This is like the seeds of 3/4 of all the bad HN threads all in one blog post. We can relitigate the concept of psychiatry, debate the implications of big pharma, yell at each other about wokeness versus PC culture, pretend not to understand how trade shows work or, I don't know, find some way to argue about how they should be run... and who knows what else. And virtually none of the comments will be from people who have studied in psychiatry, are seriously engaged (pro- or con-) with pharma, or have ever run a trade show.

If it survives on the front page, we should make a bingo card for the thread; for instance, I should score a point the first time an HN user psychoanalyzes another user over the Internet on it.

I'm not saying the post is bad (I'm not a fan of this blog, but whatever; I'm a fan of lots of things you probably hate, too). But there's a difference between a bad blog post and a bad HN submission and this, to me, seems like an archetypical example of that.

I'm glad I read the piece. It's going to generate some pointless, awful arguments here, but the comments aren't everything.

The mods can turn comments off on posts, but rarely do. I think, if we want to broaden the kinds of stories that can survive without flagging, that should happen more often.

I hope your comment stays at the top to at least inspire people to try to exceed your expectations.

That is indeed part of why I wrote it.

My opinions are pretty well documented in the site guidelines.

Well, you've done a good job of spiking it.

I loved this post (basically a balanced criticism of psychiatry by a psychiatrist), and I think it makes a great HN submission.

I actually think it's worth taking the time to break down what makes something a good or bad HN submission. Some elements present in this piece that, when combined, seem to drive the worst kinds of HN threads:

* A spicy take

* A subject almost no likely commenters have any expertise on

* A subject that lots of likely commenters have their own spicy takes on

* Invocation of "wokeness"

* Perennial HN punching bag target (here: pharma; could just as easily be something else)

Again these don't make the post itself bad. I'm not saying it is. I'm saying: grapes are great! But don't feed them to your dog.

I agree, but the benefit/interest in HN isn't just in comment threads... for me, it's my primary source of interesting relevant information (e.g. as opposed to news sites, which are mainly interesting but irrelevant (in the grand scheme of things) information)... and sometimes, that's in comments, other times it's in the articles posted.

Your complaints pop up in basically any thread except for the most bland, or specifically technical, of posts here. Saying it's a bad post because it pinged something particularly offensive in your brain is your own biases talking.

Parent comment specifically states "I'm not saying the post is bad", yet you say "Saying it's a bad post because" in your response. It would be better to read their comment in full to attempt to better understand their angle before responding with a comment like that.

Let's try not to derail this with pointless semantic mincing; the comment above mine said this was "a bad HN submission". What else is that supposed to mean?

What salient difference could they mean between "A bad post" and "A bad HN submission", aside from them simply not having a coherent train of thought?

They meant that it is a good blog post (likely - not specifically stated), but that when posted on HN, will likely inspire bad comments. I interpreted your comment as conflating the concepts 'post' and 'submission' - the difference I saw was that I read 'post' with a non-HN context (a post on an external website), but submission with a HN context (specifically, a submission on HN).

>And virtually none of the comments will be from people who have studied in psychiatry, are seriously engaged (pro- or con-) with pharma, or have ever run a trade show.

I mean that's how internet comments work on virtually any largish web site ever. I don't think submissions should be based on the commentary they might attract.

We're already off to a great start with your post. Thank you for your service.

>I should score a point the first time an HN user psychoanalyzes another user over the Internet on it.

To be sure, I think it should be the first time someone estimates someone's political party based on psych comments, a reversal of the usual trope.

Clearly another HN thread bingo square.

There's illumination here for those of us who've been prescribed shockingly expensive drugs with generic near-equivalents going for 1/40th the price (as I have):

>I asked the Lucemyra® representative why I might prescribe Lucemyra® instead of clonidine for opiate withdrawal. She said it was because Lucemyra® is FDA-approved for this indication, and clonidine isn’t. This is the same old story as Rozerem® vs. melatonin, Lovaza® vs. fish oil, and Spravato® vs. ketamine. ...

My doctor prescribes ketamine lozenges. They are quite cheap, safe, and possibly as effective as IV (more research needed here). He said his insurance didn't change at all. What the world needs is psychiatrists who are willing to take the _risk_ of prescribing a safe drug with a long history in medicine.

Yes, the long-term effects of taking ketamine frequently are not well understood. In my opinion a patient with TRD should be allowed to take this risk provided that they have tried several other drugs.

There's also illumination for people who are interested in the debate on whether or not one should research medical issues on the internet yourself, or "trust your doctor, they're a professional".

There are externalities for experimentation which include bankrupting the health system. Imagine if everyone only ate red meat. Bowel cancer would soar.

I think the thing that stands out to me about this whole thing is how nakedly corrupt it comes off as. I'm sure the legions will rush to rebut me and say "But Psychiatrists have ethical standards! They would never let ice cream influence their decision to prescribe a substandard drug!" That may be true, both philosophically and perhaps even in practice (though I doubt it...[0]) but even still, the bonanza of sleazy advertising is _so_ embarrassing to psychiatry, drug companies and the FDA.

Drugs should be prescribed on a clinical basis, full stop. Attempting to advertise your medication on any other basis should be a criminal offense. We as a society need to draw a bright moral line to stop this type of behavior. Though I laughed at Scott making light of it, this stuff isn't funny. This is a life and death issue.

> Drugs should be prescribed on a clinical basis, full stop. Attempting to advertise your medication on any other basis should be a criminal offense.

You want to jail people who advertise medication on the basis of price?

This is a false paralellism. There is no equivalent to 'taste' in terms of medication. Sure, you may urge your doctor to switch from one medication to another because it works better for you or has more acceptable side effects. But that's very clearly a clinical decision.

In any case, shilling with free ice cream or a giant house of cards does not communicate this information.

It's kind of horrifying to consider that advertising has a statistically significant chance of influencing a psychiatrist away from prescribing based on what best suits the indication.

Strong statistical significance. When I was in med school (UCLA 1970-74) everybody took aspirin and/or Tylenol. Now, I'm the only person I know of who still takes those two drugs rather than the zillions of newer, more expensive pain relievers. Why? Because none of the drug company-sponsored studies concluding that their new drug was better than my old standbys were convincing to me. As an experienced scientist who co-authored a number of investigational drug studies, I know whereof I speak. References:https://scholar.google.com/citations?user=5DdrMc8AAAAJ&hl=en

It should be nationalized.

Specifically product discovery should be switched to a non-profit quango. The people currently engaged in the advertising industry should be paid to promote positive shit whilst their business wind down over a decade.

Looks like psychiatrists have a word for every disorder except the disorder they themselves are afflicted with.

It's either that or these preponderance of woke talks and problematizing anything and everything is a prime example of the Shirky Principle in action.

https://kk.org/thetechnium/the-shirky-prin/

Last I heard (three or four years ago), the APA was suffering from a fall-off in pharma advertising. If that is the case, and it hasn't rebounded, just think what the advertising must have been fifteen years ago.

this quote from the article was especially poignant:

> Second, psychiatry has always been the slave of the latest political fad. It is just scientific enough to be worth capturing, but not scientific enough to resist capture.