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

A review of 'Public Citizens' by Paul Sabin, examining how Ralph Nader's public interest movement transformed American governance, with both positive and negative long-term effects. Longer summary

This book review discusses 'Public Citizens' by Paul Sabin, which explores how Ralph Nader and the public interest movement he inspired transformed American governance, leading to unintended consequences that now hinder progressive action. The review traces Nader's career from his early advocacy for auto safety to his creation of a new model of activism through litigation and regulatory pressure. It examines how this approach, while achieving significant reforms, also contributed to the current bureaucratic gridlock in American governance. The review concludes with a brief discussion of Nader's controversial role in the 2000 presidential election. Shorter summary

Scott Alexander reviews a book critiquing Institutional Review Boards, arguing they now harm medical research more than they help. Longer summary

Scott Alexander reviews Simon Whitney's book 'From Oversight To Overkill', which critiques the current state of Institutional Review Boards (IRBs) in medical research. The book traces the history of IRBs from their noble beginnings to their current state of over-regulation and obstruction. Whitney argues that while IRBs were intended to protect research subjects, they now cause more harm than good by delaying or preventing potentially life-saving research. The review discusses several case studies that illustrate the problems with IRBs, and concludes by considering Whitney's proposed reforms and the broader societal trends that have led to this situation. 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

A review of Ray Huang's '1587, A Year of No Significance', examining the decline of the Ming dynasty through the lens of an apparently uneventful year. Longer summary

This book review examines '1587, A Year of No Significance: The Ming Dynasty in Decline' by Ray Huang. The reviewer details the book's exploration of a seemingly uneventful year in Ming dynasty China, highlighting how it exemplifies the systemic inertia and decline of the empire. The review covers key figures like the Wan-Li Emperor, Grand Secretaries Chang and Shen, and other notable individuals, while drawing parallels to other historical contexts and discussing the broader implications of the Ming dynasty's governance style and eventual fall. Shorter summary

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

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

Scott Alexander discusses the trade-offs between accuracy and liability in medical information, extending the analysis to public health experts and the role of expertise in society. Longer summary

Scott Alexander explores the challenges of providing accurate medical information online, using his own experience with a psychiatry database and comparing it to WebMD. He argues that larger, more legitimate sources like WebMD and government agencies often provide less useful information due to liability concerns and political pressures. The post then extends this analysis to public health experts like Dr. Fauci, suggesting that while they may not always provide the best advice, they serve an important role as 'legibly mediocre' sources of information in a complex system. Scott concludes that while the current system of expertise is flawed, it's better than alternatives and deserves some appreciation. Shorter summary

Scott examines the possibility that bureaucracy sometimes serves as an intentional barrier to discourage unnecessary requests, particularly in healthcare, but questions how widely this concept applies. Longer summary

This post explores the idea that bureaucracy might sometimes serve as an active ingredient in plans rather than just being inefficient. Scott presents a hypothetical scenario where insurance companies use bureaucratic hurdles to discourage unnecessary use of expensive medications. He suggests that the time and effort required to navigate bureaucracy can act as a filter, separating those who truly need a service from those who don't. However, Scott expresses uncertainty about how widely this concept applies, noting that it doesn't explain bureaucracy in places like the DMV. He concludes that while this idea might explain some instances of bureaucracy, particularly in healthcare, it shouldn't be overgeneralized. 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 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 recounts his frustrating attempt to conduct a study on a bipolar disorder screening test, highlighting the excessive bureaucratic hurdles that ultimately led to the study's abandonment. Longer summary

Scott Alexander describes his frustrating experience trying to conduct a study on the validity of a bipolar disorder screening test. He encounters numerous bureaucratic hurdles from the Institutional Review Board (IRB), including issues with consent forms, data security, and patient privacy. Despite his best efforts and those of his colleagues, the study is eventually abandoned due to the overwhelming regulatory burden. Scott reflects on how this experience has made him skeptical of the current research approval process, arguing that it disproportionately hinders small-scale, independent researchers while favoring large institutions. He concludes by expressing hope for reform in the scientific research process to make it more accessible and efficient. Shorter summary

Scott humorously describes his frustrating attempts to dispose of an oversized trash can, exploring various communication strategies with garbage collectors. Longer summary

Scott humorously recounts his ongoing struggle to get rid of an oversized trash can. Despite putting it out for bulk pickup, garbage collectors either empty its contents or ignore it entirely due to its non-regulation size. His attempts to communicate his intent through signs, including a philosophical reference to the map-territory distinction, have so far failed. The post ends with Scott contemplating more creative ways to convey his message to the garbage collectors. Shorter summary

Scott presents a humorous list of fictional drugs banned by the FDA, each with unexpected and often ironic consequences. Longer summary

This post is a satirical list of fictional drugs banned by the FDA, each with a unique profile and an often ironic or paradoxical reason for its ban. The drugs range from treatments for pre-traumatic stress disorder to antibiotics for intelligent bacteria. Each drug description includes its intended use and the unexpected consequences that led to its ban. The post uses humor and creativity to explore themes of unintended consequences in medicine, the complexities of drug development, and the sometimes absurd nature of bureaucratic decision-making. Shorter summary