A review of 'Great and Desperate Cures' by Elliot Valenstein, which examines the history of lobotomy and psychosurgery, explaining how tens of thousands of patients underwent dangerous brain operations from the 1930s-1950s despite poor evidence of effectiveness. Longer summary

The post reviews 'Great and Desperate Cures' (1986) by psychologist Elliot Valenstein, exploring how lobotomy became widespread despite its horrific consequences. The review details the procedure itself (inserting an ice-pick-like instrument through the eye socket into the brain), then examines six factors Valenstein identifies for its acceptance: desperate patients and families, physician ambition (especially Egas Moniz and Walter Freeman), uncritical acceptance by researchers and media, territorial disputes between medical specialties, and cold economics. The post includes extensive details about key figures, particularly Freeman's aggressive promotion of transorbital lobotomy and his traveling surgery roadshows. It discusses patient outcomes, the lack of theoretical justification, media hype, and the procedure's eventual replacement by psychoactive drugs. The review concludes by reflecting on modern parallels and the tragic story of Howard Dully, lobotomized at age twelve, arguing that while Freeman likely had good intentions, the safeguards that might have prevented such harm were inadequate then and remain concerning today. Shorter summary

Scott analyzes the implications of the FDA ending compounded GLP-1 weight loss drugs, which have provided a cheaper alternative to official channels for the past three years, and examines various responses from both compounding pharmacies and pharmaceutical companies. Longer summary

Scott discusses the upcoming end to compounded GLP-1 weight loss drugs in the US, as the FDA declares the shortage over. He explains how for the past three years, compounding pharmacies have provided these drugs at $200/month compared to the official $1000/month price, helping about 2 million Americans. The post explores various strategies companies are using to try to continue providing cheaper alternatives, and how pharmaceutical companies are responding with their own direct-to-consumer models. Scott concludes by noting how this experiment in semi-free-market medicine has shown that a less regulated supply chain can work effectively. Shorter summary

Scott Alexander summarizes reader comments about CBT-i apps, their effectiveness, pricing challenges, and FDA regulation. Longer summary

This post highlights key comments from readers on the topic of CBT-i (Cognitive Behavioral Therapy for insomnia) apps. Scott Alexander summarizes several lower-cost CBT-i apps that readers pointed out, including Night Owl, Sleepedy, and Dozy. He also mentions a highly recommended CBT-i book. The post then addresses questions about the effectiveness of CBT-i, citing studies that show it works as well as or better than medications. Finally, it discusses challenges in the app economy, FDA regulation of health apps, and includes insights from experts in the field. Shorter summary

Scott Alexander criticizes the emergence of expensive, prescription-only therapy apps, using Somryst (a CBT-i app) as an example, and warns about the normalization of this trend. Longer summary

Scott Alexander discusses the emergence of prescription-only apps, focusing on Somryst, a CBT-i app for insomnia. He criticizes the high cost ($899) and prescription requirement, arguing that it defeats the purpose of making therapy more accessible. The post explains how the US healthcare system incentivizes this model, comparing it to prescription fish oil. Scott expresses disappointment in the lack of affordable alternatives and warns that this trend might become normalized, urging readers to act while they still feel outraged by it. Shorter summary

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

Scott Alexander examines and expresses skepticism about a theory that attributes high-dose melatonin supplements to patent avoidance, while reflecting on the challenges of evaluating such claims. Longer summary

Scott Alexander discusses a theory about why melatonin supplements are often sold in doses much higher than recommended. The theory, proposed by Dr. Richard Wurtman, suggests that supplement manufacturers used higher doses to avoid paying royalties on a patent for lower doses. Scott expresses skepticism about this explanation, citing reasons such as the unusualness of patenting only up to a certain dose and the fact that many supplements are sold in high doses. He also notes that some companies do sell melatonin at the recommended dose without legal issues. Scott reflects on the challenges of evaluating such claims, balancing expert knowledge against rational skepticism. An update clarifies that the patent likely influenced initial supplement production but has since expired, though high-dose traditions persist. Shorter summary

A collection of links covering topics from drug regulation and genetic testing to tax reform and AI developments, with Scott's commentary on each item. Longer summary

This is a wide-ranging links post covering various news items and studies. Topics include FDA regulations and drug pricing, genetic testing advances, Russian Facebook ads from the 2016 election, studies on education and intelligence, tax reform effects on graduate students, and various scientific developments. The post moves quickly between topics, providing brief commentary and often linking to additional sources. Several items focus on medical and healthcare issues, from insulin prices to studies on pain medication effectiveness. The post maintains Scott's characteristic mix of intellectual curiosity and light humor throughout. Shorter summary

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

Scott Alexander compares the disconnect between American and Russian psychopharmacology to having different chemical elements, exploring why effective Russian psychiatric drugs are unknown in America. Longer summary

Scott Alexander discusses the stark contrast between American and Russian psychopharmacology, using an analogy of different chemical elements to illustrate the disconnect. He points out that many effective Russian psychiatric drugs are virtually unknown in America, despite having good evidential support. The post explores reasons for this divide, including FDA approval processes and legal concerns, and highlights the resulting limitations in treatment options for conditions like anxiety. Scott suggests that while the system's incentives lead to this seemingly irrational situation, a gray market for these drugs has emerged online. Shorter summary

Scott Alexander analyzes a study revealing poor statistical literacy among doctors, critiquing both the study and its implications for medical decision-making. Longer summary

Scott Alexander discusses a study showing poor statistical literacy among doctors, particularly Ob/Gyn residents. The post highlights that only 42% of doctors correctly answered a question about p-values, and only 26% correctly solved a Bayesian probability problem about mammogram results. Scott critiques the study's questions and interpretation, notes the Dunning-Kruger effect in self-reported statistical literacy, and points out gender differences in self-assessment. He concludes by questioning the FDA's decision to restrict individuals' access to their genome information based on doctors' supposed superior statistical understanding. Shorter summary