after their deductible is met” by negotiating with the insurance company very effectively. I can’t imagine how that works or what they have to negotiate with, but they seem pretty convinced, so I would welcome more information. Otherwise, you don’t have many great options. Although there are two older forms of semaglutide not FDA-approved for weight loss - Ozempic and Rybelsus - these are both more expensive, milligram per milligram, than Wegovy itself. Canada is also of no help. The usual Canadian pharmacies don’t seem to carry Wegovy, and charge about the same amount for Ozempic as American pharmacies do. This article in Drug Discovery Trends says that compounding pharmacies have been selling semaglutide for $300/month, less than a quarter of the sticker price. This is a bit confusing: compounding pharmacies are small local operations permitted to dispense unusual medications by mixing existing ones together in nonstandard ways. They’re arguing that they can legally dispense the semaglutide because they’re mixing it with vitamins, which, fine, but how are they getting it in the first place? Everyone else seems as confused as I am: "Nobody knows how [compounding pharmacies are] getting it," said Karl Nadolsky, an endocrinologist at Spectrum Health. "Who's making it? [The pharma company that makes it] Novo [Nordisk]'s not giving it to them. They're the ones with the rights to the molecule, so how is anybody getting semaglutide?" Has nobody asked compounding pharmacists about this? Do they have a conspiracy of silence? Does the FDA sometimes send their goons in to extract the information, but the compounding pharmacists compound sleeping gas / smoke grenades and vanish into the night? Anyway, the usual authorities warn you not to take compounded semaglutide under any circumstances, but they’re the same people who tell you never to buy drugs from a Canadian pharmacy because they might be adulterated. You can decide how much you want to trust them. Postscript 3: What About Europe And The Rest Of The World? Countries that are not the US usually negotiate with pharmaceutical companies over price. Because of some combination of “negotiation works” and “they are free-riding off Americans’ hard work”, they usually get much lower prices. What does semaglutide cost elsewhere? This is hard to find out because government health agencies sometimes keep their prices secret, plus Wegovy mostly isn’t available in other countries yet. The only information I could find was from Britain, which is in the process of making Wegovy available to patients. It looks like NHS will “restrict the expensive drug’s availability to very obese people attending specialist weight-loss clinics”, but that it might be possible to get it from private clinics for £199/month = £2400/year. Wegovy has been approved in the EU but doesn’t seem to have made it there yet. I can’t find any information about any other country. Non-weight-loss-indicated versions of semaglutide are available in many countries, but I wouldn’t expect their health care systems to be flexible about redirecting it for weight. Canadian regulators have approved Wegovy, but it doesn’t seem to be available there yet. I haven’t seen any evidence that Ozempic costs less in Canada than it does in the US, and I’m not sure why. Maybe the pharma companies have figured out that anything that happens in Canada gets imported into the US, and they’re playing hardball this time. I don’t know whether Canadians will be able to get it for cheaper than Americans or not. Postscript 4: Predictions (all predictions are conditional on no singularity or global catastrophe) 10 million Americans on semaglutide (or yet-to-be-approved equally good or superior alternatives) by 2030: 75%
Inline links: NextMed, a very noble-sounding law, https://substackcdn.com/image/fetch/$s_!l_X7!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F1dbb9e98-6e07-4237-988e-3b7a61af3e5a_1381x834.png, is publishing articles, https://substackcdn.com/image/fetch/$s_!R-zS!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F0f24b293-27de-462a-84fd-bed2ba7cf07f_1723x831.png, modeled the economic future of obesity medications over the next decade, https://substackcdn.com/image/fetch/$s_!zSOS!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F0906b28a-1ad4-421d-a055-87ed95db59ce_918x261.png, https://substackcdn.com/image/fetch/$s_!QJj9!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Fb966f730-6b24-48e1-98b1-e710cda9264c_903x656.png, this is mysteriously not how things work in health care, https://substackcdn.com/image/fetch/$s_!5poy!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Fc201f05a-7d1f-4738-911f-11d0d051adf9_2880x1562.png, Institute for Clinical and Economic Review, don’t think there are technical barriers, offers a Savings Card, This startup, about the same amount for Ozempic, This article in Drug Discovery Trends, Everyone else seems as confused as I am, NHS will, private clinics
Links For December 2022
December 28, 2022 · Original source
10: Reason: Blame The Government For The Adderall Shortage. The DEA sets a cap on how much Adderall companies can produce per year, and maybe the current Adderall shortage is because they chose too low a number. “Despite the shortage, the DEA has indicated that it does not intend to raise the limit next year.” But the article is kind of equivocal about this and says supply chain problems might also be the culprit.
Inline links: Blame The Government For The Adderall Shortage
The Government Is Making Telemedicine Hard And Inconvenient Again
March 29, 2023 · Original source
The first fruit of their labor is DEA-407, which makes it hard for telemedicine doctors to prescribe controlled substances. Controlled substances are drugs like Adderall, Ritalin, Xanax, or Ambien that the government has declared to be potentially addictive. The new rules say that telemedicine doctors can no longer prescribe these (or, in some cases, can prescribe them one time in an emergency).
Inline links: DEA-407
Some like convenience and dislike inconvenience As a psychiatrist, a big part of my job is prescribing controlled substances. For example, most guidelines agrees that the first-line treatment for severe ADHD is stimulant medications (eg Adderall or Ritalin). And although psychiatrists hate to admit it, the first-line treatment for temporary crisis anxiety, especially when it’s so bad that the patient isn’t able to listen to your clever plans to solve it with therapy, is benzodiazepines (eg Valium or Klonopin). You can’t be a good well-rounded psychiatrist without the option to sometimes prescribe these drugs. "Well, your patients will have to find a different psychiatrist, or transition off of them”. Nobody ever finds different psychiatrists. Some of my patients are a bad match for my style or areas of expertise, and I’ve tried very hard to find them different psychiatrists, and it never works. Maybe there are no other psychiatrists in their area. Maybe the psychiatrists in their area don’t take the right insurance, or are too far away from mass transit. Maybe the psychiatrists have six month long wait lists. Sometimes it’s just that my ADHD patients get distracted and forget they were supposed to find new psychiatrists, and I can’t hold their hand literally all the time. As for transitioning off the medications, some patients absolutely cannot function at all without them. Did I mention that if you come off of some of them too quickly, you can literally die? The medical regulators grudgingly acknowledge these issues and have placed two loopholes in the law: If you ever see a doctor in person, even once, they can prescribe you controlled substances from then on, even if they only see you by telemedicine afterwards.
Highlights From The Comments On Telemedicine Regulations
April 03, 2023 · Original source
Some people express concerns about “pill mills”, unscrupulous companies that hire doctors to prescribe to anyone who asks. These are pretty common for Adderall in particular. Michael:
Inline links: Michael
There were some very dubious telemedicine psychiatry startups that would prescribe Adderall or Ritalin, seemed to have very low prescribing standards, and advertised very aggressively on social media. They were previously only doing SSRIs and the like, but moved to ADHD drugs when this became temporarily possible after COVID.
This is an overresponse to the adderall shortage. There was an uptick in prescriptions over the pandemic and this was blamed on Cerebral and the like. Judging by Cerebral's advertising, I'm not surprised they're being branded a pill-mill; they definitely look like one. I'm currently seeing a telemedicine psych for adhd because I couldn't find an in-person psych during the pandemic, but when I saw Cerebral's adds, I figured I should avoid them.
Attempts To Put Statistics In Context, Put Into Context
June 08, 2023 · Original source
Adderall helps ADHD: 1.3
Inline links: 1.3
Beyond "Abolish The FDA"
December 06, 2023 · Original source
If we eliminate prescriptions, then how do you get Adderall and painkillers? Remember, the FDA doesn’t fight the War on Drugs - that’s the DEA, a different agency. Many recreational drugs (including dangerous ones like methamphetamine, cocaine, and fentanyl) have accepted medical uses. Right now, you’re allowed to use those drugs with a prescription, but not otherwise. If there’s no prescription system, can everyone buy these drugs at the corner store? Can nobody buy them?
Links for May 2024
May 29, 2024 · Original source
2: Recursive Adaptation: The Growing Scientific Case for Using Ozempic and other GLP-1s to Treat Opioid, Alcohol, and Nicotine Addiction. Early studies suggest that new-generation weight loss drugs like Ozempic treat all addictions. The next step is seeing if the government and insurances will cooperate with using them for that indication. As usual, the barrier is cost, but people seem committed enough to doing something about the opioid crisis that they might be willing to act. I think these drugs might boost willpower more generally. There might come a day when they get treated like Adderall - something that many ambitious people want to be on, and look for excuses to take.
Inline links: The Growing Scientific Case for Using Ozempic and other GLP-1s to Treat Opioid, Alcohol, and Nicotine Addiction
36: Alex Tabarrok and New York magazine explain the Adderall shortage. Summary: the DEA, in its crusade against opioids, has put such strict standards on medication factories that many have gotten shut down for “trivial infractions” (for example, “orders struck from 222s must be crossed out with a line and the word cancel written next to them. Investigators found two instances in which Ascent employees had drawn the line but failed to write the word”). In this case, the FDA is the good guys trying to get the factories to re-open again, but so far the DEA hasn’t budged.
Inline links: explain the Adderall shortage
The Compounding Loophole
August 22, 2024 · Original source
I’m pretty encouraged by it. Not only does it provide GLP-1 drugs for a quarter of the price, but also people were really worried that diabetics wouldn’t be able to get their diabetes drugs because dieters would grab them off the shelf first. But now there’s more than enough GLP-1 agonists for everybody. This dramatically demonstrates how drug shortages are mostly regulatory problems (Adderall users, take note!)
Links For November 2024
November 01, 2024 · Original source
This was before they invented what we would call antidepressants today; Dexedrine is an amphetamine related to Adderall. 24: Congratulations to Open Philanthropy, the biggest effective altruist foundation… …whose grantee David Baker recently won a Nobel Prize for his research on synthetic proteins. Potential applications include new drugs, vaccines, and materials. 25: Rich Kid Memes And The Online Culture Of The One Percent. Rich people who want to signal group membership to other rich people online can’t boast about how rich they are; that would be gauche. Instead, they’ve settled on the solution of making fun of rich people in hyperspecific language that proves familiarity with the culture. 26: Tap Water Sommelier: Vladimir Putin has two sons, ages 5 and 9. They are kept in luxurious but total isolation from the outside world and raised by flunkies who are too scared to punish/restrain them in any way. Also some discussion of an unexpected historical analogue. 27: Experiment from Colombia: replacing experienced teachers with less-experience but higher-scoring-on-tests teachers significantly decreased student performance. Got to admit I was expecting the opposite of this, I’d seen US data saying that experience didn’t matter and teacher intelligence did. Looking over this more, I find lots of studies on both sides and will go back to agnosticism on this question until someone I trust investigates further. 28: Large scale-formal Intellectual Turing Test finds that people can imitate partisans effectively; ie nobody on either side can tell the difference between a Democrat arguing for Democrat values vs. a Republican-pretending-to-be-a-Democrat arguing for Democrat values (and vice versa). This study used a 100 word essay on why you supported your party (you can see if you can do better here), but past attempts with different structures (religion, vegetarianism, polyamory) have shown broadly the same results. The researchers try to put this in the context of various studies showing that people do misunderstand their opponents (eg think they’re more extreme, underestimate the level of common ground), but it seems like intellectual Turing Tests aren’t a good way to measure or tease out this misunderstanding. 29: Congratulations to Substacker WoolyAI for doing the impossible and providing a genuinely novel and interesting (to me) take on pickup artistry: 30: Did you know: if you Google “cool websites”, our subreddit (r/slatestarcodex) is the first result. 31: Moshe Koppel, who works at the intersection of computer science and Talmud, is writing a series of posts (presumably) based off of my Every Bay Area House Party, titled Jerusalem Area House Party (it’s multiple part, you have to go to the main Substack page to find the others). I won’t necessarily link everyone who riffs off one of my posts - but honestly I probably will if you also have a Wikipedia page that describes you as working on computational Talmudology. 32: David Roman says it’s a myth that Arabic scholars rescued and preserved the works of the great classical authors. 33: Medications often decrease “secondary endpoints” (eg stroke, heart attack), but the holy grail of pharma studies is proving that a certain drug decreases all-cause mortality. This is much harder (not all heart attacks kill people, and people die from lots of other things), but is the strongest possible endorsement for the drug (without it, you might worry that it only prevented non-fatal heart attacks, or that it killed as many people through side effects as it saves through heart attack prevention). Even great medications that we’re confident in can’t always clear this bar. But a new JAMA article adds another member to this select club: Adderall decreases all-cause mortality in ADHD, probably because it prevents drug addiction, car accidents, and impulsive actions. 34: Before the Gulf War got in the way, Saddam Hussein was building some crazy mosques: 35: Italy bans surrogacy - quite strictly, too, Italians aren’t even allowed to go abroad and do it. I am so sorry for all the Italians who will never get to be mothers and fathers because their government hates progress. You might hope that, whatever the other disadvantages of anti-immigrant parties, at least they’re incentivized to let natives have children, but looks like they can’t even get that one right. Starting to wonder whether the trains even run on time. 36: Elsewhere in “Italy sucks” news - did you know Italy’s tax code effectively bans startups? Companies are taxed before making any money, based on how many assets they have. If they have lots of assets but aren’t making money (eg because they’re still doing research / in stealth) then tax officials get confused and hostile and run increasingly punitive audits. Related: size of the European tech sector. It’s the red line on this chart; if you can’t see a red line at your screen resolution, then you’ve learned something important about the the EU tech sector. 37: Seen on @cremieuxrecuel’s twitter (preliminary, needs replication): Jews may have gone from 65-29 Democrat/Republican in 2020 to 58-40 this election. 38: Extelligence has a post responding to my critique of the cultural Christianity argument (among, uh, many other things), but I don’t really think it connects. I’m not telling atheists they can’t go to church/synagogue if it makes them feel happy and fulfilled - I’ve done this myself sometimes. My post was meant to argue against the claim that, for pragmatic reasons, atheists should support the Christianization of society as a defense against Islam or postmodernism or some other philosophical enemy. 39: Related: Extelligence is finally going for their Trust Assembly project/idea/startup for online consensus-based truth-seeking (I think something like a cross between Community Notes and Wikipedia, but as a browser extension, and for everything). He’s looking for potential developers/testers/users. 40: Jiankui He is the Chinese geneticist who made history with the first germline gene editing in humans (resulting in three babies supposedly immune to AIDS, although nobody has tested this). China sentenced him to three years in prison for unauthorized experimentation, but now he’s out of jail, has an English-language Twitter account, has a new lab, wants to work on Alzheimers, and seems pretty based (although not infinitely based): 41: Anthropic has a new version of their AI Claude which can use your computer. You give it permission, put it on a virtual desktop, and ask it to do things for you (eg “please find and download a picture of a cat” or “please research these ten things and put them in a text file”.) It moves your cursor, browses the Internet, and creates and saves files. People keep saying they’ll care about AI “when it operates autonomously” or “when it becomes an agent”. But this is a trivial barrier, and one which Computer Use Claude has arguably already passed. So far this feature is limited to developers (though anyone with computer knowledge can sign up for it) but I expect it to be the near future of consumer AI, to get better quickly, and to shade gradually into the “autonomous” “agentic” AI that you all think will require a paradigm shift. 42: Claim (from the IDF): Hamas faked polls showing that most Palestinians supported the October 7 attack; the real numbers are 31% in favor, 64% against. 43: Otto von Bismarck wanted to trick France into declaring war on Germany. In order to provoke the French, he sent the Ems Dispatch, a statement describing recent diplomatic events in a way that sounded maximally offensive. The French were so offended that “crowds” in Paris demanded war, and the Franco-Prussian War was declared soon afterwards. The part of this that I find most interesting is the text of the dispatch itself, which read: After the news of the renunciation of the Prince von Hohenzollern had been communicated to the Imperial French government by the Royal Spanish government, the French Ambassador in Ems made a further demand on His Majesty the King that he should authorize him to telegraph to Paris that His Majesty the King undertook for all time never again to give his assent should the Hohenzollerns once more take up their candidature. His Majesty the King thereupon refused to receive the Ambassador again and had the latter informed by the Adjutant of the day that His Majesty had no further communication to make to the Ambassador. I’m fascinated by the idea that only 150 years ago, it was obvious that if someone sent you this statement, you had to declare war or abandon all honor. If I read it carefully, I can sort of parse out that it sounds like the Prussians are unhappy, but that’s the most emotion I gather from it. Anyway, the Franco-Prussian War led to World War I which led to World War II - so if you don’t like 50 million people dying and the total devastation of Europe, blame this statement about ambassadors. 44: The first use of artificial insemination in humans: The first recorded case of artificial insemination by donor didn’t occur until 1884, when Dr. William Pancoast decided to treat a couple’s infertility by secretly inseminating the woman with sperm obtained from a medical student. The insemination happened while the patient was under anesthesia and Dr. Pancoast did not tell her what had occurred. She gave birth to a baby boy nine months later, but it was several years before the doctor finally confessed to her husband what he had done. Neither man ever informed the mother. It was 25 years later the result of this case was published. Dr. Pancoast was roundly condemned for his actions, but it did open the door for consensual sperm donor insemination. 45: ClearerThinking administers several personality tests to the same people to learn more about their comparative accuracy. I am most interested in their finding that tests with “factors” (eg the Big Five, where you rate people on a numeric scale) are inherently more accurate than those with “types” (eg Myers-Briggs, where you assign someone a specific category) and that, adjusting for this, Big Five is no more predictive than the Enneagram: 46: In 2022, I wrote Whither Tartaria, where I asked why ornate classical styles switched to more austere modernist styles around 1900 - 1950 in a variety of different arts (painting, architecture, literature, poetry, etc). I proposed seven theories, but was unsure which if any were true. Since then, Samuel Hughes of Works In Progress has been investigating. In May, he wrote a well-researched article showing that it wasn’t just increasing cost, because ornate classical architecture now costs less than ever. Now in a new article he demolishes a different theory - it’s not just decreasing cost (and subsequent lack of ability to signal wealth) - because costs didn’t decrease in several other arts, and the change was led by artists with rich people as reluctant followers. He concludes: Modernism may well be a status game of some kind; it may well signal taste more than it signals wealth; and this latter feature may be one of the things that distinguishes it from older artistic styles. But the mechanism by which this change came about must be different to the one Alexander describes. 47: Sort of kind of related - When Hamilton Lost Its Snob Appeal. The musical Hamilton was briefly an artistic/cultural phenomenon, but tastemakers eventually switched to making fun of it. Why? Rob Henderson says it happened after ticket prices came down and the common people could enjoy it. I disagree: everyone I knew who was into Hamilton got into it from the free online soundtrack long before they’d seen the show; I think this is more likely the usual fad cycle where anybody who’s too into yesterday’s fad is behind the curve and therefore uncool. 48: Related: Why are people such jerks to public intellectuals? And more. I agree this is a great mystery. 49: Some prominent Substack psychiatrists doing a video Q&A, submit your questions here. 50: Naomi Kanakia: The Literacy Delusion had a number of explanations for why reading books seemed to be so much worse for human beings (in terms of emotional wellness and productivity) than other forms of narrative entertainment, but its main theory was the integration hypothesis. That the stream of words in a book trained the human brain into a habit of self-consciousness, that reading books forced human beings to think of themselves as a stream of text, processed through time, making a coherent argument of some sort. And that this overall flattening effect forced readers to ignore aspects of their personality or their situation that were not otherwise in line with the overarching story they'd created about themselves. Basically, reading books causes repression and neurosis. The Literacy Delusion argued that, yes, human beings are storytelling machines, but that a stream of written text is a particular kind of story—a story that is particularly flat, particularly devoid of conflicting or harmonizing information—and that this flatness creates a peculiar effect on the human brain. 51: Last month, I linked Sasha Gusev’s No, Intelligence Is Not Like Height and asked people who disagreed to share their arguments; they sure did. First, several people pointed me to a new preprint, Family-GWAS Reveals Effects Of Environment And Mating On Genetic Associations, which finds that one of the main papers Gusev cited to make his case, Howe 2022, made a mistake - imputing sibling genotypes using a process designed for non-sibling genotypes - and that once that mistake is corrected, the finding disappears and intelligence and height appear similar. Second, Joseph Bronski has a more specific post where he responds to Gusev’s points one by one. He accuses Gusev of “[making] up his own chart to remove the error bars [from the originals], to obscure the fact that the study found no evidence for this in IQ”, and says that the cases where he didn’t do that are just “population stratification and range restriction”. Third, Noah Carl at Aporia, instead of writing a direct response like Bronski, argues that the usual method of attacking twin studies is obsolete; not only have the most-debated assumptions behind twin studies been thoroughly validated, but there are now other lines of evidence besides twin studies which confirm high IQ heritability. Fourth, Leonardo Parro (not framed as a response to Gusev) goes into more depth about one of those ways, a “pedigree-based analysis” demonstrating heritability of 54 - 69%, ie no “missing heritability” compared to twin studies. He summarizes this as the effect of “rare variants” compared to the usual SNPs - ie if you only look at the most common genes that are easiest to find, you get “missing heritability” compared to twin studies, but if you widen your search to rare genes that are hard to find, you don’t. 52: Extremely related: Heliospect is a startup promising polygenic selection for IQ and other traits; they were trying to stay in stealth mode but The Guardian spied on them and nonconsensually revealed their existence. The discussion on the r/ssc subreddit centered on their claim that (given enough embryos to choose from) they could increase a baby’s expected IQ by 6 points (I’ve also heard 7.5). Sasha Gusev had previously argued that current technology maxed out at 3.5 and future technology would max out at 6, so a claim of 6 - 7.5 is pretty extreme; Gwern, who wrote the pioneering analysis of this technology, was also skeptical. But Heliospect says they’ve got better predictors than academia that use the rare variants everyone else misses; after talking to the company, Gwern retracted his objections and says he finds their claim “pretty plausible”. Local ACX commenter geneticist Gene Smith also redid some calculations, changed his mind, and says “probably pretty realistic”. I find this interesting not just because of the polygenic selection angle, but because if Heliospect is right then their predictor is able to predict more genetic IQ than the “missing heritability” people believe exists, and it should be able to put this argument to bed once and for all. 53: This month in censorship: X/Twitter banned journalist Ken Klippenstein for sharing the Trump campaign’s dossier on JD Vance. Twitter’s side of the story is that the dossier was probably originally stolen by Iranian agents and they don’t want to support that kind of thing by letting people signal-boost the illicitly obtained goods; you can read Klippenstein’s side here. He appears to be unbanned now.
Inline links: https://x.com/albrgr/status/1844527064956928009, won a Nobel Prize, Rich Kid Memes And The Online Culture Of The One Percent, Tap Water Sommelier, Experiment from Colombia, experience didn’t matter, teacher intelligence did, Large scale-formal Intellectual Turing Test, you can see if you can do better here, religion, vegetarianism, polyamory, WoolyAI, https://substackcdn.com/image/fetch/$s_!4FRI!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F558ad67a-bfca-469e-abd8-2edc7c8b888a_590x916.png, if you Google “cool websites”, r/slatestarcodex, who works at the intersection of computer science and Talmud, Jerusalem Area House Party, says it’s a myth, Adderall decreases all-cause mortality in ADHD, some crazy mosques, https://substackcdn.com/image/fetch/$s_!2W0c!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fc2be0549-aa2b-411d-b6a6-da50c34f7f86_1000x572.jpeg, Italy bans surrogacy, Italy’s tax code effectively bans startups?, Related, https://substackcdn.com/image/fetch/$s_!T3h-!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F08b011b3-ef20-42e5-91b2-33946b8ca7b6_1761x1355.jpeg, @cremieuxrecuel, responding to my critique of the cultural Christianity argument, My post, is finally going for, Trust Assembly, has an English-language Twitter account, has a new lab, wants to work on Alzheimers, and seems pretty based, not infinitely based, https://substackcdn.com/image/fetch/$s_!fY_K!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F6b3b61c8-6c48-4eb7-9608-426b738ab9c8_592x111.png, which can use your computer, Claim, Ems Dispatch, The first use of artificial insemination in humans, administers several personality tests to the same people, https://substackcdn.com/image/fetch/$s_!epEc!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F47c474c6-d68a-41e4-954e-d24cd00ec040_740x388.webp, Whither Tartaria, a well-researched article showing, in a new article he demolishes a different theory, When Hamilton Lost Its Snob Appeal, Why are people such jerks to public intellectuals?, more, Some prominent Substack psychiatrists doing a video Q&A, submit your questions here, Naomi Kanakia, No, Intelligence Is Not Like Height, Family-GWAS Reveals Effects Of Environment And Mating On Genetic Associations, Howe 2022, a more specific post where he responds to Gusev’s points one by one, argues that the usual method of attacking twin studies is obsolete, goes into more depth about one of those ways, The Guardian spied on them and nonconsensually revealed their existence, discussion, previously argued, the pioneering analysis of this technology, Gwern retracted his objections, says, polygenic selection, banned journalist Ken Klippenstein, you can read Klippenstein’s side here., appears to be unbanned now
30: Did you know: if you Google “cool websites”, our subreddit (r/slatestarcodex) is the first result. 31: Moshe Koppel, who works at the intersection of computer science and Talmud, is writing a series of posts (presumably) based off of my Every Bay Area House Party, titled Jerusalem Area House Party (it’s multiple part, you have to go to the main Substack page to find the others). I won’t necessarily link everyone who riffs off one of my posts - but honestly I probably will if you also have a Wikipedia page that describes you as working on computational Talmudology. 32: David Roman says it’s a myth that Arabic scholars rescued and preserved the works of the great classical authors. 33: Medications often decrease “secondary endpoints” (eg stroke, heart attack), but the holy grail of pharma studies is proving that a certain drug decreases all-cause mortality. This is much harder (not all heart attacks kill people, and people die from lots of other things), but is the strongest possible endorsement for the drug (without it, you might worry that it only prevented non-fatal heart attacks, or that it killed as many people through side effects as it saves through heart attack prevention). Even great medications that we’re confident in can’t always clear this bar. But a new JAMA article adds another member to this select club: Adderall decreases all-cause mortality in ADHD, probably because it prevents drug addiction, car accidents, and impulsive actions. 34: Before the Gulf War got in the way, Saddam Hussein was building some crazy mosques: 35: Italy bans surrogacy - quite strictly, too, Italians aren’t even allowed to go abroad and do it. I am so sorry for all the Italians who will never get to be mothers and fathers because their government hates progress. You might hope that, whatever the other disadvantages of anti-immigrant parties, at least they’re incentivized to let natives have children, but looks like they can’t even get that one right. Starting to wonder whether the trains even run on time. 36: Elsewhere in “Italy sucks” news - did you know Italy’s tax code effectively bans startups? Companies are taxed before making any money, based on how many assets they have. If they have lots of assets but aren’t making money (eg because they’re still doing research / in stealth) then tax officials get confused and hostile and run increasingly punitive audits. Related: size of the European tech sector. It’s the red line on this chart; if you can’t see a red line at your screen resolution, then you’ve learned something important about the the EU tech sector. 37: Seen on @cremieuxrecuel’s twitter (preliminary, needs replication): Jews may have gone from 65-29 Democrat/Republican in 2020 to 58-40 this election. 38: Extelligence has a post responding to my critique of the cultural Christianity argument (among, uh, many other things), but I don’t really think it connects. I’m not telling atheists they can’t go to church/synagogue if it makes them feel happy and fulfilled - I’ve done this myself sometimes. My post was meant to argue against the claim that, for pragmatic reasons, atheists should support the Christianization of society as a defense against Islam or postmodernism or some other philosophical enemy. 39: Related: Extelligence is finally going for their Trust Assembly project/idea/startup for online consensus-based truth-seeking (I think something like a cross between Community Notes and Wikipedia, but as a browser extension, and for everything). He’s looking for potential developers/testers/users. 40: Jiankui He is the Chinese geneticist who made history with the first germline gene editing in humans (resulting in three babies supposedly immune to AIDS, although nobody has tested this). China sentenced him to three years in prison for unauthorized experimentation, but now he’s out of jail, has an English-language Twitter account, has a new lab, wants to work on Alzheimers, and seems pretty based (although not infinitely based): 41: Anthropic has a new version of their AI Claude which can use your computer. You give it permission, put it on a virtual desktop, and ask it to do things for you (eg “please find and download a picture of a cat” or “please research these ten things and put them in a text file”.) It moves your cursor, browses the Internet, and creates and saves files. People keep saying they’ll care about AI “when it operates autonomously” or “when it becomes an agent”. But this is a trivial barrier, and one which Computer Use Claude has arguably already passed. So far this feature is limited to developers (though anyone with computer knowledge can sign up for it) but I expect it to be the near future of consumer AI, to get better quickly, and to shade gradually into the “autonomous” “agentic” AI that you all think will require a paradigm shift. 42: Claim (from the IDF): Hamas faked polls showing that most Palestinians supported the October 7 attack; the real numbers are 31% in favor, 64% against. 43: Otto von Bismarck wanted to trick France into declaring war on Germany. In order to provoke the French, he sent the Ems Dispatch, a statement describing recent diplomatic events in a way that sounded maximally offensive. The French were so offended that “crowds” in Paris demanded war, and the Franco-Prussian War was declared soon afterwards. The part of this that I find most interesting is the text of the dispatch itself, which read: After the news of the renunciation of the Prince von Hohenzollern had been communicated to the Imperial French government by the Royal Spanish government, the French Ambassador in Ems made a further demand on His Majesty the King that he should authorize him to telegraph to Paris that His Majesty the King undertook for all time never again to give his assent should the Hohenzollerns once more take up their candidature. His Majesty the King thereupon refused to receive the Ambassador again and had the latter informed by the Adjutant of the day that His Majesty had no further communication to make to the Ambassador. I’m fascinated by the idea that only 150 years ago, it was obvious that if someone sent you this statement, you had to declare war or abandon all honor. If I read it carefully, I can sort of parse out that it sounds like the Prussians are unhappy, but that’s the most emotion I gather from it. Anyway, the Franco-Prussian War led to World War I which led to World War II - so if you don’t like 50 million people dying and the total devastation of Europe, blame this statement about ambassadors. 44: The first use of artificial insemination in humans: The first recorded case of artificial insemination by donor didn’t occur until 1884, when Dr. William Pancoast decided to treat a couple’s infertility by secretly inseminating the woman with sperm obtained from a medical student. The insemination happened while the patient was under anesthesia and Dr. Pancoast did not tell her what had occurred. She gave birth to a baby boy nine months later, but it was several years before the doctor finally confessed to her husband what he had done. Neither man ever informed the mother. It was 25 years later the result of this case was published. Dr. Pancoast was roundly condemned for his actions, but it did open the door for consensual sperm donor insemination. 45: ClearerThinking administers several personality tests to the same people to learn more about their comparative accuracy. I am most interested in their finding that tests with “factors” (eg the Big Five, where you rate people on a numeric scale) are inherently more accurate than those with “types” (eg Myers-Briggs, where you assign someone a specific category) and that, adjusting for this, Big Five is no more predictive than the Enneagram: 46: In 2022, I wrote Whither Tartaria, where I asked why ornate classical styles switched to more austere modernist styles around 1900 - 1950 in a variety of different arts (painting, architecture, literature, poetry, etc). I proposed seven theories, but was unsure which if any were true. Since then, Samuel Hughes of Works In Progress has been investigating. In May, he wrote a well-researched article showing that it wasn’t just increasing cost, because ornate classical architecture now costs less than ever. Now in a new article he demolishes a different theory - it’s not just decreasing cost (and subsequent lack of ability to signal wealth) - because costs didn’t decrease in several other arts, and the change was led by artists with rich people as reluctant followers. He concludes: Modernism may well be a status game of some kind; it may well signal taste more than it signals wealth; and this latter feature may be one of the things that distinguishes it from older artistic styles. But the mechanism by which this change came about must be different to the one Alexander describes. 47: Sort of kind of related - When Hamilton Lost Its Snob Appeal. The musical Hamilton was briefly an artistic/cultural phenomenon, but tastemakers eventually switched to making fun of it. Why? Rob Henderson says it happened after ticket prices came down and the common people could enjoy it. I disagree: everyone I knew who was into Hamilton got into it from the free online soundtrack long before they’d seen the show; I think this is more likely the usual fad cycle where anybody who’s too into yesterday’s fad is behind the curve and therefore uncool. 48: Related: Why are people such jerks to public intellectuals? And more. I agree this is a great mystery. 49: Some prominent Substack psychiatrists doing a video Q&A, submit your questions here. 50: Naomi Kanakia: The Literacy Delusion had a number of explanations for why reading books seemed to be so much worse for human beings (in terms of emotional wellness and productivity) than other forms of narrative entertainment, but its main theory was the integration hypothesis. That the stream of words in a book trained the human brain into a habit of self-consciousness, that reading books forced human beings to think of themselves as a stream of text, processed through time, making a coherent argument of some sort. And that this overall flattening effect forced readers to ignore aspects of their personality or their situation that were not otherwise in line with the overarching story they'd created about themselves. Basically, reading books causes repression and neurosis. The Literacy Delusion argued that, yes, human beings are storytelling machines, but that a stream of written text is a particular kind of story—a story that is particularly flat, particularly devoid of conflicting or harmonizing information—and that this flatness creates a peculiar effect on the human brain. 51: Last month, I linked Sasha Gusev’s No, Intelligence Is Not Like Height and asked people who disagreed to share their arguments; they sure did. First, several people pointed me to a new preprint, Family-GWAS Reveals Effects Of Environment And Mating On Genetic Associations, which finds that one of the main papers Gusev cited to make his case, Howe 2022, made a mistake - imputing sibling genotypes using a process designed for non-sibling genotypes - and that once that mistake is corrected, the finding disappears and intelligence and height appear similar. Second, Joseph Bronski has a more specific post where he responds to Gusev’s points one by one. He accuses Gusev of “[making] up his own chart to remove the error bars [from the originals], to obscure the fact that the study found no evidence for this in IQ”, and says that the cases where he didn’t do that are just “population stratification and range restriction”. Third, Noah Carl at Aporia, instead of writing a direct response like Bronski, argues that the usual method of attacking twin studies is obsolete; not only have the most-debated assumptions behind twin studies been thoroughly validated, but there are now other lines of evidence besides twin studies which confirm high IQ heritability. Fourth, Leonardo Parro (not framed as a response to Gusev) goes into more depth about one of those ways, a “pedigree-based analysis” demonstrating heritability of 54 - 69%, ie no “missing heritability” compared to twin studies. He summarizes this as the effect of “rare variants” compared to the usual SNPs - ie if you only look at the most common genes that are easiest to find, you get “missing heritability” compared to twin studies, but if you widen your search to rare genes that are hard to find, you don’t. 52: Extremely related: Heliospect is a startup promising polygenic selection for IQ and other traits; they were trying to stay in stealth mode but The Guardian spied on them and nonconsensually revealed their existence. The discussion on the r/ssc subreddit centered on their claim that (given enough embryos to choose from) they could increase a baby’s expected IQ by 6 points (I’ve also heard 7.5). Sasha Gusev had previously argued that current technology maxed out at 3.5 and future technology would max out at 6, so a claim of 6 - 7.5 is pretty extreme; Gwern, who wrote the pioneering analysis of this technology, was also skeptical. But Heliospect says they’ve got better predictors than academia that use the rare variants everyone else misses; after talking to the company, Gwern retracted his objections and says he finds their claim “pretty plausible”. Local ACX commenter geneticist Gene Smith also redid some calculations, changed his mind, and says “probably pretty realistic”. I find this interesting not just because of the polygenic selection angle, but because if Heliospect is right then their predictor is able to predict more genetic IQ than the “missing heritability” people believe exists, and it should be able to put this argument to bed once and for all. 53: This month in censorship: X/Twitter banned journalist Ken Klippenstein for sharing the Trump campaign’s dossier on JD Vance. Twitter’s side of the story is that the dossier was probably originally stolen by Iranian agents and they don’t want to support that kind of thing by letting people signal-boost the illicitly obtained goods; you can read Klippenstein’s side here. He appears to be unbanned now.
Inline links: if you Google “cool websites”, r/slatestarcodex, who works at the intersection of computer science and Talmud, Jerusalem Area House Party, says it’s a myth, Adderall decreases all-cause mortality in ADHD, some crazy mosques, https://substackcdn.com/image/fetch/$s_!2W0c!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fc2be0549-aa2b-411d-b6a6-da50c34f7f86_1000x572.jpeg, Italy bans surrogacy, Italy’s tax code effectively bans startups?, Related, https://substackcdn.com/image/fetch/$s_!T3h-!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F08b011b3-ef20-42e5-91b2-33946b8ca7b6_1761x1355.jpeg, @cremieuxrecuel, responding to my critique of the cultural Christianity argument, My post, is finally going for, Trust Assembly, has an English-language Twitter account, has a new lab, wants to work on Alzheimers, and seems pretty based, not infinitely based, https://substackcdn.com/image/fetch/$s_!fY_K!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F6b3b61c8-6c48-4eb7-9608-426b738ab9c8_592x111.png, which can use your computer, Claim, Ems Dispatch, The first use of artificial insemination in humans, administers several personality tests to the same people, https://substackcdn.com/image/fetch/$s_!epEc!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F47c474c6-d68a-41e4-954e-d24cd00ec040_740x388.webp, Whither Tartaria, a well-researched article showing, in a new article he demolishes a different theory, When Hamilton Lost Its Snob Appeal, Why are people such jerks to public intellectuals?, more, Some prominent Substack psychiatrists doing a video Q&A, submit your questions here, Naomi Kanakia, No, Intelligence Is Not Like Height, Family-GWAS Reveals Effects Of Environment And Mating On Genetic Associations, Howe 2022, a more specific post where he responds to Gusev’s points one by one, argues that the usual method of attacking twin studies is obsolete, goes into more depth about one of those ways, The Guardian spied on them and nonconsensually revealed their existence, discussion, previously argued, the pioneering analysis of this technology, Gwern retracted his objections, says, polygenic selection, banned journalist Ken Klippenstein, you can read Klippenstein’s side here., appears to be unbanned now
Record Low Crime Rates Are Real, Not Just Reporting Bias Or Improved Medical Care
February 18, 2026 · Original source
Increased psychiatric care: all of the would-be criminals are on SSRIs, antipsychotics, and Adderall.