In praise of emotive communication

This is a tale of two blog posts. The first is a Tumblr post that made me FEEL STUFF, and did so fantastically.

There are a lot of arguments about why the FDA is bad. Scott Alexander has posted about it several times on his site, and he's far from the only one. A person can read these articles and say "Why yes, this is a travesty! The FDA must be reigned in before it destroys us all!"

And then someone posts something like this (specifically the part by KungFuNurse) and the imagine of a snake-oil salesman killing innocent people with Patent Tonics and then skipping town with their money is simply so emotionally compelling and super-available that it's hard to not be swayed by it. It requires a real effort to remain committed to what I can see is the case via calculating costs vs. benefits, rather than the image of my poor mom being swindled and killed. :(

So I am eternally grateful when someone comes forward and puts it in no-nonsense SUPER EMOTIVE terms why the FDA is fucking them and ruining their lives. Especially because these regulations are ones that I know happen to people I KNOW PERSONALLY, rather than the snake-oil song-and-dance that touches almost no one. Because I know click-through is awful, here's the full text from the link:

your regulation is #problematic, statecucks

So, the shitlib FDA apologists etc. just love to peddle the bollocks that regulation protects the vulnerable, the marginalized, the badbrains, the executively dysfunctional, the people every PC cuck loves to pretend to give a shit about while actually cucking us over every single chance they get.

And it’s bullshit. Here’s what the nanny state actually looks like to its victims:

> you have a medication you’re going to be using every single fucking day for the rest of your goddamn life or at least until you get an artifical gland installed to produce it endogenously > you cannot do the sane thing of simply placing a regular order for it online and having it delivered to your home, > you need to walk how fucking many* kilometres (or take the goddamn bus) to one of the few pharmacies in town (because the state regulates their numbers) to buy your permitted refill (because it’s either completely illegal to buy more than 3 months supply at a time, or the pharmacies just never sell more because the public medical insurance limits its coverage to 3 months at a time) > you need to keep renewing the prescription all the fucking time

> you have a very useful medication which requires a special permit > and of fucking course you need to keep renewing the fucking prescription > only a few doctors in the entire fucking county even know how to apply for the special permits > your doctor, naturally, is not one of them > you need to get the papers the previous doctor wrote about it from the county public healthcare shitstem office something department of fuck you > you cannot go ask them in meatspace because there is no fucking person who could do it > you cannot ask them on the phone because “””security implications”””, even if you ask for them to be delivered via mail to the exact home address the motherfuckers have on file so the only way for them to not end up to the only person who should have access to them is for some creep to intercept the mail, after lying in wait for something like a couple of weeks because they can’t be expected to deliver shit on time, so basically zero chance, but nonetheless ~*~in theory~*~ it might not work that way so fuck you > you need to write a fucking letter to some fucking bureaucrats to pretty please ask them to give you your medical files uwu > there is no ready-made template because fuck you > you’ve been trying to do it for six months but unable to get it done because you have no fucking idea how to write a fucking information request for some fucking intentionally obtuse statecuck bureaucracy

> drug A basically cures your ADHD-related anxiety > of course it has no sales permit so you cannot get it even though it has been used elsewhere for decades and has no demonstrated risks or addictive potential > because fuck you

> drugs B and C seem promising for treating your ADHD-related anxiety and they have no abuse potential either > they even have sales permits > but not for ADHD-related anxiety so the doctor will not prescribe it because fuck you

> what you can get is legendary-sized massive overprescriptions of Valium and other benzodiazepines with a respectable street price because those are approved for sale > because the State wants to protect people from potentially addictive and/or risky drugs, duh > because fuck you

To every goddamn socdem shitlib FDA apologist statecuck:

#problematic, #problematic, #problematic!

NONE OF YOU ARE FREE FROM #PROBLEMATIC

(as an aside, I guess "cuck" is now basically a synomyn for "fuck?" That happened fast...)

I will keep this forever, because it drives home the frustration and real harm that is actually caused. I love this post!

OTOH, this isn't really something that you can use to change minds. Is it? It's not like it's something that anyone would propose a counter-argument to, because it just plain isn't amenable to that sort of engagement. And if something can't be counter-argued, it shouldn't be allowed to be an argument either. So this is purely to align emotional-motivation with intellectual-motivation. I'm already on record as saying this is a wonderful thing, so props for that! But it's basically for the choir, right?

And then the OP went and translated the whole thing into Respectable-Speak, which can be counter-argued if one wanted to:

The Violence Inherent in the System of Rationing Access to Drugs

In popular imagination, especially in left-leaning memeplexes, it’s common to think of barriers like FDA approvals and prescription requirements as helping people by protecting them from being harmed by the medication they use. However, I would like to argue that this has great harms to many vulnerable populations, especially (but not limited to) people with insufficient material resources, executive functioning issues, many kinds of disabilities, etc.

One common failure mode is where people will be on a steady dose of the same drug for the rest of their foreseeable life. In that case it would definitely seem reasonable that people would be able to keep using that drug without any unnecessary hassles, as the typical objections of “can we know it works for them”, “do they know how to use it” etc. are utterly moot.

This is not usually the case. The exact details vary (it’s definitely different in the US than in Finland), but around here prescription-only drugs will require constant renewals and refills under “professional supervision”. I cannot simply go to the website of a pharmacy and order my estradiol like it’s vitamins from Amazon; I have to waste the time of us both by getting the purchase rubber-stamped by a real person, either physically in the pharmacy, on the phone, or in an online chat service.

While this may seem relatively convenient (and admittedly it has been made as easy as the rules allow), it doesn’t change the fact that one cannot observe any solid reason for such barriers to access, and it doesn’t take much to render that convenience substantially less consequential if one has eg. movement difficulties, social phobia, or any of the other weird brain things reality in its persistent insistence to be inconvenient tends to heap upon the unfortunate and underprivileged.

When ones needs move outside the ordinary, things get even worse. I’m a modafinil user lucky enough to have an actual prescription for it, or more accurately, I would be if I was able to deal with the bureaucracy around the special permits required. My current doctor doesn’t know how to apply for the special permit, so I need to get the permit application the previous doctor wrote.

I cannot get the documents by showing up physically at desk whatever of building N of the county healthcare department of something.

I cannot request the documents via phone because of alleged patient confidentiality issues; not even with the limitation that I would request them to the address the healthcare department has in their patient records, which would effectively eliminate any potential privacy issues as the mail could not be redirected without physically intercepting it, and any adversary capable of consistently intercepting my mail already has full access to my confidential info anyway. Common sense and realistic threat analysis don’t matter to bureaucracy.

There obviously is no convenient web interface where I could use my online banking credentials to order them mailed to me, let alone view them right there (Finland has a system where people can use their bank logins as official ID for many government functions; this has exactly the uncomfortable implications around privacy and government-corporate collusion one would expect, yet it fails at actually solving some of the problems it would naively seem inherently suitable for).

The only available way to request those documents is to write a physical paper letter to the county healthcare archive whatever offices. There naturally is no ready-made template for it, so I would have to whip up an Official Request in the language I’m less comfortable doing written communication in (long story) which happens to be even worse than phoning strangers without explicit invitation. Unsurprisingly I’m now over six months without modafinil because of this.

The harms created by regulating access to medication obviously get even worse when one moves outside the category of drugs that have actually managed to gain official approval for treating your issues; a distinction which uncomfortably often tends to be outright orthogonal to whether they do work for treating your issues.

Semax is an OTC drug in Russia, and has been in use there for decades. It also effectively cures my ADHD-related anxiety. It is not even manufactured and sold in the West except for some obscure companies which produce/procure it for not human consumption, and I have personal communications from the customs office that importing it would be considered a repeat offense. The fact that it has no demonstrated abuse potential nor has there been any evidence of significant harmful side effects doesn’t matter, as the law treats anything which could be used for treating illnesses, ailments etc. a regulated drug, unless it has been exempted as homeopathic or certain categories of herbal.

(It shouldn’t take much astuteness from the reader to notice that the law, while judging intent and purpose instead of eg. risks or abuse potential, specifically carves out an exception for homeopathy. This obviously undermines the common argument that regulations are keeping homeopaths and other quacks in check; in this case the regulation explicitly favors the homeopaths.)

Clonidine and guanfacine are approved as blood-pressure medications in Finland, and in the US they also have approval for treating ADHD-related issues. I haven’t tested them so I can’t conclusively say that they would help significantly (unlike semax which definitely does), but the fact that they are approved for sale doesn’t help as they are not approved for this particular purpose in this particular country. Despite once again lacking in addictiveness, abuse potential etc.

The US famously not approving thalidomide is often quoted by proponents of the notoriously strict FDA regulations (note how in this case the situation in Finland is even worse than under the yoke of the FDA), but empirical evidence shows that there is no meaningful difference between rich western countries in how often drugs get recalled for safety reasons: the number is consistently around 3-4%. This implies that a very unambitious and safe reform would be to categorically permit the use of any drug for any purpose (even if not officially approve) as long as it’s approved in one such country.

Now one would expect that at least such a strict system would do a reasonable job of protecting me from harm and addiction risk.

However, such reasonableness is nowhere to be found. In the past I have been prescribed the notoriously harmful atypical antipsychotic quetiapine for mere sleep issues, as that combination is approved. Currently my anxiety issues are kept in check by intermittent benzodiazepines (diazepam aka. Valium, and oxazepam) which not only do have substantial abuse potential as evident from their respectable street price, but they also are the substance I know I would get addicted to if I ever do (or specifically, the combination of benzodiazepines with stimulants; in perfectly prescription-conforming dosages even), and the prescriptions are (due to a quirk of the system how refill sizes are calculated; my “worst case dose” is multiplied under the assumption that I would take such amounts every day) sufficiently large to make not getting addicted a matter of individual choice as the rationing of amounts is incapable of having such an effect.

TL;DR: local bureaucracy valiantly protects trans person from harmless but unusual treatments, prescribes drugs that can cause severe long-term brain damage or actual abuse and addiction instead.

Now, while this is far more respectable, and something that's more likely to get linked on my Facebook, it has no emotional resonance. I basically fell asleep reading it. It honestly felt like a long, exaggerated excuse that some FDA-hater came up with to propose all the most outlandish worst-case-scenario things that never actually happen to anyone. And even if by some coincidence they DID happen to someone, the otherside is grandma being killed by Dr Terminus, so I'm just gonna step back and figure the government's got this one handled, K?

And so I'm greatly torn between things that have emotional relevance, and things that put forth reasoned arguments. I guess this is why we need both. We determine what is the best course by using dispassionate, reasoned thinking. Then we find a way to motivate ourselves to actually care by seeking out the emotive pleas that drive it.

I'd like to end this post by dropping IMMENSE gratitude on Scott Alexander, and Eliezer Yudkowsky. These are two writers who have consistently (and for long periods of time over many subjects) done the nearly-impossible. They've put forth reasoned arguments that have all the substance and grounding of the sober 2nd post, and infused them with much of the emotive persuasion and visceral appeal of the 1st post. They literally explained important and sobering things to me with tons of support, while making me care on a personal level, and being entertaining to boot. It's an incredibly rare skill, and I am deeply grateful there are humans who can pull it off, and are willing to use their powers for Good.

<3