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27 posts found
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Apr 30, 2024
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Response to Hanson On Health Care

41 min • 6,243 words • 360 comments • 124 likes • podcast (34 min)
Scott Alexander responds to Robin Hanson's reply on medical effectiveness, clarifying interpretations and reiterating arguments about the limitations of insurance experiments in evaluating medical care. Longer summary
Scott Alexander responds to Robin Hanson's reply to his original post on medical effectiveness. Scott clarifies his interpretation of Hanson's views, discusses potential misunderstandings, and reiterates his arguments about the limitations of insurance experiments in evaluating medical effectiveness. He also addresses specific points Hanson made about cancer treatment, health insurance studies, and p-hacking in medical research. Scott concludes by restating his position that while some medicine is ineffective, it's crucial to distinguish between effective and ineffective treatments rather than dismissing medicine broadly. Shorter summary
Apr 24, 2024
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Contra Hanson On Medical Effectiveness

51 min • 7,819 words • 492 comments • 165 likes • podcast (44 min)
Scott Alexander challenges Robin Hanson's claim that medicine doesn't work by analyzing health insurance studies and presenting evidence of medicine's effectiveness. Longer summary
Scott Alexander critiques Robin Hanson's claim that medicine doesn't work, analyzing three major health insurance experiments (RAND, Oregon, and Karnataka) and other studies. He argues that these studies are underpowered to detect medication effects and don't support Hanson's conclusion, citing evidence of medicine's effectiveness in improving survival rates for various diseases. Shorter summary
Oct 27, 2023
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My Left Kidney

48 min • 7,380 words • 915 comments • 583 likes • podcast (39 min)
Scott Alexander recounts his experience donating a kidney, from initial motivation to post-surgery recovery, while discussing the broader context of organ donation. Longer summary
Scott Alexander describes his journey to donate a kidney, including his motivations, the medical process, and the challenges he faced. He discusses the effectiveness of kidney donation compared to other forms of altruism, the stigma around mental health in the donation process, and the need for systemic changes to address the kidney shortage. Scott also reflects on the experience of the surgery and recovery, and encourages others to consider donation. Shorter summary
Apr 13, 2022
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Obscure Pregnancy Interventions: Much More Than You Wanted To Know

80 min • 12,326 words • 201 comments • 102 likes • podcast (91 min)
Scott Alexander examines obscure pregnancy interventions that may improve child outcomes, rating them by evidence quality and potential impact. Longer summary
Scott Alexander reviews various obscure pregnancy interventions that could potentially improve child outcomes, particularly IQ. He rates them in tiers based on evidence strength and potential impact, with Tier 1 being most strongly supported. Key interventions discussed include embryo selection, choline supplementation, avoiding stress and certain substances, and optimizing birth timing. He emphasizes these are extreme measures not meant to induce guilt, and that standard pregnancy advice is still most important. Shorter summary
Dec 15, 2021
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Ancient Plagues

12 min • 1,790 words • 247 comments • 108 likes • podcast (14 min)
Scott Alexander analyzes the threat of ancient diseases from thawing permafrost, arguing that recent human plagues pose a greater risk than prehistoric ones. Longer summary
Scott Alexander discusses the potential threat of ancient diseases reemerging from thawing permafrost due to climate change. He argues that diseases from millions of years ago are unlikely to pose a significant threat to humans, as they would not be adapted to human biology. However, he expresses more concern about recent human plagues like the 1918 Spanish flu or smallpox potentially coming back. Scott explains that while there's no evidence of live smallpox virus found on artifacts or corpses, the possibility of viruses surviving in permafrost can't be ruled out entirely. He concludes that the biggest risk might come from scientists investigating these potential threats rather than natural exposure. Shorter summary
Nov 25, 2021
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Links For November

24 min • 3,596 words • 738 comments • 63 likes • podcast (30 min)
Scott Alexander shares 34 varied links and pieces of information on topics including science, history, politics, and technology, with brief commentary on many items. Longer summary
This post is a collection of 34 diverse links and snippets of information on various topics. It covers subjects ranging from Jeff Bezos' biological father, to studies on Christianity's growth, to climate change discussions, to updates on AI progress. The post also includes commentary on current events like the University of Austin controversy and political polling trends. Many of the links discuss recent scientific studies or historical anecdotes, often with Scott's brief analysis or opinion added. Shorter summary
Sep 02, 2021
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Long COVID: Much More Than You Wanted To Know

50 min • 7,628 words • 259 comments • 100 likes • podcast (56 min)
Scott Alexander examines the current research on Long COVID, analyzing its prevalence, symptoms, and potential impacts to assess personal risk and societal implications. Longer summary
Scott Alexander reviews the current research on Long COVID, examining its prevalence, symptoms, duration, and impact on different groups. He explores various studies, discusses potential mechanisms, and evaluates the psychosomatic argument. The post concludes with an assessment of personal risk and comparisons to other post-viral syndromes, emphasizing the uncertainties still surrounding Long COVID. Shorter summary
Mar 23, 2021
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Book Review: Antifragile

36 min • 5,496 words • 475 comments • 147 likes • podcast (36 min)
Scott Alexander reviews Nassim Taleb's 'Antifragile', which explores the concept of benefiting from disorder across various domains and critiques modern attempts to reduce volatility. Longer summary
Scott Alexander reviews Nassim Taleb's book 'Antifragile', which introduces the concept of antifragility - things that gain from disorder and volatility. The book explores this concept through various domains including finance, evolution, exercise, and government policy. Taleb argues that many modern systems and approaches, in trying to reduce volatility, actually increase fragility to large shocks. The review discusses Taleb's critique of academia, his preference for practical knowledge over theory, and his views on the benefits of smaller, decentralized systems. Scott compares Taleb's ideas to other thinkers like James Scott and David Chapman, seeing 'Antifragile' as part of a broader intellectual counterculture questioning conventional approaches to knowledge and governance. Shorter summary
Apr 30, 2019
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Buspirone Shortage In Healthcaristan SSR

19 min • 2,878 words • 486 comments • podcast (21 min)
Scott Alexander analyzes how FDA regulations contribute to drug shortages and high prices, using buspirone and insulin as examples. Longer summary
Scott Alexander discusses two issues in the pharmaceutical industry: the buspirone shortage and high insulin prices. He argues that both problems stem from regulatory issues, particularly FDA policies that inadvertently encourage monopolies and make it difficult for generic manufacturers to enter the market. For buspirone, the Generic Drug User Fee Amendments (GDUFA) of 2012 and 2017 have created a fee structure that favors large-scale monopolies. For insulin, the complex nature of biologics and the FDA's stringent approval process for biosimilars make it extremely difficult and expensive to produce generic versions. Scott criticizes the tendency to blame these issues on the free market, arguing instead that poorly designed regulations are the root cause. Shorter summary
Apr 24, 2019
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Links 4/2019

18 min • 2,733 words • 591 comments
A diverse collection of links covering technology, science, economics, politics, and culture, including critiques of studies, interesting scientific findings, and current events. Longer summary
This post is a collection of links to various interesting articles, studies, and news items. It covers a wide range of topics including technology, science, economics, politics, and culture. Some highlights include: a list of places branding themselves as the next Silicon Valley, a study on declining fertility in dogs, critiques of bad scientific studies, an article on antidepressant tapering, data on value drift in effective altruism, and discussions on the Mueller Report's impact on media credibility. The post also includes links to various interesting facts, studies, and developments in fields such as nutrition, drug use, e-cigarettes, and urban development. Shorter summary
Apr 05, 2018
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Links 4/18: Siter Plate

15 min • 2,179 words • 638 comments
Scott shares a diverse collection of interesting links and news items, covering topics from ancient history to modern politics and technology, with brief commentary on each. Longer summary
This post is a collection of interesting links and news items on various topics. It covers a wide range of subjects including ancient Sumerian debates, conspiracy theories, academic research, political developments, AI safety, and social issues. The post presents these items in a concise format, often with brief commentary or analysis from Scott. Some notable items include studies on divorce laws and domestic violence, controversial research on firearms and naloxone, updates on AI safety research, and discussions of recent political events in Italy and South Africa. Shorter summary
Jan 31, 2018
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Powerless Placebos

8 min • 1,173 words • 115 comments • podcast (10 min)
The post examines research suggesting placebos are largely ineffective, explores exceptions, and proposes explanations for observed placebo effects based on brain function and study design. Longer summary
This post discusses the placebo effect, focusing on Hróbjartsson and Gøtzsche's research which found that placebos have little benefit over no treatment in most conditions. The author explores the reasons behind this, suggesting that regression to the mean may have been mistaken for placebo effects in earlier studies. The post also discusses exceptions where placebos seem more effective, such as pain and nausea, and offers a potential explanation for the placebo effect based on the brain's predictive processing model. The author concludes by speculating on why depression might not show strong placebo effects in clinical trials despite common assumptions. Shorter summary
Mar 06, 2017
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Antidepressant Pharmacogenomics: Much More Than You Wanted To Know

42 min • 6,454 words • 123 comments
Scott Alexander critically examines pharmacogenomic testing for antidepressants, particularly the GeneSight test, expressing skepticism about its current effectiveness and validity. Longer summary
Scott Alexander critically examines the field of pharmacogenomics for antidepressants, particularly focusing on the GeneSight test. He reviews the scientific evidence, discusses potential flaws in studies, and expresses skepticism about the current state and effectiveness of such testing. The post delves into the complexities of antidepressant metabolism, the challenges of predicting drug response, and the limitations of current genetic testing approaches. Shorter summary
Feb 09, 2017
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Considerations On Cost Disease

47 min • 7,274 words • 21 comments • podcast (51 min)
Scott Alexander examines the phenomenon of cost disease, where costs for basic services like education and healthcare have increased dramatically without corresponding improvements in quality or wages. Longer summary
Scott Alexander explores the concept of cost disease, where costs for essential services like education, healthcare, and housing have increased significantly over the past few decades without corresponding improvements in quality or wages. He presents data showing how these costs have risen much faster than inflation, while worker salaries in these fields have remained stagnant or even declined. Alexander considers various potential explanations for this phenomenon, including market failures, increased regulation, lawsuit fears, and changing risk tolerance. He argues that this cost disease is a major factor behind many current political and economic debates, and expresses concern about its impact on living standards and economic progress. Shorter summary
Dec 06, 2016
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Links 12/16: Site Makes Right

13 min • 1,974 words • 837 comments
A links post featuring various news and articles about politics, science, and culture, with Scott's commentary on research papers and current events. Longer summary
This is a links post compiling various interesting news and articles from around the web. Topics range from climate change and politics to scientific studies and charitable giving. Scott comments on several research papers, including ones about non-citizen voting and healthcare in Cuba. The post also includes interesting side notes about geography, prison marriages, and literary references. Many of the links are accompanied by Scott's brief commentary or witty observations. Shorter summary
Nov 10, 2016
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Book Review: House of God

36 min • 5,502 words • 153 comments
Scott Alexander reviews 'House of God', a satirical novel about medical internship that exposed systemic issues in healthcare and influenced real-world changes. Longer summary
Scott Alexander reviews the novel 'House of God' by Samuel Shem, a satirical and magical realist portrayal of medical internship. The book uses dark humor and exaggeration to highlight the absurdities and ethical dilemmas in the medical system, particularly regarding the treatment of elderly patients. Scott discusses how the book inverts common assumptions about healthcare, its historical impact on medical practices, and its emotional resonance with his own experiences as a doctor. Shorter summary
Aug 25, 2016
ssc
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Devoodooifying Psychology

14 min • 2,098 words • 291 comments
Scott examines psychological phenomena attributed to the unconscious mind, noting many have failed to replicate, and suggests a shift away from the power of the unconscious in psychological research. Longer summary
This post explores the concept of 'voodoo death' and its parallels in psychology, suggesting that many psychological phenomena previously attributed to the power of the unconscious mind may be less significant than once thought. Scott examines several examples, including the placebo effect, stereotype threat, self-esteem, and social priming, noting that many of these effects have failed to replicate in recent studies. He proposes a pattern of shifting away from the power of the unconscious in psychological research, while acknowledging the limitations of his analysis. The post concludes by considering the implications for Freudian psychology and suggesting a need to reevaluate our understanding of the unconscious mind. Shorter summary
Jun 26, 2016
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Book Review: Unlearn Your Pain

44 min • 6,720 words • 274 comments
Scott reviews 'Unlearn Your Pain', finding its psychosomatic theory of chronic pain intriguing but overstated, while acknowledging the book's techniques may still be helpful via placebo effects. Longer summary
Scott reviews the book 'Unlearn Your Pain' by Dr. Howard Schubiner, which argues that most chronic pain is psychosomatic and can be cured through psychological techniques. While Scott finds some of the book's claims intriguing, he is skeptical of its more sweeping assertions about the psychological origins of pain. He examines the evidence for and against psychosomatic theories of chronic pain, concluding that while psychological factors likely play a role, the book overstates its case and ignores contradictory evidence. Scott suggests the book's techniques may work primarily through placebo effects rather than by addressing repressed trauma as claimed. Shorter summary
Mar 09, 2016
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Links 3/16: Rulink Class

20 min • 3,099 words • 52 comments
A links roundup post covering recent developments in science, medicine, psychology and politics, with particular focus on research replication issues and the 2016 election season. Longer summary
This is a links roundup post covering various recent research findings, news, and developments. It covers topics from toxoplasma research, drug trials, and scientific replication crises to politics and social issues. The post discusses several important developments in psychology including failed replications of established theories like ego depletion, updates on clinical trials and drug research, and various political developments around the 2016 election season. It maintains a light tone while discussing serious academic and scientific topics, including several meta-analyses and study critiques. Shorter summary
Dec 08, 2015
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Links 12/15: Ma’oz Tz-URL

19 min • 2,827 words • 785 comments
A collection of interesting links covering recent research, controversies, and developments across various fields including science, economics, politics and sociology, with Scott's brief commentary on each. Longer summary
This is a link roundup post covering various topics and recent research findings. Scott shares interesting links about economics, science, politics, and sociology. The post includes studies on racial bias in policing, diet soda effects, mass shootings statistics, refugee integration in Sweden, and various other topics. He also discusses controversial topics like cultural appropriation and gun control debates, while maintaining a balanced and analytical perspective. The format follows Scott's typical style of providing brief commentary and context for each link shared. Shorter summary
Sep 24, 2015
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The Problems With Generic Medications Go Deeper Than One Company

16 min • 2,383 words • 532 comments
The post examines three major issues with generic medications: barriers to market entry, problematic FDA initiatives, and inconsistent pricing across pharmacies. Longer summary
This post discusses the problems with generic medications in the United States, focusing on three main issues. First, it explores why competitors don't easily emerge to challenge price gouging, using the example of Daraprim's price increase. The author suggests that FDA approval processes, including bioequivalence studies, create significant barriers to entry. Second, it critiques the FDA's Unapproved Drugs Initiative of 2006, which allowed companies to gain exclusive rights to public domain drugs by conducting studies, leading to price increases. Finally, it highlights the wide price disparities for generic drugs at different pharmacies, suggesting that comparison shopping can lead to significant savings. Shorter summary
May 24, 2015
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Links 5/15: Link Floyd

11 min • 1,656 words • 742 comments
A curated collection of interesting links spanning medicine, economics, social issues and quirky stories, with Scott's commentary on various developments and findings. Longer summary
This is a collection of interesting links and news curated by Scott Alexander, covering a wide range of topics from medical research to economics, social issues, and quirky stories. The post includes discussions of new medical findings about heart receptors, debates about alcohol health effects, archaeological stories, studies about demographics and education, and various social and economic developments. Scott adds his own commentary and insights to many of the links, particularly around housing policy, scientific studies, and mental health care. Shorter summary
Apr 25, 2015
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Nefarious Nefazodone And Flashy Rare Side Effects

16 min • 2,478 words • 331 comments
Scott examines how rare but severe drug side effects often lead to underprescription compared to drugs with common but less severe side effects, potentially resulting in suboptimal patient care. Longer summary
This post discusses the issue of rare but severe side effects in psychiatric medications versus common but less severe side effects. Scott uses two main examples: nefazodone vs SSRIs for depression, and modafinil vs Adderall for stimulants. He argues that drugs with rare but spectacular side effects (like nefazodone and modafinil) are often underprescribed compared to drugs with more common but less severe side effects (like SSRIs and Adderall). The post explores the reasons for this, including doctors' risk aversion, lawsuit concerns, and media coverage of rare side effects. Scott suggests that this pattern may lead to suboptimal treatment choices for patients. Shorter summary
Oct 26, 2014
ssc
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Alcoholics Anonymous: Much More Than You Wanted To Know

38 min • 5,838 words • 175 comments
Scott Alexander examines the effectiveness of Alcoholics Anonymous, finding it and other treatments only marginally better than no treatment, based on flawed and inconclusive studies. Longer summary
Scott Alexander reviews the evidence on Alcoholics Anonymous (AA) effectiveness, finding most studies to be flawed or inconclusive. He notes that AA seems to work about as well as other treatments, but only slightly better than no treatment at all. The post explores various studies, their methodologies, and their limitations, ultimately concluding that while AA and other treatments may help, their effects are small and often indistinguishable from each other or from brief interventions by doctors. Shorter summary
Jul 07, 2014
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SSRIs: Much More Than You Wanted To Know

56 min • 8,645 words • 129 comments
Scott analyzes various criticisms of antidepressants, concluding they have modest but real benefits over placebo, with important considerations about side effects and efficacy. Longer summary
This post examines various criticisms of SSRIs and antidepressants, addressing claims about their efficacy, side effects, and comparisons to placebo and psychotherapy. Scott analyzes studies on antidepressant effectiveness, discussing issues like publication bias, effect sizes, and the meaning of 'clinical significance'. He explores side effects, particularly sexual dysfunction, weight gain, and emotional blunting. The post concludes that while antidepressants are not miracle drugs, they do have a modest but statistically significant benefit over placebo and can be a reasonable option for many people with depression, especially if they understand and prepare for potential side effects. Shorter summary
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