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hg00 comments on Open thread, Sep. 19 - Sep. 25, 2016 - Less Wrong
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For a while now, I have been working on a potentially impactful project. The main limiting factor is my own personal productivity- a great deal of the risk is frontloaded in a lengthy development phase. Extrapolating the development duration based on progress so far does not yield wonderful results. It appears I should still be able to finish it in a not-absurd timespan, it will just be slower than ideal.
I've always tried to improve my productivity, and I've made great progress in that compared to ten or even five years ago, but at this point I've picked most of the standard low hanging fruit. I've already fiddled with some extremely easy and safe kinda-nootropics already- melatonin, occasional caffeine pills- but not things like modafinil or amphetamines, or some of the less studied options.
And while thinking about this today, I decided to just run some numbers on amphetamines. Based on my current best estimates of market realities and the potential success and failure cases of the project, assuming amphetamines could improve my productivity by 30% on average, the expected value of taking amphetamines for the duration of development comes out to...
...a few hundred human lives.
And, in the best-reasonable case scenario, a lot more than that. This wasn't really unexpected, but it's surprisingly the first time I actually did the math.
So I imagine the God of Dumb Trolley Problems sits me down for a thought experiment and explains: "In a few years, there will be a building full of 250 people. A bomb will go off and kill all of them. You have two choices." The god leans in for dramatic effect. "Either you can do nothing, and let all of them die... or..." It lowers its head just enough for shadows to cast over its features... "You take this low, safe dose of Adderall for a few years, and the bomb magically gets defused."
This is not a difficult ethical problem. Even taking into account potential side effects, even assuming the amphetamines were obtained illegally and so carried legal liability, this is not a difficult ethical problem. When I look at this, I feel like the answer of what I should do is blindingly obvious.
And yet I have a strong visceral response of "okay yeah sure but no." I assume part of this is fairly extreme risk aversion to the idea of getting anything like amphetamines outside of a prescription. Legal trouble would be pretty disastrous, even if unlikely. And part of me is spooked about doing something like this without expert oversight.
But why not just try to get an actual prescription? For this, or some other advantageous semi-nootropic, at least. Once again, I just get a gross feeling about the idea of trying to manipulate the system. How about if I just explain the situation in full, with zero manipulation, to a sympathetic doctor? The response from my gut feels like a blank "... no."
So basically, I feel stuck. Part of me wants to recognize the risk aversion as excessive, and suggests I should at least take whatever steps I can safely. The other part is saying "but that is doing something waaaay out of the ordinary and maybe there's a reason for that that you haven't properly considered."
I am not even sure what I want to ask with this post. I guess if you've got any ideas or insights, I'd like to hear them.
Drugs are prescribed based on a cost-benefit analysis. In general, the medical establishment is pretty conservative (there's little benefit to the doctor if your problem gets solved, but if they hurt you they're liable to get sued). In the usual case for amphetamines, the cost is the risk of side effects and the benefit is helping someone manage their ADHD. For you, the cost is the same but it sounds like the benefit is much bigger. So even by the standards of the risk-averse medical establishment, this sounds like a risk you should take.
You're an entrepreneur. A successful entrepreneur thinks and acts for themselves. This could be a good opportunity to practice being less scrupulous. Paul Graham on what makes founders successful:
I'd recommend avoiding Adderall as a first option. I've heard stories of people whose focus got worse over time as tolerance to the drug's effects developed.
Modafinil, on the other hand, is a focus wonder drug. It's widely used in the nootropics community and bad experiences are quite rare. (/r/nootropics admin: "I just want to remind everyone that this is a subreddit for discussing all nootropics, not just beating modafinil to death.")
The legal risks involved with Modafinil seem pretty low. Check out Gwern's discussion.
My conclusion is that buying some Modafinil and trying it once could be really valuable, if only for comfort zone expansion and value of information. I have very little doubt that this is the right choice for you. Check out Gwern's discussion of suppliers. (Lying to your doctor is another option if you really want to practice being naughty.)
The idea that doctors who describe Adderal to ADHD patients are conversative about prescribing it seems to be an extraordinary claim.
How many doctors do you think get sued for giving patients adderal?
There a lot of money from drug companies who lobby that drugs like Adderal don't get perscribed in a conservative fashion.
I'm assuming you think the answer is "not many". If so, this shows it's not a very risky drug--it rarely causes side effects that are nasty enough for a patient to want to sue their doctor.
From what I've read about pharmaceutical lobbying, it consists primarily of things like buying doctors free meals for in exchange for using the company's drug instead of a competitor's drug. I doubt many doctors are willing to run a serious risk of losing their career over some free meals.
No. It also consists of lobbying the relevant politicians to make it hard to sue doctors and generally policies to reduce harms caused by drugs. Drugmakers fought state opioid limits amid crisis:
That argument assumes that only side effects that can be proven in court to be bad are meaningful to worry about. Giving that establishing causation of drug effects usually takes millions of money to run well controlled studies that get published in leading medical journals that allow the drug companies that publish the studies that don't follow best standards of science that the journals pledged to honor (the CONSORT standards), it's not easy to prove all causation.
Thanks for the links.
I do notice that the idea of trying modafinil does not result in the nearly the same degree of automatic internal 'no' as amphetamines. That would suggest my inhibitions are somehow related to the relative perceived potency, or potential health effects... or I'm disinclined to do something that could signal 'drug abuser', which I associate much more strongly with amphetamines than modafinil. Hm.
I've also been going around and asking the more conservative people in my circle about this situation as well, to try to give a more coherent voice to my subverbal objections. So far I've found that they actually support me trying things, which suggests I really should try to recalibrate those gut reactions a bit.
Upon reflection, I think I could actually get modafinil completely legitimately. I feel a bit dumb for not resolving to do this sooner, given that I was fully aware of modafinil- even to the point of very nearly purchasing some a while ago, before I knew it was schedule 4- and given that I was fully aware of what modafinil was often used to treat. At this point, the choice is pretty massively overdetermined.
Glad I could help :D
Amphetamine is officially more dangerous than modafinil (for good reason), but doctors actually respond worse to patients asking for modafinil than asking for amphetamine because it's weird. The easiest way to get modafinil is probably to start with amphetamine and later ask for modafinil because it's weaker and safer.
That's... pretty goofy. I would hope sleep specialists, at least, would tend to reach for modafinil before amphetamines.
Yes, I'm sure that narcoleptics are referred to sleep specialists who know that it is on-label for narcolepsy. Probably that makes them more likely to prescribe it off-label.
But few people go to sleep specialists. Scott Alexander has written many times about how as a psychiatry resident he sees patients who need a stimulant, but can't take amphetamine. He brainstorms with his supervisor and suggests modafinil and even in this perfect setup, he gets pushback.
But I wasn't talking about sleep problems, which includes the approved use of modafinil. I was talking about using it in place of amphetamine for ADHD, which is further off-label.
If they don't give me what I want after I say the correct sequence of words I won't be returning to them.
It's easy to find a doctor who will work with you.