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.
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.