text stringlengths 136 178k | author stringclasses 5
values | id stringlengths 6 9 | title stringlengths 9 112 | source stringclasses 1
value |
|---|---|---|---|---|
# Know Your Amphetamines
In the 1950s, a shady outfit called Obetrol Pharmaceuticals made a popular over-the-counter diet pill called Obetrol. If you're familiar with any of: the 1950s, shady pharma, or diet pills, your next question will be "did it contain amphetamines?" and the answer is yes, loads of them. Obetrol was a mix of four different amphetamine salts: racemic amphetamine sulfate, dextroamphetamine sulfate, methamphetamine saccharate, and methamphetamine hydrochloride. Why did they need four different kinds of speed? I'm not sure. The uncharitable explanation is: for the same reason Dr. Nick's Cure-All Home Remedy has twelve different herbs, ie customers think things with more ingredients are better.
By the 1970s, people figured out meth was bad, so Obetrol replaced their two methamphetamine salts with two more kinds of non-methylated amphetamine. But the FDA continued to crack down, and although the historical paper trail goes kind of dark, it looks like Obetrol had disappeared by the 1980s.
As usual in pharma, someone bought Obetrol Pharmaceuticals, then someone else bought *them*, and after a few iterations of this, all their intellectual property ended up with a company called Richwood. They decided to rebrand Obetrol as "**Adderall**" and pitch it as an ADHD cure.
Treating ADHD with amphetamines was hardly a new invention. Psychiatrists had been doing it since the 1930s, albeit with slightly different drugs. Remember, many organic chemicals come in two versions, a "right-handed" or "d" version and a "left-handed" or "l" version. Benzedrine (a 50-50 d/l split) and Dexedrine (pure d-amphetamine) were the treatments of choice throughout the mid-20th century. So why was it Adderall - a weird combination of four different salts selected kind of at random by a sketchy diet pill company - that caught on?
I'm not sure. My best guess is good timing plus good advertising. In the early 20th century, ADHD was called "minimal brain dysfunction" and diagnosed only in the most extreme cases. A few children with absolute and total inability to function at all got diagnosed and given Benzedrine or Dexedrine; everyone else was left to fend for themselves. As far as I know, this wasn't because doctors had a principled commitment only to diagnose extreme cases - I found [a paper from 1975](https://sci-hub.se/https://www.annualreviews.org/doi/abs/10.1146/annurev.me.26.020175.000401?journalCode=med) arguing that up to 5 - 10% of children probably had minimal brain dysfunction, the same number estimated to have ADHD today. Parents just didn't know about it and didn't really have "take my kid to a psychiatrist" in their set of plausible options to consider.
In the early 1990s, psychiatric research, a series of popular self-help books, and the business interests of Richwood Pharmaceuticals all converged on the idea that it was important to get more people diagnosed with ADHD. Adderall entered the market at exactly the right time, and it became everyone's go-to ADHD medication.
*US Ritalin consumption in millions of doses/year, probably a good proxy for number of ADHD diagnoses, approximately septupled during the 1990s ([source](https://web.archive.org/web/20071012061712/http://www.dea.gov/pubs/cngrtest/ct051600.htm))*
Even if we agree that amphetamines are the right treatment for ADHD (many people don't!), how concerned should we be that the particular amphetamines we use are a random mix of salts selected by sketchy 1950s diet-pill peddlers? **Dexedrine** is an older formulation with pure d-amphetamine (sulfate). No l-amphetamine, no weird combination of salts. Should we just use that?
This is hard to study, because it's not obvious how to dose both medications. If we start out suspecting that both isomers are equally strong, we might dose 10 mg of Dexedrine vs. 10 mg of Adderall. But in fact we have reason to think that d-amphetamine is a bit stronger, so maybe 7 mg of Dexedrine vs. 10 mg of Adderall? But then any difference we find might just be a question of choosing the wrong doses rather than a real distinction.
[Arnold, Huestis, and Smeltzer, 1976](https://jamanetwork.com/journals/jamapsychiatry/article-abstract/491507) and [Gross, 1976](https://pubmed.ncbi.nlm.nih.gov/1106966/) compare pure d-amphetamine to a mix of d and l amphetamines. Both studies find that both d-amphetamine and l-amphetamine are effective stimulants, but that d-amphetamine seems to work better for most people. A [rat model](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265273/) also finds some modest superiority for d-amphetamine, showing that both isomers improve attention, but d-amphetamine additionally improves hyperactivity and impulsivity.
Is there any advantage at all to including l-amphetamine? AHS find that a small subgroup of patients seem to do better on it, but this is a study from 1976 and honestly I don't trust them to find small subgroups responsibly. And Gross finds that some people have fewer side effects on a mix of both than on d-amphetamine alone. This is a bit strange - shouldn't two chemicals have more side effects than one chemical? My guess is that d-amphetamine is just stronger, and so people getting their amphetamines as a mix of a strong chemical and a weak chemical are effectively on a lower dose and get fewer side effects.
[James et al](https://sci-hub.se/10.1097/00004583-200111000-00006) switch children back and forth between Adderall and Dexedrine to see which works best. They find the winner changes from measure to measure. But the tiebreaker was just asking the teacher which week the child seemed to be doing the best work in class, and the teacher chose a Dexedrine week almost twice as often as an Adderall week.
[Joyce, Glaser, and Gerhardt](https://sci-hub.se/10.1007/s00213-006-0550-9) claim to find that Adderall creates stronger and more prolonged changes in dopamine release than other amphetamines. But they use a bizarre dosing regimen which equates 0.5 nmol Dexedrine, 0.68 nmol Adderall, and 1 nmol racemic amphetamine as "identical doses" of each, based on a theory that l-amphetamine has no independent action but just modulates d-amphetamine. As far as I can tell this is totally false, and their study contradicts everything else I know, so I am going to nervously ignore it for now.
What about the evidence from patient ratings? Online databases contain several thousand of these...
...and they pretty conclusively show that on average patients prefer Dexedrine to Adderall. This is unblinded and uncontrolled, we don't know what dose any of them were on, and patients sometimes like addictive medications that aren't very good for them by normal medical standards. But again it seems like a pretty resounding victory for Dexedrine, which is what I'd expect. Honestly it's pretty weird that our go-to ADHD medication includes four random salts and a bunch of l-amphetamine when a pure d-amphetamine medication we could use instead is *right there*.
I do appreciate Dr. Charles Popper's contribution [here](https://sci-hub.se/https://www.liebertpub.com/doi/abs/10.1089/cap.1994.4.217?journalCode=cap); he notes that since Adderall has so many different salts, they take different amounts of time to get absorbed by your body, which means Adderall has a more gradual onset and offset compared to something purer like Dexedrine. Things with gradual onsets and offsets are probably less addictive and less likely to produce withdrawals and "crashes". As far as I can tell, this is the strongest pro-Adderall argument.
**Vyvanse** is the newest and most expensive member of the amphetamine stimulant family. It's lisdexamphetamine - ie Dexedrine attached to a random inactive molecule called lysine. As long as the lysine is attached, it can't stimulate anything. The body removes the lysine at a slow, consistent rate, which means that you get a slow, consistent release of stimulant into the bloodstream. This is advertised as especially good for people who are worried about addiction. It's hard to abuse or overdose on Vyvanse; no matter how much you take, your body will still only activate it at the same, slow rate.
My patients love Vyvanse. I try hard to convince people to take older, less expensive medications unless they're absolutely sure that the newer flashier one works better, but my patients are very convinced Vyvanse works better than Adderall. I used to think this was because something about the complicated timed release mechanism makes it "smoother". This is definitely what the pharma company that designed it *wants* me to think, and I admit there is some evidence for it.
But one neglected perspective is that once you take away the lysine, Vyvanse is basically Dexedrine, not Adderall. Almost everyone likes Vyvanse better than what they were taking before. But usually they were taking Adderall before. If Dexedrine is really better than Adderall - and common sense and the patient rating websites say it is - then that goes some of the way to explaining Vyvanse's superiority before we even get to the complicated timed release stuff. Pharmaceutical companies are always trying to re-release old medications in ways that bamboozle you into thinking they're new medications, so they can charge more money for them. In this case they did so good a job that I honestly can't tell if that's what they're doing or not.
**Evekeo** takes Adderall's questionable decision to include l-amphetamine and doubles down on it. Remember, Dexedrine is 100% d-amphetamine and Adderall is 75% d, 25% l. Well, Evekeo is 50-50. This should make it strictly worse than Adderall, and my patients' feedback seems to agree with this. The supposed point of making it is those studies that show a small subgroup of people seem to get some extra benefit from l-amphetamine. The real point of making it is probably as a me-too drug; it doesn't require any research, since l-amphetamine and d-amphetamine have both been around forever, but since it's new and different you can charge a lot of money for it.
I can't think of any situation where it would be reasonable to prescribe Evekeo as a first-line stimulant. If someone has done sort of okay on Adderall but has lots of side effects, and you put them on Dexedrine and they get worse instead of better, I suppose you could try putting them on Evekeo to see if they really are in the small subgroup of l-amphetamine beneficiaries. I'm just annoyed that this relatively rare legitimate use case serves a fig leaf for the inevitable Big Pharma campaign to push this new on-patent very expensive medication on a bunch of people who don't need it.
**Desoxyn** is the undisputed king of the patient rating websites. Here's the same graph as before, except I've added Desoxyn to the last column:
These are some amazing numbers. Adderall itself usually has one of the highest ratings of the thousands of drugs on the site, Dexedrine beats Adderall handily, and Desoxyn wipes the floor with Dexedrine (except on WebMD, which has the smallest sample size). This drug is getting ratings that shouldn't even be possible. And the patient summaries are in line with this - here are a few:
> I have been on every derivative and variation of stimulant, SSNRis SSRI, Tricyclics, beta blockers and all sorts of combinations of above and never have come across such an amazing compound. as Desoxyn. I think that there is a definable difference in mood thoughts and the way thoughts flow with memory and with present day crises.
And:
> After dealing with depression and ADD for most of my life, and having tried literally every conventional anti-depressant and ADD medication, I can honestly and without hesitation say that Desoxyn is the absolute best medication I've ever used to treat my ADD.
And:
> How is this not more widely prescribed? My doc had me on Strattera at first, didn't help at all. Next I switched to Concerta, which worked, but increased my anxiety, and I had a crash. Next I switched to Adderall, which had almost the same effect as Concerta but on top of that I had no appetite. Finally I switched to Desoxyn and that's when my life started to turn around. My grades instantly went up and homework became fun for me. Math problems became like a puzzle, and history became fun, like watching a real-life movie. Right when I made the switch to Desoxyn, I got caught up on ALL my homework and my grades instantly switched from D's and F's to B's and A's. Not only that, but my social anxiety was completely GONE.
All the reviews are like this. And I bet all of these patients are telling the truth. Sometimes I read drug reviews and I wonder whether these people are special cases, or driven to exaggerate, but these descriptions match my impression of how the average Desoxyn patient feels.
What's the catch? Desoxyn is methamphetamine. The FDA and DEA discourage doctors from prescribing it, but it's still technically legal with an MD's prescription, and there are still some doctors who will use it for the most refractory cases. It is officially indicated for ADHD and obesity (really!), but gets used off-label for narcolepsy and various sleep disorders.
There's a lot of confusion around the difference between amphetamine and methamphetamine. On the one hand you have anti-psychiatry activists who will say that using Adderall for ADHD is exactly like giving kids crystal meth; on the other you'll have people who say that obviously *normal* amphetamine is okay, but *meth*-amphetamine is a demonic substance that will hijack your brain and destroy your life. The truth is more complicated.
Methamphetamine crosses the blood-brain barrier more effectively than unsubstituted amphetamine, but I'm not sure how much that matters since people take different doses of both, and a high dose of unsubstituted will end up with more reaching the brain than a low dose of meth. It seems to [inhibit the dopamine transporter more effectively](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631950/), which might matter, but I'm not enough of a pharmacologist to know how much. Meth takes effect more quickly, which seems to increase addictiveness in a sort of behaviorist sense where the sooner a stimulus gets reinforced, the more rewarding it will feel. If all of this sounds kind of weak to you, you're not alone. [Shoblock et al](https://www.researchgate.net/publication/10983202_Neurochemical_and_behavioral_differences_between_d-methamphetamine_and_d-amphetamine_in_rats) write:
> Despite the repeated claims of METH being more addictive or preferred than AMPH, proven differences between METH and AMPH in addiction liability and in reward efficacy have evaded researchers. Animals self-administer METH and AMPH at comparable rates (Balster and Schuster 1973) and humans prefer similar doses (Martin et al. 1971). Also, neither humans nor animals discriminate between equal doses of METH and AMPH (Huang and Ho 1974; Kuhn et al. 1974; Lamb and Henningfield 1994). Furthermore, while METH is commonly believed to be a more potent central psychostimulant than AMPH, no direct comparison on the potency of the two drugs to stimulate central processes have been verified. In addition, no previous study has directly compared the acute effects of the two drugs on locomotor activity, an important central process that contributes tothe definition of psychostimulant. Moreover, there are no known neurobiological differences in action between METH and AMPH that would account for the putatively greater addictive, rewarding, or psychomotor properties of METH.
I think there's been a little bit more research since then, but the general takeaway - that the science doesn't support the vast gulf between these two drugs in the popular imagination - still seems true.
What's going on? I think addicts use meth very differently from the way generally responsible ADHD patients use amphetamine. It's weirdly hard to find good data on methamphetamine route of administration, but [this study](https://sci-hub.se/10.3109/10826084.2013.841244) shows that about 60% of users inject it, 23% snort it, and 52% smoke it - also, see [this paper](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672287/) about "the second case of rectal methamphetamine abuse in the literature". Route of administration makes a really big difference in how addictive and dangerous a drug is (see eg crack cocaine vs. regular cocaine), and I think this is a big part of the difference between seemingly okay Adderall users and very-not-okay meth users.
But maybe even bringing up route of administration is getting too complicated. The simplest explanation of the difference between meth users and responsible amphetamine users is that the meth users take much, much more. [This study](https://sci-hub.se/10.1300/j069v21n01_04) asks abusers how much they use in an average day, and gets numbers from about 300 to 800 mg. An average clinical dose of either Adderall or Desoxyn would be about 20 mg a day.
So abusers are taking about 25x a normal dose, and are usually snorting or injecting it. I think this explains the lion's share of the difference between "methamphetamine abuse" and "responsible Adderall use" without having to appeal to chemical differences between meth and unsubstituted amphetamines. Those differences do exist, and they're one reason why drug abusers prefer the methylated version. They're just not as dramatic as you would think from seeing a successful college student on Adderall vs. a toothless vagrant on meth.
All of this would seem to suggest that doctors should be less scared of prescribing Desoxyn - *except that* if it were true, Desoxyn wouldn't have as big an advantage over Adderall as the ratings suggest. I'm not sure what's going on here. Maybe this is just the effect of the small but real advantages in BBB penetration and level of dopamine transporter inhibition. Or maybe it's at least partly placebo - an ADHD patient whose doctor gives them meth feels like they've been allowed to dabble in forbidden magics, and is properly grateful in a way that makes them feel like their medication is more effective. I'm not sure. I only have secondhand accounts to go on - I'm too much of a wuss to prescribe Desoxyn myself.
When I treat ADHD with amphetamines, I usually start with Adderall/extended release Adderall, even though realistically Dexedrine would probably be an equally good or better choice. If it's not working very well or there are too many side effects, I switch to Dexedrine/extended release Dexedrine. If Dexedrine doesn't work because it seems too strong or the patient "crashes" too hard afterwards, or if I'm worried the patient is at risk of addiction, I will try Vyvanse (or [some other solution to stimulant “crashes”](https://lorienpsych.com/2020/10/30/adderall/#10_Help_I_get_a_crash_every_evening_when_my_Adderall_runs_out)); if Dexedrine works less well than Adderall *and* I am very confused *and* the patient is in an experimenting kind of mood, I *might* try Evekeo. If none of these work, a braver person than I am might try Desoxyn. As for me, I give up on amphetamines and start looking at Ritalin, modafinil, or other options. | Scott Alexander | 31845554 | Know Your Amphetamines | acx |
# Open Thread 157
This is the weekly visible open thread. Odd-numbered open threads will be **no-politics**, even-numbered threads will be politics-allowed. This one is odd-numbered, so be careful. Otherwise, post about anything else you want. Also:
**1.** Thanks to everyone who expressed concerns about aspects of the comment system. Substack says they're interested in helping. I've made [the first comment to this thread](https://astralcodexten.substack.com/p/open-thread-157/comments#comment-1113344) a list of comment-related concerns Substack already knows about. If you have another one not on the list, post it as a reply to that comment thread. If you see one you like, heart it (even though removing hearts is one of the things on my list). That way we'll get a list of everyone's concerns in order of concernedness, and I can send it to the Substack team.
**2.** Thanks for your generous support. I am overwhelmed by the amount involved, which it's probably against some kind of etiquette to say but which you can find good speculation about [here](https://www.reddit.com/r/slatestarcodex/comments/l2zij5/astral_codex_ten_is_now_1_in_the_technology/gkc3fo2/). I welcome your subscriptions, but I want to make sure you're not worrying that I'm going to starve in the rain or something; please only subscribe if you can definitely afford it.
**3.** Some people are predicting that now that the blog is back up NYT might *still* publish their article about me. I guess I have no right to object anymore. Balaji Srinivasan's rule about hit pieces is to get out in front of them and reveal any negative information they're going to use before they do. Right now the negative information I know they've collected is an incident in college where I was writing a humor thing in a college paper, tried to write a column mocking racists, did it so badly that people thought I was asserting the racism, then did a bad job apologizing afterwards. Someone else says they might use some old comments of mine to suggest I support eugenics. I support it in the sense of improving people's genetics and genetic outcomes - long-term through genetic engineering, medium-term through having things like the [Nobel sperm bank](https://en.wikipedia.org/wiki/Repository_for_Germinal_Choice) (but less badly done) available for people who want them, and short-term through voluntary community-based efforts like [Dor Yeshorim](https://en.wikipedia.org/wiki/Dor_Yeshorim). I don't support any form of eugenics more coercive or racist than that. I think these are the main pieces of negative information on me they're pursuing, so I look forward to seeing them treat everything else I've done fairly and in-context.
**4.** Stop trying to sign up for my psychiatry practice. It says in three different places there that it's only currently open to patients who are transferring from my previous practice. If you keep trying to sign up for it, I will have to take the signup form down, in a way that inconveniences those patients. | Scott Alexander | 31833110 | Open Thread 157 | acx |
# Logistics
**Substack**
First, thanks for following me to Substack.
I know some of you are skeptical. I was too at first, but Substack has gone above and beyond in allaying my concerns. They've let me test out a "no popup telling you to subscribe" feature. They've changed the comment section to be more like WordPress. We've agreed I'm here for a year, but if it goes badly I can leave in 2022 with no hard feelings.
And I know some of you are concerned about the risk of corporate deplatforming. My weak answer is that so far Substack has been great at resisting calls for this, I think it's worth rewarding them with my business, and I'm proud to contribute to companies that share my values. My strong answer is that if I start feeling too constrained, I'll leave. The past six months weren't fun, but at least I credibly signaled willingness to destroy everything and start over when needed. I'm saving the Substack mailing list regularly to my hard drive, and if I go somewhere else I'll let you all know.
And I know Substack is supposed to be an email newsletter thing, but consider reading it online instead so you can participate in the comments. If you miss the old layout, the anonymous author of [Applied Divinity Studies](https://applieddivinitystudies.com) has made a [Chrome extension thing](https://applieddivinitystudies.com/slatestarsubstack/) you can use to convert the Substack layout to the older one.
**Paid Subscriptions**
The boring reason I'm at Substack is money. I'm not supposed to talk about numbers, but you can read about the deal they offered Matt Yglesias [here](https://www.honeycopy.com/marketing-ideas/paid-newsletter) and draw your own conclusions. I'm trying to build a new kind of medical practice that provides affordable care to uninsured people. The risk of failure is high - I expect the medical care part to go fine, but I'm less sure I'll be able to make money off it. I need a stable income stream while I experiment with this, and this is it. I realize how weird it is to accept a steady day job as a writer to support your pie-in-the-sky plans to practice medicine, yet here we are.
From your perspective, the money works like this: if you like this blog, consider subscribing. $10/month or $100/year, which I hear is standard Substack rate. I already got a lot of subscriptions yesterday and I'm at zero risk of starving, but this will help me devote more time to blogging and get me over the hump in starting my new practice.
All "important" content will be freely available regardless of subscription status, but subscribers will get a little extra. In particular, there will be one subscribers-only Open Thread a week (on Wednesdays), along with the normal free Open Thread on Sundays, and occasional subscriber-only AMA (ask me anything) threads. I also plan to occasionally post shorter or lighter content for subscribers only, maybe once or twice a month. This would be along the lines of SSC posts like [If Only Turing Was Alive To See This](https://slatestarcodex.com/2019/06/20/if-only-turing-was-alive-to-see-this/) or [Bulls\*\*t Jobs (Part 1 of ∞)](https://slatestarcodex.com/2018/08/29/bullst-jobs-part-1-of-%e2%88%9e/). I might also paywall a few very impulsive Culture War posts, just to prevent them from going viral. I predict this will be less than 10% of content, and less than 1% of content weighted by some measure of importance.
Please don't buy a paid subscription if it would be financially stressful for you, or funge against your ability to support better causes. If you're deeply pained by the idea of not reading occasional shorter unimportant content, but also too poor to afford the full subscription, you can use [this coupon](https://astralcodexten.substack.com/932d293e). Please be honest.
I've complained before that subscriber models annoy nonsubscribers and clog up search engines by presenting stubs for posts most people can't read. After talking to Substack about this concern, they've agreed not to display any hint of subscription-only posts to nonsubscribers. I might occasionally remind you that they exist, but you won't get teased by the titles or see stubs that cut off halfway. If you do see these, something has gone wrong and you should let me know.
**Advertising Wrap-up**
Speaking of money, I think I've paid back everyone who took out advertising on SSC that didn't happen because the blog closed down.
If you took out advertising that got disrupted and I didn't pay you back, or I paid you the wrong amount, please contact me at scott[at]slatestarcodex[dot]com. If I have some other SSC-related obligation to you that I forgot about, remind me of that too.
**Publicity**
Still against it, sorry.
I've revealed my real name to prevent people from threatening me with it, but I'm still going by Scott Alexander.
I'm not interested in further pursuing a vendetta against the New York Times and I'm not going to respond to interview requests about it. I'd prefer my story not get used to support any political points more complicated than "newspapers should not reveal anonymous bloggers' real names", especially not Grand Narratives About Media.
My new psychiatry practice is (I think) potentially genuinely interesting, but I'd prefer people not get too excited about it until I've been doing it a year or two and can confirm that the business model actually works. My patients are random innocent people who happened to get matched with me at my past clinic and don't need to be ambushed for a news story about changing trends in mental health blah blah blah.
If it's a boring enough news day that you want to cover me, consider instead covering the many other fascinating and under-covered people and institutions in and around the rationalist community, some of whom are probably women or minorities or whatever. The [Qualia Research Institute](https://www.qualiaresearchinstitute.org/) is doing absolutely picture-perfect mad science. [Metaculus](https://www.metaculus.com/questions/) is fast becoming what PredictIt should have been; I intend to shill it pretty hard but I can't do it all by myself. Catherine Olsson, Ibasho, and [MicroCOVID](https://www.microcovid.org) already have [one WIRED article about how great they are](https://www.wired.com/story/group-house-covid-risk-points/), but they deserve at least a dozen.
**Book Review Contest**
I'll have more information on how I'm going to do this in a week or two. I still have all the entries you sent in, and I'm still accepting new entries at least for now.
**Normal Posts**
...will start next week. I have some from last year I still want to get up, so expect a few of them to be a bit outdated. | Scott Alexander | 31783158 | Logistics | acx |
# Still Alive
**I.**
*This was a triumph
I'm making a note here, huge success*
No, seriously, it was awful. I [deleted my blog](https://slatestarcodex.com/2020/06/22/nyt-is-threatening-my-safety-by-revealing-my-real-name-so-i-am-deleting-the-blog/) of 1,557 posts. I wanted to protect my privacy, but I ended up with articles about me in *New Yorker*, *Reason*, and *The Daily Beast*. I wanted to protect my anonymity, but I Streisand-Effected myself, and a bunch of trolls went around posting my real name everywhere they could find. I wanted to avoid losing my day job, but ended up quitting so they wouldn't be affected by the fallout. I lost a five-digit sum in advertising and Patreon fees. I accidentally sent about three hundred emails to each of five thousand people in the process of trying to put my blog back up.
I had, not to mince words about it, a really weird year.
513,000 people read my blog post complaining about the *New York Times*' attempt to dox me (for comparison, there are 366,000 people in Iceland). So many people cancelled their subscription that the *Times'* exasperated customer service agents started pre-empting callers with "Is this about that blog thing?" A friend of a friend reports her grandmother in Slovakia heard a story about me on Slovak-language radio.
I got emails from no fewer than four *New York Times* journalists expressing sympathy and offering to explain their paper's standards in case that helped my cause. All four of them gave totally different explanations, disagreeing about whether the reporter I dealt with was just following the rules, was flagrantly violating the rules, was unaffected by any rules, or what. Seems like a fun place to work. I was nevertheless humbled by their support.
I got an email from Balaji Srinivasan, a man whose anti-corporate-media crusade straddles a previously unrecognized border between endearing and terrifying. He had some very creative suggestions for how to deal with journalists. I'm not sure any of them were especially actionable, at least not while the Geneva Convention remains in effect. But it was still a good learning experience. In particular, I learned never to make an enemy of Balaji Srinivasan. I am humbled by his support.
I got emails from two different prediction aggregators saying they would show they cared by opening markets into whether the *Times* would end up doxxing me or not. One of them ended up with a total trade volume in the four digits. For a brief moment, I probably had more advanced decision-making technology advising me in my stupid conflict with a newspaper than the CIA uses for some wars. I am humbled by their support.
I got an email from a very angry man who believed I personally wrote the entirety of Slate.com. He told me I was a hypocrite for wanting privacy even though Slate.com had apparently published some privacy-violating stories. I tried to correct him, but it seemed like his email client only accepted replies from people on his contact list. I think this might be what the Catholics call "invincible ignorance". But, uh, I'm sure if we got a chance to sort it out I would have been humbled by his support.
I got an email from a former member of the GamerGate movement, offering advice on managing PR. It was very thorough and they had obviously put a lot of effort into it, but it was all premised on this idea that GamerGate was some kind of shining PR success, even though as I remember it they managed to take a complaint about a video game review and mishandle it so badly that they literally got condemned by the UN General Assembly. But it's the thought that counts, and I am humbled by their support.
I got an email from a Russian reader, which I will quote in full: *"In Russia we witnessed similar things back in 1917. 100 years later the same situation is in your country :)"*. I am not sure it really makes sense to compare my attempted doxxing to the Bolshevik Revolution, and that smiley face will haunt my dreams, but I am humbled by his support.
Eventually it became kind of overwhelming. 7500 people signed a petition in my favor. Russia Today wrote an article about my situation as part of their propaganda campaign against the United States. Various tech figures started a campaign to stop granting interviews to NYT in protest. All of the humbling support kind of blended together. At my character level, I can only cast the spell *Summon Entire Internet* once per decade or so. So as I clicked through email after email, I asked myself: did I do the right thing?
**II.**
*I'm not even angry
I'm being so sincere right now*
Before we go any further: your conspiracy theories are false. An SSC reader admitted to telling a *New York Times* reporter that SSC was interesting and he should write a story about it. The reporter pursued the story on his recommendation. It wasn't an attempt by the *Times* to crush a competitor, it wasn't retaliation for my having written some critical things about the news business, it wasn't even a political attempt to cancel me. Someone just told a reporter I would make a cool story, and the reporter went along with it.
Nor do I think it was going to be a hit piece, at least not at first. I heard from most of the people who the *Times* interviewed. They were mostly sympathetic sources, the interviewer asked mostly sympathetic questions, and someone who knows *New York Times* reporters says the guy on my case was their non-hit-piece guy; they have a different reporter for hatchet jobs. After I torched the blog in protest, they seem to have briefly flirted with turning it into a hit piece, and the following week they switched to interviewing everyone who hated me and asking a lot of leading questions about potentially bad things I did. My contacts in the news industry said even this wasn't necessarily sinister. They might have assumed I had something to hide, and wanted to figure out what it was just in case it was a better story than the original. Or they might have been deliberately interviewing friendly sources first, in order to make me feel safe so I would grant them an interview, and then moved on to the unfriendly ones after they knew that wouldn't happen. I'm not sure. But the pattern doesn't match "hit piece from the beginning".
As much crappy political stuff as there is in both the news industry and the blogsphere these days, I don't think this was a left-right political issue. I think the *New York Times* wanted to write a fairly boring article about me, but some guideline said they had to reveal subjects' real identities, if they knew them, unless the subject was in one of a few predefined sympathetic categories (eg sex workers). I did get to talk to a few sympathetic people from the *Times*, who were pretty confused about whether such a guideline existed, and certainly it's honored more in the breach than in the observance (eg [Virgil Texas](https://www.nytimes.com/2020/02/29/us/politics/bernie-sanders-chapo-trap-house.html)). But I still think the most likely explanation for what happened was that there was a rule sort of like that on the books, some departments and editors followed it more slavishly than others, and I had the bad luck to be assigned to a department and editor that followed it a lot. That's all. Anyway, they did the right thing and decided not to publish the article, so I have no remaining beef with them.
(aside from the sorts of minor complaints that Rob Rhinehart expresses so eloquently [here](https://www.robrhinehart.com/the-new-york-times/))
I also owe the *Times* apologies for a few things I did while fighting them. In particular, when I told them I was going to delete the blog if they didn't promise not to dox me, I gave them so little warning that it probably felt like a bizarre ultimatum. At the time I was worried if I gave them more than a day's warning, they could just publish the story while I waited; later, people convinced me the *Times* is incapable of acting quickly and I could have let them think about it for longer.
Also, I asked you all to email an NYT tech editor with your complaints. I assumed NYT editors, like Presidents and Senators, had unlimited flunkies sorting through their mailbags, and would not be personally affected by any email deluge. I was wrong and I actually directed a three to four digit number of emails to the personal work inbox of some normal person with a finite number of flunkies. That was probably pretty harrowing and I'm sorry.
As for the *Times'* mistakes: I think they just didn't expect me to care about anonymity as much as I did. In fact, most of my supporters, and most of the savvy people giving me advice, didn't expect me to care as much as I did. Maybe I should explain more of my history here: back in the early 2010s I blogged under my real name. When I interviewed for my dream job in psychiatry, the interviewer had Googled my name, found my blog, and asked me some really pointed questions about whether having a blog meant I was irresponsible and unprofessional. There wasn't even anything controversial on the blog - this was back in the early 2010s, before they invented controversy. They were just old-school pre-social-media-era people who thought having a blog was fundamentally incompatible with the dignity of being a psychiatrist. I didn't get that job, nor several others I thought I was a shoo-in for. I actually failed my entire first year of ACGME match and was pretty close to having to give up on a medical career. At the time I felt like that would mean my life was over.
So I took a bunch of steps to be in a better position for the next year's round of interviews, and one of the most important was deleting that blog, scrubbing it off the Web as best I could, and restarting my whole online presence under a pseudonym. I was never able to completely erase myself from the Internet, but I made some strategic decisions - like leaving up a bunch of older stuff that mentioned my real name so that casual searchers would find that instead of my real blog. The next year, I tried the job interview circuit again and got hired.
But I still had this really strong sense that my career hung on this thread of staying anonymous. Sure, my security was terrible, and a few trolls and malefactors found my real name online and used it to taunt me. But my attendings and my future employers couldn't just Google my name and find it immediately. Also, my *patients* couldn't Google my name and find me immediately, which I was increasingly realizing the psychiatric community considered important. Therapists are supposed to be blank slates, available for patients to project their conflicts and fantasies upon. Their distant father, their abusive boyfriend, their whatever. They *must not know you as a person*. One of my more dedicated professors told me about how he used to have a picture of his children on a shelf in his office. One of his patients asked him whether those were his children. He described suddenly realizing that he had let his desire to show off overcome his duty as a psychiatrist, mumbling a noncommital response lest his patient learn whether he had children or not, taking the picture home with him that night, and never displaying any personal items in his office ever again. That guy was kind of an extreme case, but this is something [all psychiatrists](https://webcache.googleusercontent.com/search?q=cache:rcPcxd0-nqQJ:https://blogs.scientificamerican.com/mind-guest-blog/why-psychiatrists-don-t-share-personal-information-with-patients/) think about, and [better pychiatrist-bloggers than I](https://twitter.com/JohnDiesattheEn/status/1067072479192068096) have quit once their side gig reached a point where their patients might hear about it. There was even a very nice and nuanced article about the phenomenon in - of all places - *[The New York Times](https://opinionator.blogs.nytimes.com/2015/04/04/do-you-google-your-shrink/)*.
After all that, yeah, I had a phobia of being doxxed. But psychotherapy classes *also* teach you to not to let past traumas control your life even after they've stopped being relevant. Was I getting too worked up over an issue that no longer mattered?
*The New York Times* thought so. Some people kept me abreast of their private discussions (in Soviet America, newspaper's discussions get leaked to *you*!) and their reporters had spirited internal debates about whether I really needed anonymity. Sure, I'd gotten some death threats, but everyone gets death threats on the Internet, and I'd provided no proof mine were credible. Sure, I might get SWATted, but realistically that's a really scary fifteen seconds before the cops apologize and go away. Sure, my job was at risk, but I was a well-off person and could probably get another. Also, hadn't I blogged under my real name before? Hadn't I published papers under my real name in ways that a clever person could use to unmask my identity? Hadn't I played fast and loose with every form of opsec other than whether the average patient or employer could Google me in five seconds?
Some of the savvy people giving me advice suggested I fight back against this. Release the exact death threats I'd received and explain why I thought they were scary. Play up exactly how many people lived with me and exactly why it would be traumatic for them to get SWATted. Explain exactly how seriously it would harm my patients if I lost my job. Say why it was necessary for my career to publish those papers under my real name.
Why didn't I do this? Partly because it wasn't true. I don't think I had particularly strong arguments on any of these points. The amount I dislike death threats is basically the average amount that the average person would dislike them. The amount I would dislike losing my job...and et cetera. Realistically, my anonymity let me feel safe and comfortable. But it probably wasn't literally necessary to keep me alive. I feel bad admitting this, like I conscripted you all into a crusade on false pretenses. Am I an entitled jerk for causing such a stir just so I can feel safe and comfortable? I'm sure the *New York Times* customer service representatives who had to deal with all your phone calls thought so.
But the other reason I didn't do it was...well, suppose Power comes up to you and says hey, I'm gonna kick you in the balls. And when you protest, they say they don't want to make anyone *unsafe*, so as long as you can *prove* that kicking you in the balls will cause long-term irrecoverable damage, they'll hold off. And you say, well, it'll hurt quite a lot. And they say that's subjective, they'll need a doctor's note proving you have a chronic pain condition like hyperalgesia or fibromyalgia. And you say fine, I guess I don't have those, but it might be dangerous. And they ask you if you're some sort of expert who can prove there's a high risk of organ rupture, and you have to admit the risk of organ rupture isn't exactly *high*. But also, they add, didn't you practice taekwondo in college? Isn't that the kind of sport where you can get kicked in the balls pretty easily? Sounds like you're not really that committed to this not-getting-kicked-in-the-balls thing.
No! There's no dignified way to answer any of these questions except "fuck you". Just don't kick me in the balls! It isn't rocket science! *Don't kick me in the fucking balls!*
In the *New York Times'* worldview, they start with the right to dox me, and I had to earn the right to remain anonymous by proving I'm the perfect sympathetic victim who satisfies all their criteria of victimhood. But in my worldview, I start with the right to anonymity, and they need to make an affirmative case for doxxing me. I admit I am not the perfect victim. The death threats against me are all by losers who probably don't know which side of a gun you shoot someone with. If anything happened at work, it would probably inconvenience me and my patients, but probably wouldn't literally *kill* either of us. Still! Don't kick me in the fucking balls!
I don't think anyone at the *Times* bore me ill will, at least not originally. But somehow that just made it even more infuriating. In *Street Fighter*, the hero confronts the Big Bad about the time he destroyed her village. The Big Bad has destroyed so much stuff he doesn't even remember: "For you, the day [I burned] your village was the most important day of your life. For me, it was Tuesday." That was the impression I got from the *Times*. They weren't hostile. I wasn't a target they were desperate to take out. The main emotion I was able to pick up from them was annoyance that I was making their lives harder by making a big deal out of this. For them, it was Tuesday.
It's bad enough to get kicked in the balls because Power hates you. But it's infuriating to have it happen because Power can't bring itself to care. So sure, deleting my blog wasn't the most, shall we say, *rational* response to the situation. But iterated games sometimes require [a strategy that deviates from apparent first-level rationality](https://en.wikipedia.org/wiki/Superrationality), where you let yourself consider lose-lose options in order to influence an opponent's behavior.
Or, in layman's terms, sometimes you have to be a crazy bastard so people won't walk all over you.
In 2010, a corrupt policewoman demanded a bribe from impoverished pushcart vendor Mohammed Bouazizi. He couldn't afford it. She confiscated his goods, insulted him, and (according to some sources) slapped him. He was humiliated and destitute and had no hope of ever getting back at a police officer. So he made the very reasonable decision to douse himself in gasoline and set himself on fire in the public square. One thing led to another, and eventually a mostly-peaceful revolution [ousted the government of Tunisia](https://en.wikipedia.org/wiki/Tunisian_Revolution). I am very sorry for Mr. Bouazizi and his family. But he did find a way to make the offending policewoman remember the day she harassed him as something other than Tuesday. As the saying goes, "sometimes setting yourself on fire sheds light on the situation".
**III.**
*As I burned it hurt because
I was so happy for you*
But as I was thinking about all this, I got other emails. Not just the prediction aggregators and Russians and so on; emails of a totally different sort.
I got emails from other people who had deleted their blogs out of fear. Sometimes it was because of a job search. Other times it was because of *\*gestures expansively at everything\**. These people wanted me to know they sympathized with what I was going through.
I got emails from people who hadn't deleted their blogs, but wished they had. A lot of them had stories like mine - failed an interview they should have aced, and the interviewer mentioned their blog as an issue. These people sympathized too.
I got emails that were like that, only it was grad students. Apparently if you have a blog about your field, that can [make it harder to get or keep a job in academia](https://twitter.com/McCormickProf/status/1292930218970222599). I'm not sure what we think we're gaining by ensuring the smartest and best educated people around aren't able to talk openly about the fields they're experts in, but I hope it's worth it.
I got an email from a far-left blogger with a similar story, which got me thinking about socialists in particular. Imagine you're writing a socialist blog - as is 100% your right in a democratic society. Aren't employers going to freak out as soon as they Google your name, expecting you to start a union or agitate for higher wages or seize the means of production or something? This is a totally different problem from the cancel culture stories I usually hear about, but just as serious. How are you supposed to write about communism in a world where any newspaper can just figure out your real name, expose you, and lock you out of most normal jobs?
I got emails from some transgender bloggers, who talked about how trans people go by something other than their legal name and have a special interest in not getting outed in the national news. I don't think the *Times* would deliberately out trans people - probably there's some official policy against it. But the people emailing me understood that we're all in this together, and that if oppressed people don't stand up for the rights of the privileged, no one will. Or something. Man, it's been a *weird* year.
I got an email telling me to look into the story of [Richard Horton](https://en.wikipedia.org/wiki/Richard_Horton_(blogger)), a police officer in the UK. He wrote a blog about his experience on the force which was by all accounts incredible - it won the Orwell Prize for being the best political writing in Britain that year. *The* *Times* (a British newspaper unrelated to NYT) hacked his email and exposed his real identity, and his chief forced him to delete the blog in order to keep his job. I wonder whether maybe if police officers were allowed to write anonymously about what was going on without getting doxxed by newspapers, people wouldn't have to be so surprised every time something happens involving the police being bad. See for example [The Impact Of The Cessation Of Blogs Within The UK Police Blogosphere](https://www.researchgate.net/publication/265605568_The_Impact_of_the_Cessation_of_Blogs_Within_the_UK_Police_Blogosphere), a paper somebody apparently needed to write.
I got an email telling me to look into the story of Naomi Wu, a Chinese woman who makes videos about engineering and DIY tech projects under the name SexyCyborg. She granted an interview to a Vice reporter under the condition that he not reveal some sensitive details of her personal life which could get her in trouble with the Chinese authorities. Vice agreed, then revealed the details anyway (who could have guessed that a webzine founded by [a violent neo-fascist leader](https://en.wikipedia.org/wiki/Gavin_McInnes) and named after the abstract concept of evil would stoop so low?) In [a Medium post](https://medium.com/@therealsexycyborg/shenzhen-tech-girl-naomi-wu-my-experience-with-sarah-jeong-jason-koebler-and-vice-magazine-3f4a32fda9b5), Wu wrote that "Vice would endanger me for a few clicks because in Brooklyn certain things are no big deal...I had no possible recourse against a billion dollar company who thought titillating their readers with my personal details was worth putting me in jeopardy." She then went on to dox the Vice reporter involved, Which Was Morally Wrong And I Do Not Condone It - but also led to some interesting revelations about how much more journalists cared when it's one of their own and not just some vulnerable woman in a dictatorship.
Getting all these emails made me realize that, whatever the merits of my own case, maybe by accident, I was fighting for something important here. Who am I? I'm nobody, I'm a science blogger with some bad opinions. But these people - the trans people, the union organizers, the police whistleblowers, the sexy cyborgs - the *New York Times* isn't worthy to wipe the dirt off their feet. How dare they assert the right to ruin these people's lives for a couple of extra bucks.
...but I was also grateful to get some emails from journalists trying to help me understand the perspective of their field. They point out that reporting is fundamentally about revealing information that wasn't previously public, and hard-hitting reporting necessarily involves disclosing things about subjects that they would rather you not know. Speculating on the identities of people like Deep Throat, or Satoshi Nakamoto, or QAnon, or that guy who wrote *Primary Colors*, is a long-standing journalistic tradition, one I had never before thought to question. Many of my correspondents brought up that some important people read my blog (Paul Graham was the most cited name). Isn't there a point past which you stop being that-guy-with-a-Tumblr-account who it's wrong to dox, and you become more like Satoshi Nakamoto where trying to dox you is a sort of national sport? Wouldn't it be fair to say I had passed that point?
With all due respect to these reporters, and with complete admission of my own bias, I reject this entire way of looking at things. If someone wants to report that I'm a 30-something psychiatrist who lives in Oakland, California, that's fine, I've had it in my About page for years. If some reporter wants to investigate and confirm, I have some suggestions for how they could use their time better - isn't there still a war in Yemen? - but I'm not going to complain too loudly. But I don't think whatever claim the public has on me includes a right to know my name if I don't want them to. I don't think the public needs to know the name of the cops who write cop blogs, or the deadnames of trans people, or the dating lives of sexy cyborgs. I'm not even sure the public needs to know the name of Satoshi Nakamoto. If he isn't harming anyone, let him have his anonymity! I would rather we get whatever pathologies come from people being able to invent Bitcoin scot-free, than get whatever pathologies come from anyone being allowed to dox anyone else if they can argue that person is "influential". Most people don't start out trying to be influential. They just have a Tumblr or a LiveJournal or something, and a few people read it, and then a few more people read it, and bam! - they're influential! If influence takes away your protection, then none of us are safe - not the random grad student with a Twitter account making fun of bad science, not the teenager with a sex Tumblr, not the aspiring fashionista with an Instagram. I've read lots of interesting discussion on how much power tech oligarchs should or shouldn't be allowed to have. But this is the first time I've seen someone suggest their powers should include a magic privacy-destroying gaze, where just by looking at someone they can transform them into a different kind of citizen with fewer rights. Is Paul Graham some weird kind of basilisk, such that anyone he stares at too long turns into fair game?
And: a [recent poll](https://www.outsidethebeltway.com/62-of-americans-afraid-to-share-political-views/) found that 62% of people feel afraid to express their political beliefs. This isn't just conservatives - it's also moderates (64%), liberals (52%) and even many strong liberals (42%). This is true even among minority groups, with more Latinos (65%) feeling afraid to speak out than whites (64%), and blacks (49%) close behind. 32% of people worry they would be fired if their political views became generally known, including 28% of Democrats and 38% of Republicans. Poor people and Hispanics were more likely to express this concern than rich people and whites, but people with post-graduate degrees have it worse than any other demographic group.
And the kicker is that these numbers are up almost ten percentage points from the last poll *three years ago*. The biggest decline in feeling safe was among "strong liberals", who feel an entire 12 percentage points less safe expressing their opinion now than way back in the hoary old days of 2017. What happens in a world where this trend continues? Does everyone eventually feel so unsafe that we completely abandon the public square to professional-opinion-havers, talking heads allowed to pontificate because they have the backing of giant institutions? What biases does that introduce to the discussion? And if we want to avoid that, is there any better way then a firm stance that people's online pseudonymity is a basic right, not to be challenged without one hell of a compelling public interest? Not just "they got kinda big, so now we can destroy them guilt-free", but an *actual* public interest?
I'm not trying to convince the *New York Times* - obviously it would very much fit their business plan if we came to rely on professional-opinion-havers backed by big institutions. I'm trying to convince you, the average Internet person. For the first ten or twenty years of its history, the Internet had a robust norm against doxxing. You could troll people, you could Goatse or Rickroll them, but doxxing was beyond the pale. One of the veterans of this era is Lawrence Lessig, who I was delighted to see [coming to my defense](https://medium.com/@lessig/hey-nyt-please-just-dont-44f36a87c21). We've lost a lot of that old Internet, sold our birthright to social media companies and content providers for a few spurts of dopamine, but I think this norm is still worth protecting.
If me setting myself on fire got the *New York Times* to rethink some of its policies, and accidentally helped some of these people win their own fights, it was totally worth it.
**IV.**
*Now these points of data make a beautiful line
And we're out of beta, we're releasing on time
So I'm glad I got burned
Think of all the things we learned
For the people who are still alive*
There's a scene in *Tom Sawyer* where Tom runs away from town and is presumed dead. He returns just as they're holding his funeral, and gets to listen to everyone praise his life and talk about how much they loved him. Seems like a good deal. Likewise, Garrison Keillor said that - since they say such nice things at people's funerals - it was a shame he was going to miss his own by just a few days.
After deleting the blog I felt like I was attending my own funeral. I asked people to send the *Times* emails asking them not to publish the article. Some people ccd me on them. These weren't just "Dear NYT, please do not dox this blogger, yours, John". Some of them were a bit over-the-top. I believe a few of them may have used the words "national treasure". I can only hope the people at my real funeral are as kind.
Other people just sent me the over-the-top emails directly. I got emails from people in far-away, very poor countries, telling me that there was nothing at all like a rationalist movement in their countries and my blog was how they kept up with the intellectual currents of a part of the world they might never see. I am humbled to be able to help them.
I got emails from medical interns and residents, telling me they enjoyed hearing about my experiences in medicine. You guys only have like three minutes of free time a week, and I am humbled that you would spend some of it reading me.
I got emails from people saying I was one of their inspirations for going into science academia. I am so, so, sorry. I am humbled by their continued support even after I ruined their lives.
I got emails from people in a host of weird and difficult situations, telling me about how reading my blog was the only thing that kept them sane through difficult times. One woman insisted that I start blogging before she got pregnant again because I was her postpartum coping strategy. I hope I've made it in time - but in any case I am humbled by their support.
I got emails from couples, saying that reading my blog together once a week was their romantic bonding activity. Again, I hope I've restarted in time, before anyone's had to divorce. They are very cute and I am humbled by their support.
And more along the same lines, and some even more humbling than these. I want to grab some of you by the shoulders and shake you and shout "IT'S JUST A BLOG, GET A LIFE". But of course I would be a hypocrite. I remember back to when I was a new college graduate, desperately trying to make sense of the world. I remember the sheer *relief* when I came across a few bloggers - I most clearly remember [Eliezer Yudkowsky](https://www.lesswrong.com/tag/original-sequences) - who seemed to be tuned exactly to my wavelength, people who were making sense when the entire rest of the world was saying vague fuzzy things that almost but not quite connected with the millions of questions I had about everything. These people weren't perfect, and they didn't have all the answers, but their existence reassured me that I wasn't crazy and I wasn't alone. I was an embarrassing fanboy of theirs for many years - I kind of still am - and if my punishment is to have embarassing fanboys of my own then I accept it as part of the circle of life.
And also - I am maybe the worst person possible to argue that this doesn't matter. Almost everything good in my life I've gotten because of you. I met most of my friends through blogging. I met my housemates, who are basically my family right now, through blogging. I got introduced to my girlfriend by someone I know through blogging. My patients are doing better than they could be - some of them vastly better - because of things I learned from all of you in the process of blogging. Most of the [intellectual progress I've made over the past ten years](https://slatestarcodex.com/2020/01/08/what-intellectual-progress-did-i-make-in-the-2010s/) has been following up on leads people sent me because of my blogging. To the degree that the world makes sense to me, to the degree that I've been able to untie some of the thornier knots and be rewarded with the relief of mental clarity, a lot of it has been because of things I learned while blogging. However many over-the-top dubious claims you want to make about how much I have improved your life, I will one-up you with how much you have improved mine. And after reading a few hundred of your emails, I've realized, crystal-clear, that I am going to be spending the rest of my life trying to deserve even one percent of the love you've shown and the gifts you've given me.
So I've taken the steps I need to in order to feel comfortable revealing my real name online. I talked to an aggressively unhelpful police officer about my personal security. I got advice from people who are more famous than I am, who have allayed some fears and offered some suggestions. Some of the steps they take seem extreme - the Internet is a scarier place than I thought - but I've taken some of what they said to heart, rejected the rest in a calculated way, and realized realistically I was never that protected anyhow. So here we are.
And I left my job. They were very nice about it, they were tentatively willing to try to make it work. But I just don't think I can do psychotherapy very well while I'm also a public figure, plus people were already calling them trying to get me fired and I didn't want to make them deal with more of that.
As I was trying to figure out how this was going to work financially, Substack convinced me that I could make decent money here. With that in place, I felt like I could also take a chance on starting my dream business. You guys have had to listen to me write *ad nauseum* about [cost disease](https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/) - why does health care cost 4x times more per capita than it did just a generation ago? I have a lot of theories about why that happened and how to fix it. But as Feynman put it, "what I cannot create I cannot understand". So I'm going to try to start a medical practice that provides great health care to uninsured people for 4x less than what anyone else charges. If it works, I plan to be insufferable about it. If it doesn't, I can at least have a fun conversation with Alex Tabarrok about where our theories went wrong. Since I'm no longer protecting my anonymity, I can advertise it here - [Lorien Psychiatry](https://lorienpsych.com/) - though I'm not currently accepting blog readers as patients, sorry.
That's taken up most of my time over the past six months. Going back to blog posts like this is a strange feeling. I wondered if I'd enjoy the break. I didn't particularly; it felt at least as much like trying to resist an addiction as it did resting from a difficult task. There's so much left to say! I never got the chance to tell you whether the SSC Survey found birth order effects to be biologically or socially mediated! And the predictive processing community is starting to really chip away at the question of why psychotherapies work - I need to explain this to someone else before I can be sure I understand it! I only discovered taxometrics a few months ago and I haven't talked your ears off about it yet - that will change! I made predictions about Trump - now that he's come and gone I need to grade them publicly so you can raise or lower your opinion of me as appropriate! And there's the book review contest! We are absolutely going to do the book review contest!
So here goes. With malice towards none, with charity towards all, with firmness in the [ṛta](https://astralcodexten.substack.com/p/youre-probably-wondering-why-ive) as reflective equilibrium gives us to see the ṛta, let us restart our mutual explorations, begin anew the joyful reduction of uncertainty wherever it may lead us.
My name is Scott Siskind, and I love all of you so, so much.
*But look at me, still talking when there's Science to do
When I look out there it makes me glad I've got you
I've experiments to run, there is research to be done
On the people who are still alive
And believe me I am still alive
I'm doing science and I'm still alive
I feel fantastic and I'm still alive
Still alive* | Scott Alexander | 31751211 | Still Alive | acx |
# You're Probably Wondering Why I've Called You Here Today
Welcome to Astral Codex Ten! Some of you are probably veterans of my old blog, Slate Star Codex. Others may be newbies wondering what this is all about.
I'm happy to finally be able to give a clear answer: this is a blog about ṛta.
Ṛta is a Sanskrit word, so ancient that it brushes up against the origin of Indo-European languages. It's related to English "rationality" and "arithmetic", but also "art" and "harmony". And "right", both in the senses of "natural rights" and "the right answer". And "order". And "arete" and "aristos" and all those other Greek words about morality. And "artificial", as in eg artificial intelligence. More speculatively "reign" and related words about rulership, and "rich" and related words about money.
(also "arthropod", but insects creep me out so I'll be skipping this one)
The dictionary defines ṛta as "order", "truth", or "rule", but I think of it as the intersection of all these concepts, a sort of hidden node at the center of art and harmony and rationality and the rest. What are the laws of thought? How do they reveal themselves, at every level, from the flow of electricity through the brain to the flow of money through the global economy? How can we cleave to them more closely, for our own good and the good of generations still to come?
In practice, articles (another ṛta relative!) here tend to focus on reasoning, science, psychiatry, medicine, ethics, genetics, AI, economics and politics. The political posts sometimes stray into choppy waters, and I have immense sympathy for people who are sick of that and prefer to pass.
But on the other hand, this picture:
The top and bottom chess sets in this picture are exactly the same color. Download it and check on Paint or Photoshop if you don't believe me. We use "as different as black and white" to mean obviously, undeniably different. But in fact a slightly different context can confuse our brains so completely that we mistake white for black and vice versa. I believe the same laws of thought apply in the frontal lobe as in the visual cortex. The same forces that transform gray chess sets to white or black, outside our conscious control or comprehension, influence how we think about policies, coalitions, and principles, making them appear self-evidently good or viciously evil. I think this is the century where we'll either learn to understand and deal with our cognitive biases, or else all kill each other.
(there will also be the normal kind of politics on here, where I yell at people for being crooks and liars, because I'm only human)
I'm privileged to be at the intersection of a number of communities exploring these concepts. The rationalist community is a group of people, mostly centered around the website [Less Wrong](https://www.lesswrong.com/about), investigating reasoning and probability. The [effective altruist](https://www.effectivealtruism.org/) community is a group, inspired by philosophers like Will MacAskill and Peter Singer, who work on how best to use charitable resources for the greater good. And I work in psychiatry, which it turns out is pretty relevant to questions about how people end up believing strange things - both as an investigative science and as a terrible warning. These groups aren't always great at reporting their ideas and conclusions to the general public, so I'm here to help. Most of the interesting stuff you see here will be influenced by at least one of them; most of the errors will be mine alone.
And finally, the highlight of my last blog was its loyal and active readership, who constantly corrected my errors, resolved my lingering questions, and inspired most of "my" best ideas. Substack has committed to do everything they can to help keep that community alive. *I* commit to doing everything I can to keep that community alive. So take a look around, and feel free to comment here, the subreddit, the Discord, or the vintage-style bulletin board.
But for now - welcome to Astral Codex Ten! I am genuinely glad you're here! | Scott Alexander | 919248 | You're Probably Wondering Why I've Called You Here Today | acx |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.