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 responds to three concerns about embryo selection: embryo personhood rights, loss of trait diversity, and the ethics of preventing disabilities, arguing that none of these objections are fatal to the technology. Longer summary

Scott Alexander responds to three major concerns about embryo selection raised in response to a previous post. First, he addresses whether embryos have personhood rights, arguing that embryos lack the qualities (consciousness, intelligence, etc) that make humans morally valuable. He refutes various counterarguments about potential personhood and responds to edge cases like sleeping hermits. Second, he discusses concerns about trait diversity, arguing that the technology's limited power and slow adoption mean diversity concerns are premature. Third, he addresses the ethics of telling disabled people you'd prefer they didn't exist, comparing it to other situations where we try to prevent certain conditions without devaluing existing people. Shorter summary

Scott announces a new subscriber-only AMA session, setting clear boundaries about which questions he will and won't answer. Longer summary

Scott Alexander announces a new Ask Me Anything (AMA) session for paid subscribers, where non-subscribers can read responses but only subscribers can ask questions and comment. He sets boundaries for questions he won't answer, including requests for medical advice, attempts to generate controversial statements, and pointless hypotheticals. Shorter summary

A review of 'Two Arms and a Head', a paraplegic's memoir and argument for physician-assisted suicide, exploring the book's content and the broader debate around Medical Assistance in Dying. Longer summary

This review examines 'Two Arms and a Head', a memoir and suicide note written by Clayton Schwartz, a philosophy student who became paraplegic after a motorcycle accident. The book details the physical and emotional devastation of paraplegia, argues for the legalization of physician-assisted suicide, and criticizes society's approach to disability. The review also explores the current state of Medical Assistance in Dying (MAiD) and the arguments against it from disability rights organizations. Shorter summary

Scott Alexander examines the problematic nature of emotional support animal letters, highlighting the ethical dilemmas for psychiatrists and the system's shortcomings. Longer summary

Scott Alexander discusses the issue of emotional support animal letters, highlighting the challenges and ethical dilemmas faced by psychiatrists when asked to provide these letters. He explains the legal requirements, the lack of clear evaluation criteria, and the pressure on mental health professionals to approve these requests. The post explores various scenarios and potential responses, ultimately pointing out that the current system creates a form of gatekeeping that favors those who can navigate the process, resulting in a disguised class system. Shorter summary

Scott Alexander argues that using polygenic screening to select low-risk embryos can be considered as preventing genetic disorders, drawing parallels with other accepted preventive practices. Longer summary

Scott Alexander discusses the ethical implications of using polygenic screening to select embryos with lower risk of genetic disorders, specifically schizophrenia. He argues that this practice can be considered as prevention of the disorder, despite objections that it's merely replacing a high-risk individual with a low-risk one. To support his argument, Scott presents three analogous situations: preventing fetal alcohol syndrome, selecting embryos in IVF, and preventing child abuse through parenting workshops. He concludes that polygenic selection is ethically comparable to these widely accepted practices and can be fairly described as preventing schizophrenia. Shorter summary

Scott Alexander argues that schizophrenia should be described as predominantly genetic, addressing counterarguments and emphasizing the importance of this perspective for prevention strategies. Longer summary

Scott Alexander argues that it's fair and accurate to describe schizophrenia as predominantly genetic. He responds to various arguments against this characterization, comparing the situation to how we discuss smoking causing lung cancer. Scott emphasizes that while environmental factors play a role, genetic factors account for the majority of variance in schizophrenia risk. He argues that acknowledging the genetic nature of schizophrenia is important for developing effective prevention strategies, such as polygenic screening, rather than focusing solely on hard-to-control environmental factors. Shorter summary

Scott Alexander summarizes and responds to various comments on his kidney donation post, covering a wide range of related topics and perspectives. Longer summary

Scott Alexander provides highlights from comments on his kidney donation post, covering various perspectives and topics. These include comments from other kidney donors and recipients, discussions on opt-out organ donation systems, debates on radiation risk from screening tests, issues with rejection during the donation process, polls about willingness to donate, and developments in artificial organ technology. Scott also responds to many comments, offering additional insights and reflections on the donation process and related ethical considerations. Shorter summary

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

Scott Alexander critiques the Social Model of Disability as flawed and proposes the Biopsychosocial Model as a more balanced alternative. Longer summary

Scott Alexander critiques the Social Model of Disability, which claims that disability is solely caused by societal barriers and not by individual impairments. He argues that this model, while well-intentioned, is flawed and often taken too literally. Scott proposes the Biopsychosocial Model as a more balanced alternative, acknowledging both biological and social factors in disability. He discusses the history of the Social Model, its limitations, and why a more nuanced approach is necessary for understanding and addressing disabilities. Shorter summary

Scott Alexander summarizes and responds to comments on his book review about IRBs, covering various perspectives on research regulation. Longer summary

Scott Alexander summarizes key comments on his book review of 'From Oversight to Overkill' about IRBs (Institutional Review Boards). The post covers various perspectives on IRBs and research regulations, including stories from researchers, comparisons to other industries, discussions on regulation and liability, debates on act vs. omission distinctions, potential applications to AI governance, and other miscellaneous observations. Scott provides additional context and his own thoughts on many of the comments. Shorter summary

Scott Alexander responds to comments on his post about new telemedicine regulations, addressing various concerns and criticisms raised by readers. Longer summary

Scott Alexander summarizes and responds to various comments on his original post about new telemedicine regulations. He addresses concerns about drug addiction, debates the effectiveness of telemedicine compared to in-person care, discusses the issue of 'pill mills', clarifies his analogy about blind people accessing Braille, responds to criticism of his characterization of Christian doctors, examines which part of the government is responsible for the regulations, and looks at how other countries handle telemedicine prescriptions. Shorter summary

Scott Alexander analyzes the potential role of psychopharmacology in the FTX crash, discussing medications used by SBF and others, and their possible effects on decision-making. Longer summary

Scott Alexander discusses the psychopharmacology aspects of the FTX crash, focusing on the medications Sam Bankman-Fried (SBF) and other FTX employees may have been taking. He examines claims about SBF's use of Emsam (selegiline), modafinil, and other stimulants, explaining their effects and potential risks. Scott also critiques the actions of FTX's company psychiatrist and discusses the broader implications of stimulant use in high-pressure work environments. The post ends with Scott's personal anecdote about testifying as an expert witness. Shorter summary

Scott Alexander argues that doctors should prescribe fluvoxamine for COVID-19 despite FDA inaction, urging them to overcome discomfort with off-label use when evidence supports it. Longer summary

Scott Alexander discusses the use of fluvoxamine (Luvox) as a potential treatment for COVID-19. He argues that despite strong evidence from clinical trials showing its effectiveness, many doctors are hesitant to prescribe it due to it being off-label use. The FDA has not added COVID-19 to the drug's label, citing bureaucratic issues. Scott criticizes this inaction and suggests that doctors should be willing to prescribe off-label when evidence supports it, even if it feels uncomfortable. He relates personal experiences of hesitating to prescribe off-label medications due to social pressure and encourages doctors to critically examine their reasons for not prescribing fluvoxamine for COVID-19. Shorter summary

Scott Alexander examines the concept of 'Pascalian Medicine', weighing the pros and cons of taking multiple unproven but potentially beneficial treatments. Longer summary

Scott Alexander explores the concept of 'Pascalian Medicine', where one takes multiple unproven but safe treatments based on a small chance they might work. He discusses this in the context of COVID-19 treatments like Vitamin D and ivermectin, and extends it to other conditions. The post examines arguments for and against this approach, including safety concerns, societal impacts, and the risk of being exploited by bad actors. Scott concludes that while this strategy might work for individuals, it's problematic on a societal level, and reconciling inside and outside views on the probability of treatments working remains challenging. Shorter summary

Scott summarizes and responds to comments on his previous article about FDA approval of Paxlovid, acknowledging some valid points while maintaining his criticism of the approval process. Longer summary

This post summarizes comments on Scott's previous article about FDA approval of Paxlovid. It covers manufacturing challenges, FDA approval processes, production capacity, ongoing studies, and ethical considerations. Scott acknowledges some valid points raised by commenters about reasons for FDA delays, but maintains his criticism of the approval process, suggesting a need for different levels of approval and questioning the current drug approval system. Shorter summary

Scott Alexander corrects and expands on the story of Omegaven, a life-saving infant nutritional fluid, using it to illustrate systemic issues with medical regulation and drug approval. Longer summary

Scott Alexander revisits a story about Omegaven, a fish-oil-based nutritional fluid for infants, correcting some details from his previous post. He explains how the fluid was discovered to prevent liver disease in infants requiring IV nutrition, and the challenges faced in getting it approved by the FDA. While the FDA comes off relatively well in the story, Scott argues that the real problem is the systemic hurdle of drug approval that makes everything in medicine illegal by default. He discusses how this hurdle makes scientific discoveries harder and potentially costs lives, even when many individuals involved are trying their best. Shorter summary

Scott Alexander argues that the FDA is too strict, not too lax, and proposes unbundling FDA approval to allow for more nuanced drug regulation. Longer summary

Scott Alexander criticizes an Atlantic article that argues for stricter FDA standards following the approval of aducanumab, an Alzheimer's drug with questionable efficacy. He contends that the FDA is already too strict, citing examples like the delayed approval of COVID-19 tests and vaccines. Scott argues that the FDA's excessive caution has likely cost many lives. He proposes unbundling FDA approval into separate decisions about legality, insurance coverage, and the FDA's endorsement level. This would allow for more nuanced approvals and potentially reduce costly mistakes while still permitting access to promising treatments. Shorter summary

The post examines the medical benefits, risks, and ethical considerations of infant circumcision, presenting a balanced view based on various studies and historical context. Longer summary

This post discusses the benefits, harms, and ethics of infant circumcision. It covers various aspects including effects on penile cancer, HIV and STD transmission, UTIs, penile problems, and surgical risks. The authors also examine the impact on sensitivity and sexual satisfaction, and discuss the ethical considerations of performing this procedure on infants. The post presents a balanced view, citing numerous studies and historical context, and acknowledges the complexity of the ethical debate surrounding infant circumcision. Shorter summary

Scott Alexander discusses the ethical dilemma of writing doctor's notes for back pain as a psychiatrist, leading to reflections on 'bullshit jobs' and procedural inefficiencies in the economy. Longer summary

Scott Alexander discusses the ethical dilemma of writing doctor's notes for patients with back pain, despite being a psychiatrist. He explores the pros and cons of writing such notes, and shares his strategy of radical honesty. This leads him to reflect on David Graeber's concept of 'bullshit jobs' and how much of the economy might consist of similar procedural rituals that don't add real value. The post highlights the tension between following procedures and providing practical help, and questions why profit-focused companies would engage in such seemingly inefficient practices. Shorter summary

Scott Alexander offers a detailed guide on navigating the inpatient mental health system, balancing caution with the importance of seeking necessary treatment. Longer summary

Scott Alexander provides a comprehensive guide on navigating the inpatient mental health system, covering topics from avoiding involuntary commitment to getting the best care possible when hospitalized. He discusses strategies for interacting with mental health professionals, understanding hospital procedures, and protecting one's rights. The post balances the need for caution with the importance of seeking necessary treatment, offering practical advice for patients and their loved ones. Shorter summary

Scott shares reader responses to his IRB experience, ranging from similar frustrations to defenses of the system, and discusses concerns about increasing bureaucracy in research. Longer summary

This post highlights responses to Scott's previous article about his frustrating experience with the Institutional Review Board (IRB) process. Many readers shared similar stories of bureaucratic hurdles and absurd requirements they faced when trying to conduct research. Some commenters offered advice on how to navigate the system more effectively or suggested that experiences may vary depending on the institution. Others defended the importance of IRBs in preventing unethical research, citing historical examples like the Tuskegee Syphilis Experiment. Scott acknowledges some fair criticisms but maintains that IRBs have become overly burdensome for low-risk studies. He expresses concern about new NIH policies that may further increase bureaucratic requirements for basic science research. Shorter summary

Scott Alexander explores the complex ethical and legal issues surrounding sexual consent for institutionalized and intellectually disabled individuals, arguing for a nuanced approach that balances protection and autonomy. Longer summary

Scott Alexander discusses the complex issue of consent for institutionalized and intellectually disabled individuals, particularly regarding sexual activity. He explores the tension between protecting vulnerable people from abuse and respecting their autonomy and human desires. The post examines current practices in mental hospitals, long-term care facilities, and legal cases involving disabled individuals. Scott argues that while strict legal protections are necessary, there may be ethical grounds for a more nuanced approach in certain situations, allowing for non-verbal forms of consent and considering the overall well-being of the individuals involved. He critiques both overly restrictive policies and potentially exploitative ones, advocating for a careful, case-by-case consideration of these sensitive issues. Shorter summary

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

Scott Alexander shares his experiences and reflections as a final-year psychiatric resident, discussing communication techniques, challenges in psychotherapy, and the anxiety of managing patient risks. Longer summary

Scott Alexander reflects on his experiences as a final-year psychiatric resident. He discusses the differences between resident years, the challenges of dealing with patients and attendings, and the techniques he's learned for effective communication. He also shares his struggles with psychotherapy, his frustrations with psychoanalysis, and the constant anxiety of managing suicide risk among patients. The post ends with Scott contemplating the 'reverse lottery' nature of psychiatric practice and how a patient's suicide attempt has affected his approach to patient care. Shorter summary