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!

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Aug 02, 2024
acx

Your Book Review: Two Arms and a Head

69 min • 9,621 words • 568 comments • 222 likes • podcast (55 min)
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
May 09, 2024
acx

The Emotional Support Animal Racket

11 min • 1,438 words • 867 comments • 425 likes • podcast (10 min)
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
Feb 23, 2024
acx

Who Does Polygenic Selection Help?

9 min • 1,185 words • 622 comments • 177 likes • podcast (8 min)
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
Feb 01, 2024
acx

It's Fair To Describe Schizophrenia As Probably Mostly Genetic

29 min • 3,953 words • 340 comments • 198 likes • podcast (22 min)
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
Nov 07, 2023
acx

Highlights From The Comments On Kidney Donation

78 min • 10,916 words • 489 comments • 106 likes • podcast (56 min)
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
Oct 27, 2023
acx

My Left Kidney

54 min • 7,464 words • 952 comments • 517 likes • podcast (39 min)
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
Jul 14, 2023
acx

Contra The Social Model Of Disability

25 min • 3,485 words • 781 comments • 258 likes • podcast (21 min)
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
Apr 17, 2023
acx

Highlights From The Comments On IRBs

58 min • 8,045 words • 127 comments • 58 likes • podcast (43 min)
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
Apr 03, 2023
acx

Highlights From The Comments On Telemedicine Regulations

36 min • 4,965 words • 134 comments • 100 likes • podcast (27 min)
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
Nov 16, 2022
acx

The Psychopharmacology Of The FTX Crash

53 min • 7,401 words • 375 comments • 219 likes • podcast (47 min)
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
Nov 24, 2021
acx

Pascalian Medicine

18 min • 2,497 words • 510 comments • 111 likes • podcast (19 min)
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
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 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
Dec 10, 2019
ssc

[ACC] What Are The Benefits, Harms, And Ethics Of Infant Circumcision?

17 min • 2,321 words • 466 comments • podcast (17 min)
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
Aug 29, 2018
ssc

Bulls**t Jobs (Part 1 of ∞)

6 min • 715 words • 308 comments • podcast (6 min)
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
Mar 22, 2018
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Navigating And/Or Avoiding The Inpatient Mental Health System

61 min • 8,438 words • 208 comments • podcast (54 min)
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
Aug 31, 2017
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Highlights From The Comments On My IRB Nightmare

29 min • 3,963 words • 183 comments
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
Apr 04, 2017
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Determining Consent

21 min • 2,866 words • 483 comments
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
Nov 10, 2016
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Book Review: House of God

40 min • 5,502 words • 153 comments
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
Jul 12, 2016
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3/4

26 min • 3,531 words • 596 comments
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
Feb 24, 2016
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Two Attitudes In Psychiatry

17 min • 2,354 words • 422 comments
Scott Alexander explores two contrasting attitudes in psychiatry, discussing their merits and pitfalls, while reflecting on his own tendency to favor a more straightforward approach. Longer summary
Scott Alexander discusses two contrasting attitudes in psychiatry: Attitude 1, which takes patients' requests at face value, and Attitude 2, which seeks to unravel underlying complexities. He provides examples where Attitude 2 is clearly beneficial, but also highlights its potential for misuse. The author admits to leaning towards Attitude 1, partly due to personal preferences and social pressures. He expresses uncertainty about whether this approach is always correct and worries about potentially missing important underlying issues. The post reflects on the challenges of balancing these approaches in psychiatric practice. Shorter summary
Oct 12, 2015
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Against Against Autism Cures

40 min • 5,489 words • 862 comments
Scott Alexander critiques the autism rights movement's opposition to curing autism, arguing that severe cases cause immense suffering that justifies continued research into cures. Longer summary
Scott Alexander discusses the autism rights movement and their opposition to curing autism. While supporting most of their work, he disagrees with the stance against cures. He argues that severe autism causes immense suffering that cannot be alleviated solely through better treatment, and that research into cures should continue. He acknowledges the benefits autism can bring, but believes the costs outweigh them for many individuals. The post examines outcomes for autistic adults, issues with institutionalization, and ethical considerations around curing or preventing autism. Shorter summary
Jun 29, 2015
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Reflections From The Halfway Point

20 min • 2,766 words • 485 comments
Scott reflects on his psychiatry residency experiences, discussing the realities of psychiatric hospitals, patient care challenges, and his transition to outpatient work. Longer summary
Scott reflects on his experiences halfway through his four-year psychiatry residency. He discusses the unexpected orderliness of psychiatric hospitals, the limitations of short-term psychiatric care, and the challenges of dealing with patients' requests and complaints. He contrasts the security theater aspect of inpatient care with the actual therapeutic benefits, noting that many patients don't find their hospital stay helpful. Scott expresses his exhaustion from constant moral self-questioning and looks forward to transitioning to outpatient work. He concludes by sharing his concerns about outpatient psychiatry, wondering if he might be useless or if the job is more difficult than it seems, given the mistakes he's observed in other outpatient psychiatrists. Shorter summary