How to explore Scott Alexander's work and his 1500+ blog posts? This unaffiliated fan website lets you sort and search through the whole codex. Enjoy!

See also Top Posts and All Tags.

Minutes:
Blog:
Year:
4622 tags
Show all filters
30 posts found
Aug 22, 2024
acx

The Compounding Loophole

13 min • 1,806 words • 330 comments • 210 likes • podcast (11 min)
Scott Alexander examines how compounding pharmacies are producing cheaper versions of GLP-1 agonist drugs, exploring the economics, safety, and future implications of this practice. Longer summary
Scott Alexander discusses the 'compounding loophole' that allows compounding pharmacies to produce cheaper versions of GLP-1 agonist drugs like semaglutide (Ozempic). He explains how these pharmacies operate, the cost differences, safety concerns, and potential future implications. The post covers the legal basis for this practice during drug shortages, the impact on drug manufacturers like Novo Nordisk, and speculates on what might happen when the shortage ends. Scott also touches on the broader implications for drug pricing and availability. Shorter summary
Apr 16, 2024
acx

Updates on Lumina Probiotic

13 min • 1,699 words • 167 comments • 152 likes • podcast (11 min)
Scott Alexander updates on Lumina probiotic, discussing FDA trials, effectiveness, potential risks, and his nuanced stance on the product. Longer summary
Scott Alexander provides updates on Lumina, a genetically modified anti-tooth-decay bacterium. He clarifies information about FDA testing, discusses rat trial results, reports on recent colonization studies, addresses potential side effects, and shares some anecdotal results. Scott also explains his stance on Lumina, emphasizing that while he sees potential benefits, he doesn't fully endorse it and acknowledges the uncertainties and risks involved. Shorter summary
Dec 07, 2023
acx

Defying Cavity: Lantern Bioworks FAQ

22 min • 3,074 words • 417 comments • 222 likes • podcast (18 min)
Scott Alexander reviews Lantern Bioworks' Lumina, a genetically modified bacterium designed to prevent tooth decay, discussing its science, safety, and commercialization plans. Longer summary
Scott Alexander discusses Lantern Bioworks' new product, Lumina, a genetically modified bacterium designed to prevent tooth decay. The post covers the science behind the product, its origins, usage, potential risks, and the company's plans for commercialization. Scott explains the genetic modifications made to the bacterium, addresses safety concerns, and discusses the regulatory path Lantern is pursuing. The article also touches on the product's pricing strategy and availability. Shorter summary
Dec 06, 2023
acx

Beyond "Abolish The FDA"

17 min • 2,333 words • 470 comments • 196 likes • podcast (14 min)
Scott Alexander examines the complexities of abolishing the FDA and proposes more practical alternatives to increase medical innovation while maintaining safeguards. Longer summary
Scott Alexander discusses the challenges of abolishing the FDA, a popular libertarian idea. He explores various issues that would arise, such as the fate of prescription medications, drug contamination inspections, and the potential for exploitation by unethical companies. The post then proposes two more practical alternatives to complete FDA abolition: legalizing artificial supplements and creating an 'experimental drug' category. These suggestions aim to increase medical innovation and access while maintaining some safeguards. Shorter summary
Nov 24, 2022
acx

Semaglutidonomics

31 min • 4,257 words • 752 comments • 217 likes • podcast (30 min)
Scott Alexander analyzes the economic and societal implications of semaglutide, a new effective weight loss drug, and its potential to reshape obesity treatment. Longer summary
Scott Alexander explores the economic and societal impact of semaglutide, a new weight loss drug. He discusses its effectiveness, current limited availability, and potential future widespread use. The post covers the drug's history, its current pricing and accessibility issues, and projections for its future market. Scott also touches on the broader implications for obesity treatment and the possibility of a 'post-obesity' future. Shorter summary
Oct 05, 2022
acx

How Trustworthy Are Supplements?

51 min • 7,076 words • 166 comments • 179 likes • podcast (48 min)
Scott Alexander investigates the reliability of dietary supplements, finding that while issues exist, most are not completely fake as some media reports claim. Longer summary
Scott Alexander examines the trustworthiness of dietary supplements, debunking widespread claims that most are completely fake. He analyzes studies, consumer lab reports, and industry insider accounts to conclude that while there are issues in the supplement industry, outright fraud is rare, especially for common vitamins and minerals. More complex botanicals and trendy supplements may have more variability, but complete absence of active ingredients is uncommon. Scott suggests consumers should be discerning, especially with lesser-known products, but notes that for many supplements, precise dosing may not be critical. Shorter summary
Mar 10, 2022
acx

Progesterone Megadoses Might Be A Cheap Zulresso Substitute

5 min • 693 words • 88 comments • 52 likes • podcast (8 min)
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 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
Nov 23, 2021
acx

Highlights From The Comments On The FDA And Paxlovid

11 min • 1,474 words • 64 comments • 62 likes • podcast (11 min)
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
Aug 20, 2021
acx

Highlights From The Comments On Aducanumab

45 min • 6,181 words • 225 comments • 57 likes • podcast (39 min)
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
Aug 08, 2021
acx

Contra Drum On The Fish Oil Story

26 min • 3,628 words • 276 comments • 114 likes • podcast (24 min)
Scott Alexander defends his criticism of the FDA's approval process in the infant fish oil case, arguing that systemic issues cause harmful delays even when the FDA follows its mandate. Longer summary
Scott Alexander responds to Kevin Drum's criticism of his interpretation of the infant fish oil story. He maintains that his account was substantially correct, despite some minor errors. Scott argues that the FDA's approval process, while following its mandate, causes unnecessary delays in life-saving treatments. He uses analogies to illustrate how the FDA's structure can be problematic even when individual employees perform well. Scott emphasizes that his criticism is not about the FDA failing its mandate, but about the design of the system itself causing delays in implementing known beneficial treatments. He concludes by addressing Drum's skepticism of FDA critics, arguing that anger towards the FDA often comes from personal experiences with its shortcomings. Shorter summary
Aug 06, 2021
acx

Details Of The Infant Fish Oil Story

26 min • 3,615 words • 284 comments • 129 likes • podcast (25 min)
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
Aug 05, 2021
acx

Adumbrations Of Aducanumab

39 min • 5,324 words • 650 comments • 259 likes • podcast (34 min)
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
Apr 27, 2021
acx

Verses Written On The Occasion Of Getting The COVID Vaccine

4 min • 456 words • 340 comments • 152 likes
Scott Alexander writes a humorous poem about getting the COVID-19 vaccine, set to a Les Misérables tune, exploring lockdown frustrations and the complexities of returning to normalcy. Longer summary
This post is a creative writing piece in the form of verses set to the tune of a song from Les Misérables. It humorously depicts the experience of getting the COVID-19 vaccine and the conflicting desires between citizens wanting freedom and epidemiologists urging continued caution. The verses highlight various frustrations with lockdowns, and end with the narrator receiving the vaccine but still being advised to follow restrictions. The piece concludes with the narrator expressing a sense of freedom and resentment towards the FDA for delays in vaccine approval. Shorter summary
Mar 31, 2021
acx

Oh, The Places You'll Go When Trying To Figure Out The Right Dose Of Escitalopram

17 min • 2,325 words • 127 comments • 76 likes • podcast (18 min)
Scott Alexander investigates the optimal dosage of Lexapro, comparing it to other antidepressants and exploring the reasons behind its effectiveness at lower doses. Longer summary
Scott Alexander explores the question of the right dose for Lexapro (escitalopram), an antidepressant. He examines official recommendations, compares Lexapro to other SSRIs, and investigates why Lexapro might be effective at lower doses. The post delves into studies on antidepressant dosing, the unique properties of Lexapro, and the potential benefits and risks of higher doses. Scott concludes that while there's no strong evidence for high doses of any antidepressant being more effective, prescribing higher doses of Lexapro might be as safe as other SSRIs and potentially more beneficial in some cases. Shorter summary
Mar 02, 2021
acx

Shilling For Big Mitochondria

18 min • 2,465 words • 292 comments • 132 likes • podcast (18 min)
Scott Alexander explores the history and mechanism of DNP, a dangerous but effective weight-loss drug, and discusses recent developments in safer mitochondrial uncoupling agents. Longer summary
Scott Alexander discusses 2,4-dinitrophenol (DNP), a controversial and dangerous weight-loss drug that works by uncoupling mitochondria. He traces its history from the 1930s to modern times, explaining its effectiveness and severe side effects. The post then explores recent developments in mitochondrial uncoupling research, including potential safer alternatives and therapeutic applications beyond weight loss. Shorter summary
Feb 16, 2021
acx

Coronavirus: Links, Discussion, Open Thread

24 min • 3,279 words • 658 comments • 154 likes • podcast (21 min)
Scott Alexander analyzes the COVID-19 pandemic's progress, predicts future waves, and speculates on its long-term impact and transition to an endemic disease. Longer summary
Scott Alexander discusses the current state and future predictions for the COVID-19 pandemic in the US. He outlines the past waves of infections, predicts future waves due to new virus strains, analyzes vaccine efficacy against these strains, and speculates on how the pandemic might eventually transition to an endemic seasonal illness like the flu. He also touches on potential long-term societal changes and makes several specific predictions about future developments. Shorter summary
May 09, 2019
ssc

Is There A Case For Skepticism Of Psychedelic Therapy?

8 min • 1,039 words • 100 comments • podcast (9 min)
Scott Alexander presents a case for skepticism about psychedelic therapy in psychiatry, outlining seven points of concern while still supporting further research. Longer summary
Scott Alexander discusses reasons for skepticism about the potential of psychedelic therapy in psychiatry. He outlines seven main points of concern: small studies by enthusiasts leading to unreplicable results, the tendency for all psychotherapies to have amazing success stories, comparison with ketamine's underwhelming results, the case of NSI-189 which failed in trials despite anecdotal success, the lack of obvious effects given widespread psychedelic use, the possibility that insights from psychedelics are illusory, and potential FDA restrictions limiting access and effectiveness. Despite these concerns, Scott supports psychedelic research and hopes to be proven wrong. Shorter summary
Dec 08, 2017
ssc

What To Make Of New Positive NSI-189 Results?

15 min • 2,043 words • 171 comments • podcast (16 min)
Scott Alexander examines the rise, fall, and alleged resurrection of the antidepressant NSI-189, expressing skepticism about its efficacy and the broader challenges in developing new antidepressants. Longer summary
Scott Alexander discusses the disappointing results of NSI-189, a promising new antidepressant, in FDA trials. He explains how the drug initially failed to outperform placebo on the primary endpoint, leading to a stock crash for Neuralstem. However, the company later released positive secondary endpoint results, causing their stock to rise again. Scott expresses skepticism about these new results, suggesting they may be due to statistical manipulation rather than true efficacy. He reflects on the challenges of developing new antidepressants and the tendency to get overly excited about new drugs, ending with a sardonic hope for another new antidepressant, SAGE-217. Shorter summary
May 18, 2017
ssc

Postmarketing Surveillance Is Good And Normal

13 min • 1,738 words • 74 comments
Scott Alexander argues that the 33% rate of post-marketing safety events for FDA-approved drugs is not necessarily concerning and explains why post-marketing surveillance is a normal part of drug safety monitoring. Longer summary
Scott Alexander discusses a study showing that 33% of FDA-approved drugs in the past decade have faced post-marketing safety events. He argues that this doesn't necessarily mean the FDA is too lax, explaining that post-marketing surveillance is a normal and necessary part of drug safety monitoring. He points out that only 1.3% of drugs were actually withdrawn from the market, which he considers a good success rate. Scott explains why it's impossible to catch all potential side effects in pre-approval studies and gives examples of safety communications that range from important to seemingly trivial. He concludes that the 33% figure alone is meaningless without a broader cost-benefit analysis of FDA approval standards. Shorter summary
Jan 18, 2017
ssc

Watch New Health Picks

14 min • 1,929 words • 632 comments
Scott Alexander discusses potential Trump administration health-related appointments, focusing on FDA commissioner candidates Jim O'Neill and Balaji Srinivasan, and their potential to implement beneficial reforms. Longer summary
Scott Alexander discusses potential Trump administration picks for key health-related positions, particularly the FDA commissioner and NIH chief. He expresses excitement about the possibility of Jim O'Neill or Balaji Srinivasan being chosen for FDA commissioner, viewing them as principled libertarians who could implement beneficial reforms. Alexander outlines several policies these candidates might pursue, such as medical reciprocity with other countries and streamlining generic drug approvals. He also mentions John Ioannidis as a surprising potential pick for NIH chief, praising his work in improving medical research standards. The post concludes by noting that pharmaceutical industry stocks haven't moved much in response to these potential appointments. Shorter summary
Aug 29, 2016
ssc

Reverse Voxsplaining: Drugs vs. Chairs

12 min • 1,657 words • 737 comments • podcast (12 min)
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
Jan 20, 2016
ssc

Side Effects May Include Anything

8 min • 1,072 words • 286 comments
Scott Alexander criticizes websites that misleadingly suggest drug side effects by scraping FDA data, potentially causing patients to stop taking necessary medications. Longer summary
Scott Alexander criticizes websites like EHealthMe that automatically generate pages suggesting connections between drugs and side effects based on FDA data scraping. He argues these sites are misleading and potentially harmful, as they can cause patients to stop taking necessary medications due to unfounded fears of side effects. The post begins with a personal anecdote about a patient concerned about Xolair causing depression, then delves into how these websites operate and why their information is unreliable. Scott emphasizes the scummy nature of these practices and their potential to harm vulnerable individuals, concluding with a stark example of how such misinformation could lead to tragedy. Shorter summary
Nov 12, 2014
ssc

How To Use 23andMe Irresponsibly

15 min • 1,998 words • 73 comments
Scott Alexander explains how to interpret 23andMe genetic data using SNPedia, listing various SNPs and their alleged effects while emphasizing the unreliability of such interpretations. Longer summary
Scott Alexander humorously explores how to use 23andMe genetic testing data 'irresponsibly' by looking up various SNPs (Single Nucleotide Polymorphisms) and their purported effects. He provides instructions on how to access raw genetic data from 23andMe and interpret it using SNPedia. The post then lists several interesting SNPs associated with traits like violence, empathy, anxiety, divorce risk, and longevity. Scott repeatedly emphasizes that these associations are often unreliable, exaggerated, or misinterpreted, and should be taken as entertainment rather than medical advice. Shorter summary
Jul 24, 2014
ssc

Some Antibiotic Stagnation

9 min • 1,171 words • 44 comments
Scott Alexander debunks a misleading graph on antibiotic discovery and presents more accurate data, discussing reasons for the decline in antibiotic development. Longer summary
Scott Alexander critiques a misleading graph about antibiotic discovery, pointing out its numerous errors and omissions. He then presents his own data on antibiotic discovery rates, showing a decline but not as severe as the original graph suggested. The post discusses potential causes for this decline, including scientific challenges, economic factors, and regulatory issues. Scott also notes that using antibiotics as a measure of scientific progress may be unfair due to the nature of their discovery, and contrasts this with the rapid progress in antidiabetic drugs. Shorter summary