Scott Alexander proposes using high-dose oral progesterone as a potential low-cost alternative to Zulresso for treating postpartum depression, based on pharmacological research. Longer summary

Scott Alexander explores the possibility of using high-dose progesterone as a cheaper alternative to Zulresso for treating postpartum depression. He explains that Zulresso is a metabolite of progesterone and presents research suggesting that a specific regimen of oral progesterone could potentially mimic the effects of Zulresso. The post discusses the pharmacokinetics, dosing schedule, and potential cost savings, with progesterone treatment costing only about $11 compared to Zulresso's $35,000. Scott acknowledges potential obstacles in implementation but hopes researchers will investigate this approach further. Shorter summary

Scott Alexander compiles reader comments on healthcare systems in various countries, discussing economics, drug pricing, and personal experiences. Longer summary

This post is a collection of reader comments on healthcare systems in various countries, focusing on the US, Germany, Netherlands, UK, Australia, Switzerland, and several others. It covers topics like drug pricing, healthcare economics, and personal experiences with different systems. The post is structured into four main sections: comments on US healthcare, discussions on drug pricing and subsidies, explanations of why healthcare economics are unique, and detailed accounts of healthcare systems in specific countries. Shorter summary

Scott Alexander reviews comments on his posts about aducanumab and the FDA, acknowledging some mistakes while defending his overall critique of FDA conservatism. Longer summary

Scott Alexander reviews comments on his recent posts about aducanumab and the FDA. He acknowledges some mistakes in his original post, but defends his overall critique of the FDA as overly conservative. The comments cover various aspects of drug approval, including the aducanumab controversy, surrogate endpoints, the FDA's impact on small biotech companies, and comparisons to other regulatory systems. Scott reflects on how to improve his fact-checking process while still writing passionate pieces. 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

Scott Alexander provides a comprehensive guide on ketamine as a depression treatment, covering administration methods, effectiveness, safety, dosage, and potential side effects. Longer summary

This post is a comprehensive guide on ketamine as a treatment for depression, covering various aspects such as methods of administration, effectiveness, safety, dosage, and potential side effects. Scott Alexander explains the differences between IV ketamine, esketamine (Spravato), and oral/intranasal ketamine, discussing their relative costs and accessibility. He also delves into ketamine-assisted psychotherapy, the duration of ketamine's effects, and current theories on how it works. The post is written in a FAQ format, aiming to provide thorough and evidence-based information while acknowledging areas of uncertainty in the research. 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 examines the Amish health care system, which costs much less than the American system while maintaining good health outcomes, and considers its implications for broader healthcare policy. Longer summary

Scott Alexander explores the Amish health care system, comparing it to the modern American system. He notes that the Amish spend much less on healthcare while maintaining good health outcomes, though they have slightly lower life expectancy. The Amish system relies on church aid and a simple insurance-like institution called Amish Hospital Aid. Key factors in their lower costs include collective bargaining, avoiding unnecessary care, not suing doctors, and price-sensitive consumption. Scott considers the applicability of this system to wider society and reflects on how healthcare costs have changed over time, suggesting a possible self-reinforcing cycle between rising costs and the spread of health insurance. Shorter summary

Scott Alexander follows up on his critique of a book about the Baumol effect, presenting data that challenges the book's claims about rising wages driving cost increases in education and healthcare. Longer summary

Scott Alexander follows up on his review of Tabarrok and Helland's book about the Baumol effect and rising costs in education and healthcare. He expresses disappointment with Tabarrok's response to his critique and further explores the issues. Scott presents data showing that wages in high-productivity sectors and for doctors and teachers have not risen as much as claimed, which challenges the book's central thesis. He also clarifies his understanding of how the Baumol effect can make things less affordable for individuals even if not for society as a whole. The post analyzes various data sources and graphs to support these points, maintaining a critical stance towards the original book's arguments. Shorter summary

Scott Alexander reviews a book attributing rising service costs to the Baumol effect, finding it convincing but raising some concerns about conflicting data and affordability issues. Longer summary

Scott Alexander reviews the book 'Why Are The Prices So D*mn High?' by economists Alex Tabarrok and Eric Helland, which attributes rising costs in services like healthcare and education to the Baumol effect. The authors argue that as productivity increases in some sectors, wages rise across all sectors, making labor-intensive services relatively more expensive. Scott finds their case convincing but raises some concerns, including data on stagnant real wages, conflicting information on professional salaries, and the apparent decrease in affordability of services like education, which the Baumol effect shouldn't cause. He seeks further clarification on these points to fully accept the Baumol effect as the primary explanation for cost disease. Shorter summary

Scott Alexander proposes a hypothetical low-cost psychiatric practice to combat medical cost disease, exploring its potential and the barriers to its implementation. Longer summary

Scott Alexander explores the idea of creating a low-cost psychiatric practice called 'Cheap-O Psychiatry' to combat cost disease in medicine. He outlines a model that would significantly reduce overhead costs through telemedicine, self-booking, and direct payment, potentially offering appointments for as low as $35. The post discusses why such practices aren't more common, speculating on factors like the shortage of doctor-entrepreneurs, the dominance of insurance in the mid-range market, and the exhausting nature of rapid patient turnover. Scott suggests that such a venture might need to be done as a political protest to demonstrate the potential for cost reduction in healthcare. Shorter summary

Scott Alexander offers various strategies for obtaining affordable mental health care and medication in the US, including discount programs, therapy alternatives, and supplement options. Longer summary

This post provides detailed advice on how to access mental health care and medication on a budget in the US. Scott outlines various strategies for obtaining prescription medications at lower costs, including using discount websites, pill splitting, and patient assistance programs. He also discusses affordable therapy options and supplement alternatives to prescription drugs. The post is aimed at those who don't qualify for government assistance and includes both legal and potentially legal methods. Scott emphasizes that this is not medical advice and should be used at one's own risk. Shorter summary

Scott Alexander summarizes various responses to his post on 'cost disease', presenting diverse explanations for dramatic cost increases in healthcare, education, and infrastructure. Longer summary

Scott Alexander summarizes and responds to various commentators' explanations for the 'cost disease' phenomenon he described in a previous post, where costs for healthcare, education, and infrastructure have risen dramatically over time without corresponding improvements in quality. The post presents diverse perspectives from economists, bloggers, and readers, exploring theories ranging from administrative bloat and regulatory burden to market failures and changes in societal expectations. Shorter summary

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

Scott Alexander argues that the EpiPen price hike is due to over-regulation and cronyism in the pharmaceutical industry, not lack of regulation as suggested by Vox. Longer summary

This post criticizes Vox's article on EpiPen price hikes, arguing that the problem isn't lack of regulation but over-regulation and cronyism. Scott Alexander contrasts the pharmaceutical industry with the unregulated chair industry, pointing out that chair prices don't suddenly spike 400%. He then details how FDA regulations and patent laws prevent competitors from entering the EpiPen market, despite the drug being off-patent and inexpensive to produce. The post highlights several failed attempts by companies to create generic versions of EpiPens, and how lobbying by the manufacturer Mylan has helped maintain their monopoly. Scott uses an extended analogy comparing the situation to a hypothetical government-controlled chair market to illustrate the absurdity of the current system. 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 critiques the inefficiency of psychiatric care for poverty-related issues, suggesting a Basic Income Guarantee as a potentially more effective solution. Longer summary

Scott Alexander discusses the inefficiency of psychiatric care for patients whose primary issue is poverty. He relates a case where a suicidal patient, in debt for $5000, is hospitalized at a cost of $5000, which doesn't address the underlying financial problem. The post criticizes the current system as wasteful and patronizing, highlighting the dilemma between libertarian and liberal approaches to such issues. Scott suggests that a Basic Income Guarantee might be more effective and cost-efficient than current psychiatric interventions for poverty-related issues, potentially saving money in both psychiatric care and prison systems. Shorter summary

Scott Alexander examines overpriced medical products like Lovaza and Deplin, arguing they serve a purpose in the medical system, but criticizes exorbitant BRCA gene testing prices as harmful. Longer summary

Scott Alexander discusses two examples of overpriced medical products: Lovaza (fish oil) and Deplin (folate), which are essentially the same as much cheaper supplements. He argues that these products serve a purpose by making these substances 'Official' in the medical system, allowing doctors to prescribe them without fear of liability. The post then examines the case of BRCA gene testing, where a company charges exorbitant prices for a service that could be much cheaper. Scott criticizes this practice, contrasting it with the FDA's ban on 23andMe offering BRCA testing, suggesting potential conflicts of interest. Shorter summary

Scott Alexander critiques the medical system's preference for expensive prescription sleep aids like Ramelteon over cheaper alternatives like melatonin, while sharing interesting facts about melatonin's uses. Longer summary

Scott Alexander discusses Ramelteon, a prescription sleep medication that mimics melatonin. He compares it to over-the-counter melatonin, highlighting the absurdity of the medical system that creates expensive prescription drugs when cheaper, effective alternatives exist. The post criticizes the pharmaceutical industry and medical practice for overlooking simple solutions like melatonin. Scott also shares interesting facts about melatonin, including its potential uses beyond sleep aid. Shorter summary