The story tells of how some guy took some drug and apparently had positive effects. How does this anecdote affect me? Any medication I use should be tested in clinical trials and be prescribed to me personally, or be deemed safe for sale over the counter; i.e. non-prescribed use. Are other people using these anecdotes as sufficient reasons to actually take random drugs? I have to ask: Are these people insane?
If you have “an Everest of work”, the solution is to get less work, not to take drugs. Be the person you are.¹
① (Not applicable to actually prescribed medication or care from a licenced professional.)
Does your doctor prescribe your caffeine and alcohol? How about your artificial light and your exercise? Or perhaps your intake of B-complex vitamins or various edible oils? The various natural dietary supplements available at every Walgreens and CVS? All of these have known effects on mood and productivity, and pretty much everybody just tries 'em and sees what happens.
Nearly as many people have the experience of going to a doctor, getting diagnosed with something moderately uncommon, and going through a trial-and-error treatment process where they are guiding what happens as much or more than the doctor.
So no, they are not necessarily insane. What is covered by prescription varies a lot from country to country, and the line is at least as much about medical economics as it is about safety. There are plenty of things that aren't available over the counter not because they're more dangerous, but because they were discovered after the FDA was created and because the financial incentives are to keep them as prescription drugs.
> Does your doctor prescribe your caffeine and alcohol?
Strawman. I said “or be deemed safe for sale over the counter”.
> many people have the experience of going to a doctor, getting diagnosed with something moderately uncommon, and going through a trial-and-error treatment process where they are guiding what happens as much or more than the doctor.
The key word here are, I think, “going to a doctor”, as opposed to unsupervised self-medicating, or at least without supervision of a trained and licenced professional.
> What is covered by prescription varies a lot from country to country […]
That is not a straw man. My point is that the distinction between "thing I am doing to my body alone" and "thing I am doing to my body with the involvement of a licensed professional" is somewhat arbitrary.
Alcohol is not in fact safe for sale over the counter. But still, we sell it over the counter. Having a licensed professional involved on average makes some things better, but only on average, and only for some things. You don't have to be insane to say, "For X, I know better than my doctor." Indeed, that's an important component of people getting optimal treatment outcomes, doctor or no.
> My point is that the distinction between "thing I am doing to my body alone" and "thing I am doing to my body with the involvement of a licensed professional" is somewhat arbitrary.
Then you should have made that point explicitly. Instead, it looks like you are arguing against something I did not write.
And yes, the line is very arbitrary. However, that doesn’t mean that it does not exist, or that you are free to set it anywhere you feel like without worry or care. Unless you have the enormous resources to research on your own (but you don’t, nobody does), you should pick some other party which has done so (scientifically) and has subsequently set the line somewhere. And unless you have reason to doubt their veracity, you should adhere to that line. No, “I feel like it, it could be fun” or “I could make more money by using these performance-enhancing drugs” are not good enough reasons.
The point was made by the comment taken together. But I did make that point explicitly in the last paragraph. That you took the first sentence as if it were a standalone argument is not something for which I feel responsible.
> that doesn’t mean that it does not exist, or that you are free to set it anywhere you feel like without worry or care
Speaking of arguing against something I didn't write...
I still have trouble seeing it – it still looks very much like a classic strawman attack to me. I’ll believe you when you say that this is not what you intended, and that this is not what you see when you read it, but it is not what I saw or see. I think we can respectfully agree to disagree here.
> > […] that you are free to set it anywhere you feel like […]
I didn’t really mean you personally; I probably should have written “one” instead of “you”. The reason I didn’t is that it flows much worse, and “you” is also often used in that sense.
"Excessive alcohol use led to approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) each year in the United States from 2006 – 2010, shortening the lives of those who died by an average of 30 years. Further, excessive drinking was responsible for 1 in 10 deaths among working-age adults aged 20-64 years." from http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
"5,000 people under age 21 die each year from alcohol-related car crashes, homicides, suicides, alcohol poisoning, and other injuries such as falls, burns, and drowning. [...] More than 190,000 people under age 21 visited an emergency room for alcohol-related injuries in 2008 alone." from http://www.niaaa.nih.gov/alcohol-health/special-populations-...
If somebody invented it today, it would be thoroughly illegal. My point here is that teddyh's conflation of "legal to buy without a prescription" and "safe" is incorrect.
> If somebody invented it today, it would be thoroughly illegal. My point here is that teddyh's conflation of "legal to buy without a prescription" and "safe" is incorrect.
Fine, so exclude alcohol for being a special case as it was grandfathered in. I’ll readily grant this, since reclassifying something from safe to non-safe is generally risk-free. How does this affect the issue at hand, which was about Modafinil, Provigil and the like? If you think that alcohol is a special case, treat it as such; either it is an exception since it was grandfathered in, in which case it shouldn’t fall under the categories which you should consider safe merely because they are non-prescription, or it really is safe, in which case my argument is still valid. You can’t have it both ways, and it is really an irrelevant outlier example. What matters is not how I categorize it, but how you categorize it, and however you do, the argument works.
As I mention in my profile, anonymous argumentative people get less leeway. And you in particular seem to be looking for things to argue with, not trying to understand my point. So this is the last reply unless yours make a substantial jump in quality.
I am saying that what you claim as a clear bright line is in fact a wide blurry line that zigzags all over the place. The majority of Americans screw with their metabolisms and brain chemistry every day without the involvement of a doctor. And they do it based on nothing more than, "Well, that seems ok."
That Modafinil currently requires a prescription while caffeine and alcohol don't is mainly historical accident. That tells us very little about their relative safety. So again, your conflation of "legal" with 'safe" so you can call people insane doesn't really work.
There are obviously some things which affect metabolisms and brain chemistry which are either perfectly harmless or things that should obviously be permitted without supervision, e.g. exercise. Likewise, there are many, many things which nobody should ever mess with without serious medical consultation and possibly exploration of all other alternative options.
The question is, how does one draw the line between them? The government/state/doctors (one’s local FDA equivalent) purports to do this, and they have a lot in their favor, with large budgets, scientific studies and general trustworthiness. They are, however, hampered by tradition (e.g. grandfather clauses) and politics (e.g. drug war). This makes them obviously imperfect. The second, fallback, alternative, which people have relied on for as long as people have existed, is the grapevine. Hearsay, rumors, anecdotes, fads, trends, that sort of thing. These also have obvious problems, which I trust I don’t need to enumerate further.
My first argument is this: However imperfect the first option is, it is obviously better than the second option. I also suggested a third option, namely to select another large institution with the same advantages as the first option, but perhaps with less of the disadvantages. One could even mix and match, and, for instance, follow the FDA’s recommendations for all things except for weed, where one might choose to follow the equivalent authority in Portugal or maybe the Netherlands. My second argument is that with this third option, simply choosing the fallback second option is, indeed, of questionable sanity and prone to self-selection, cherry-picking and other kinds of experimental failure, all of which leads to bad science and extremely questionable and unreliable results.
The first option is the simple one, and is obviously acceptable. The third option is reasonable. The second one is indefensible given the availability of the other two.
The ease by which people fall to the second option when the first (large, traditional and authoritative) one fails them reminds me of this passage from Father Brown in The Oracle of the Dog (G. K. Chesterton, 1926):
‘ […] It’s part of something I’ve noticed more and more in the modern world, appearing in all sorts of newspaper rumours and conversational catchwords; something that’s arbitrary without being authoritative. People readily swallow the untested claims of this, that, or the other. It’s drowning all your old rationalism and scepticism, it’s coming in like a sea; and the name of it is superstition.’ He stood up abruptly, his face heavy with a sort of frown, and went on talking almost as if he were alone. ‘It’s the first effect of not believing in God that you lose your common sense and can’t see things as they are. Anything that anybody talks about, and says there’s a good deal in it, extends itself indefinitely like a vista in a nightmare. And a dog is an omen, and a cat is a mystery, and a pig is a mascot and a beetle is a scarab, calling up all the menagerie of polytheism from Egypt and old India; Dog Anubis and great green-eyed Pasht and all the holy howling Bulls of Bashan; reeling back to the bestial gods of the beginning, escaping into elephants and snakes and crocodiles; and all because you are frightened of four words: “He was made Man.”’
Your argument has a couple of false dichotomies. A, the person you're calling insane isn't necessarily picking from your first two options. And B, for each X, they may be choosing a different heuristic based on a sense of risk that has finer discrimination than your draw-a-line dichotomy.
The people I know who self-experiment certainly do better than running with, as your section option suggests, fads and hearsay. That's true both when they're using things that are legal but have mysterious health impacts and things that are sold by prescription but have reasonably well understood health impacts.
That you are ignorant of what they're up to isn't license to call them insane.
I am doubtful of anyone’s ability to, by themselves, research these matters sufficiently to have a supportable opinion on what risks are involved and what is safe or not. If I’m right about this, it makes options one or three the only reasonable options. I think this quote by Richard Feynman summarizes my thoughts quite well:
“Now, I might be quite wrong, maybe they do know all these things. But I don’t think I’m wrong, see, I have the advantage of having found out how hard it is to get to really know something, how careful you have to be about checking the experiments, how easy it is to make mistakes and fool yourself. I know what it means to know something. And therefore, I can’t… I see how they get their information, and I can’t believe that they know it – they haven’t done the work necessary, they haven’t done the checks necessary, they haven’t done the care necessary. I have a great suspicion that they don’t know.”
— Richard Feynman, The Pleasure of Finding Things Out (1981)
This is why we have large double-blind studies with control groups, and published papers, and peer review, and committees, and so forth – it’s really hard to actually know something. By contrast, it’s extremely easy to read a lot about something, listen to what a lot of people say about it and come to have what you might consider a reasonable, well-informed opinion about something, and therefore think you know something. But you don’t then actually know, you just think you do.
You are not right about that. I think your faith in the medical system is touching, and I hope you never have to experience enough of it to lose that faith.
Doctors have a reasonably good general medical background, but most of them have little or no idea on specific issues that they have not encountered directly in their recent practice. When something like that comes up, they go research it. Given typical patient loads, they research it quickly.
It is very easy for people to do that research themselves. They have access to all the same material that doctors do. Educated laypeople will quickly end up knowing more than the average doctor about their specific conditions.
Or pop over here, where HNers are currently discussing how an active advocate made a huge difference for another cancer patient, and how scarily little doctors know: https://news.ycombinator.com/item?id=8886164
With well-documented drugs like modafinil, your average GP will have little or no advantage in prescribing them over an educated layman who has really studied the topic. Indeed, the way many drugs with mental effects get used in practice is a doctor saying, "Well, let's try this." Followed by, "Does that feel better?" When I was my grandfather's conservator, his GP did exactly that with Prozac. When I asked some follow-up questions, it was painfully clear that he knew approximately nothing about the drug other than that the pharma marketroid said it could help with moods.
The point of the medical licensing system isn't to create perfect wisdom and great outcomes. It's to place some broad limits to limit some obvious harms and establish a mechanism of control. It should be no surprise that smart and motivated people can, in specific and limited circumstances, do better than that very low bar.
When your doctor is untrained, and you might do as well a job (or better) yourself, the conclusion is not to do the job yourself, but to get a competent doctor. Sure, that might not always be an option, but you should follow this principle as long as you are able.
Anyway, you’re talking about individual doctors; I was talking about the medical establishment as a whole, and in particular the FDA (or their local equivalent) and the medical scientists who do the studies upon which the FDA’s decisions are based. I have more faith in these sorts of institutions than any single random GP doctor – I don’t let my views on them tar the whole system with doubt.
> It should be no surprise that smart and motivated people can, in specific and limited circumstances, do better than that very low bar.
Yes, there are exceptions to every rule. But everyone believes themselves to be the exception, so you can’t trust your own opinion.
> I said “or be deemed safe for sale over the counter”.
You also said "Any medication [that] I use ...". So, are you saying that these rules are just for yourself or that everybody should follow the same logic that you do because you think it's the only logic and that anyone else who follows any different logic is "insane" as you said earlier?
In any case ~ I'm guessing you've never tried Marijuana, but what I'm really wondering is if you think all Marijuana users are insane? If the answer is no, then you're obviously contradicting your own argument. Otherwise, I'll have to conclude that you're just being a ridiculously overbearing ultra-conservative dickhead who speaks in one word sentences like "Strawman".
> ...you should find some other suitable scientific institution to trust.
Why? Because you said so? You didn't give a reason why you think that revealed knowledge is somehow better than rational knowledge....
If I know large groups of people who take a certain drug whether it be Modafinil or Marijunana and everybody reports positive effects...I feel quite confident enough to self-experiment. How am I insane?
> To instead trust random people’s anecdotes on the internet is quite possibly the worst thing you could do.
Do you have any proof that that's what's happening though?
In my experience people don't read one article and make a decision. They typically use this thing called a Search Engine to find out more information about the topic and end up reading dozens of articles, studies, user testimonials, etc.
The rules I stated are (as I wrote) for myself, and others might follow different rules (like the one I suggested in my linked comment), but yes, using anecdotes from the Internet as sufficient reason to take drugs seems to me to be insane. (Not necessary clinically insane, mind you, just your garden-variety crazy people type of insanity.)
> [Do] you think all Marijuana users are insane?
The people who live where it is legal are certainly not insane (necessarily). The people who don’t might choose to place their trust in credible scientific institutions other than their local government or doctors, and those people are not necessarily insane either. However, if you choose to smoke weed for a reason like “all my friends are doing it” or “I read about how some other people claim to be doing it” then yes, that is slightly insane and idiotic.
> Why? Because you said so?
No, but because it would be obviously better to do what I wrote than to trust a too-small non-random (often self-selecting) sample of stories of unknown veracity.
> > Strawman.
> That seems very rude and uncalled for.
It was a strawman argument. I never called for avoiding caffeine or exercise just because these things affect people’s mood – I explicitly exempted all things which do not require a doctor’s prescription. To pretend I said otherwise and argue against it is a strawman argument.
That's a very conservative way of looking at it. One can also observe that the political establishment concerned with the "war on drugs" is driven by moral panic, not science, and the legality and availability of psychoactive substances is therefore a function of politics, uncorrelated with safety or efficacy.
I trust random strangers on the internet to provide me with accurate and useful information about the composition and subjective effects of various experimental drugs far more than I trust the official bodies in charge of regulating them, because the official bodies are proven to be untrustworthy, while random strangers on the internet may or may not be untrustworthy.
If, for political reasons such as you mention, you don’t trust your the government of your own country to determine which medications are safe, you should find some other suitable scientific institution to trust. Perhaps some other country’s, which does not have the problem you see in your own country.
To instead trust random people’s anecdotes on the internet is quite possibly the worst thing you could do.
If you have “an Everest of work”, the solution is to get less work, not to take drugs. Be the person you are.¹
① (Not applicable to actually prescribed medication or care from a licenced professional.)