Must not blog about FTX . . . must not blog about . . . ah, $#@% it
I think the most surprising thing for me was that “In line with most tech companies” is a great euphemism for “yes, everyone was on stimulants”. And just how matter of fact the article is about software engineering being fundamentally incompatible with the human mind.
And like… I can’t focus very well at my software engineering job, to the degree that I basically relate to all the discussions of people with ADHD now (it wasn’t an issue before college). And I don’t really have particular problems with anything else (chores, writing, massive amounts of DMing). Just my job.
I know a few friends on Adderall, but I thought they were the minority. I don’t know how to feel if it’s really that common. I’m honestly still skeptical of the claim, just because I don’t want to believe it.
Were there any mainstream media stories critical of their use of performance enhancing drugs (which SBF and others seem to have been quite open about on Twitter) before the crash? It seems that would be a red flag worth looking into when reporting on SBF and FTX - but probably didn't fit the narrative of the boy wonder next Warren Buffet story journalists wanted to tell.
I've been working in tech for a long time. I've never (in my life) taken anything like adderall. At most, I have some caffeine (but I don't even like coffee.)
After reading this: I'm curious about how this type of thing would affect me. Can anyone describe the difference? (How much of it do we think is placebo effect?)
Edit: To clarify my "placebo" comment. I don't think the stimulants have _no_ effect. But I'm wondering if _some_ (maybe more than half) might be due to knowing you took a pill that supposed to help you concentrate.
Sure seems like an awful lot of things de facto require stimulants for success now. Compulsory education (for boys anyway), coding, professional gaming and sports, financial trading...or even in mundane occupations and daily routines, who doesn't get started with a caffeinated beverage? (Much more fun when also mixed with amphetamines, too. Espresso + dexadrine led to some...memorably long uptimes. Glad to have kicked that habit.) Perhaps there's a more systemic price to be paid for the general overclocking of humanity, beyond potential acute failures like this one.
(Can't resist 8: Based on your expertise and years of training, Dr. Alexander, do you agree that __injecting__ bleach would on net be more harmful than drinking it?)
I am not qualified to talk about the pharmacological aspects of the article, but I did simplify the financial aspect of FTXs fall:
Something this makes me wonder is if Jane Street or other non-exploded trading firms have far more capable and systematic psychiatrists on staff to manage the drug cocktails their teams are on
>But if you’re already a cryptocurrency trader, maybe it only takes a tiny amount of risk-curve-shifting to turn you into a cryptocurrency trader who makes riskier trades.
Can we stop pretending that risky trades were SBF's main fault instead of committing fraud?
>Please don’t rush out to abuse drugs just because you read about them in an article on how they contributed to a $10 billion bankruptcy.
Yeah, that's what the annual nootropic survey is for.
In defence of the defence attorney, even lawyers have their own ethical rules. If his client says she didn't drink the bleach, he's not allowed to make up his own, better case.
You also should consider doing expert testimony again; you had basically the definitive expert witness experience of being cross-examined on something with a counter-intuitive answer that you don't have to hand. Taking an honest crack at it is the best you can do in the circumstances, so well done!
It's also worth bearing in mind that judges have all heard the same thing hundreds of times, so are aware it's mostly a parlour trick.
I thought modafinil was primarily used for narcolepsy
Scott, I just have to say, I love how you write disclaimers. They're great.
Re: footnote #5
I feel like there's kind of obviously a class of people who wear opposite-sex clothes for reasons other than identifying with the opposite sex, and "transvestite" is a perfectly-fine word for this class of people.
To the extent it's considered an "offensive" term now, the reason AFAIK is literally just "transvestism's existence is very mildly inconvenient for the SJ narrative, so SJ has decided to cancel everyone who acknowledges it". Certainly this isn't a case of "we came up with a new word, if you aren't with the current fashion you're bad" - there is no new SJ-approved word for transvestism, *all* of them (crossdresser, trap, etc.) are now "slurs", it's just been cut out of the accepted language as an expressible concept in the exact mold of Newspeak.
(I stress again, the existence of transvestism isn't even *that* inconvenient for the SJ narrative! You can totally believe transvestism is a thing and also transgenderism is a thing! It just slightly complicates the explanation!)
Fascinating/awesome write up! This whole debacle feels like a crossover episode of silicon valley and 30 Rock with Chris Parnell aka Dr Spaceman (spe-ch-men) being in three episodes as the company psychiatrist/performance coach
This is 👀. Somewhere along the line the concept of primum non nocere got lost.
The office was only on Adderall because of cowards who know Desoxyn is the best treatment for ADHD and refuse to prescribe it.
> this is a violation of the Goldwater Rule that psychiatrists aren’t supposed to publicly assess famous figures
Would this article fall under that rule? You're not giving a psych evaluation of him, but would speculating about how his medication might have affected his risk tolerance, count as "publicly assessing" him?
What a wonderful S.A. (i.e. "an essay as outstanding as a post by S.A.S."). I am grateful to live in this time. No cocaine for my brain, no emsam and no jhanna, just this. I am high on ACX.
Good to know it was just good old regular idiocy then. And not drug induced idiocy which caused this.
But seriously, anytime someone is labelled "the next Warren Buffett" they are usually the complete opposite. It is amazing how reliable this seems to be.
One data point: I have a relative with Parkinson's. All of a sudden out of nowhere, he lost tens of thousands of dollars gambling. His doctor took him off his medicine (I don't know which one it was), and he stopped gambling--he had never gambled before. He wrote the drug company, and they paid for his losses.
Here's a thought that crossed my mind which I'm not sure how seriously to take:
If you think, on utilitarian grounds, that you ought to be a lot less risk averse than seems intuitive, then you'll probably find that your instinctive risk averse responses in many situations are getting in the way of acting quickly how you would want, on reflection, to act. So if there are drugs that make one's instinctive responses less risk averse, one might consider taking those as a kind of moral enhancement.
SBF et al. famously did think that they ought to be much less risk averse than is intuitive. I wonder, then, if it's possible that risk curve shifting was not an unintended side effect of the stimulants, but rather part of the point of taking them.
(Of course, this only makes sense if you think the drugs shift your risk curve in a way that is predictable and doesn't overshoot or otherwise make one act irrationally, and I don't know if it's plausible SBF et al. would have thought that.)
🤯🤯🤯🤯 this is making me want to stop taking Ritalin.
I definitely went through a period where I was weirdly addicted to online furniture and fixture/hardware shopping while I was doing a reno and it struck me as very odd. Nothing before or after that reno triggered compulsive behavior in the same way. I also totally overshot my furniture budget. 🤦♀️ Never thought it was the adhd meds...
Wonder what else it’s doing to me that I don’t realize.
Also, Hamilton Morris has discussed combining adderall and Ayahuasca (an maoi) and he did not die.
I find the idea of being on stimulants to do your job both fascinating and terrifying. I don't really touch drugs so my experience is far more about caffeine than anything harder, but my every experience with stimulants is that you're not really gaining anything. Sure, you're more focused, more active and more productive now... but there's always a later and generally the work I get done during a caffeine rush is matched by all the work I don't get done when dealing with the post-crash brain fog.
Maybe people are more willing to mortgage their downtime in exchange for their productive hours than I am. It still feels like a real faustian bargain to me, though.
Can't wait for the inevitable Much More Than You Needed To Know About The Safety of Drinking Bleach when Scott retires.
Very interesting recent paper challenging the role of MAO-B inhibitors in the metabolism of dopamine. Disclaimer, I haven't read it closely, but the journal is fairly reputable and the topic is relevant here. It is making some controversial claims so I have some skepticism, but again I have yet to read closely.
Also interesting to note, I believe MAO-A is responsible for the metabolism of tyramine and therefore selegiline (as a selective MAO-B inhibitor at lower doses) is generally not considered to be a risk for noradrenergic hypertensive crises. I also believe that with lower amounts of tyramine in modern foods (among other reasons) has led to the risk of such crises in general being much rarer than was previously expected. This seems to be backed up by user reports on such drugs, but of course there is a selection bias in that these reports cannot be made by people who died from strokes related to an explosion of blood pressure.
Interested in hearing peoples opinions on both points.
EDIT: Oh, I just noticed you posted this in the footnotes. Apologies, but still interested in any discussion!
So modafinil breaks birth control and causes hypersexuality. Why is no one else pointing to this as the cause of increased ADHD diagnoses?
Can stimulants get you in a loop where after taking them, reloading with another dose sounds like a great idea? Basically the Gandhi murder pill thought experiment but with real pills and less murder?
As for risk curves... I have a friend who's bipolar, though one of the lucky (?) ones who spends ~80% time in various degrees of mania. His favorite quote is a piece of philosophy he accidentally received from a third world waiter struggling with English: "Everything is highly recommended".
Re: Footnote 8: Three words: dose-response curve. Too much: bad. Not enough: not a problem. "Dose-response curve" is a much more expert-sounding answer than "I don't know", even though it means the same thing.
Except: is "dose-response curve" three words or two? I don't know!
Acetaminophen might increase risk-taking.
This post also makes me feel less bad about not being able to manipulate tiny numbers all day. I’ve been beating myself up about this perceived failure, but you’ve normalized it. Thank you for this. 🙏
Agree with all of this, but the "regular" in Caroline's comment quite obviously means "consistent" rather than "standard".
Scott decides to run challenge mode where he will be pruning out comments, and the same week this all happens. I'm wondering if he still has time to do the challenge pruning, or have events overtaken him?
As to the psychiatrist, I'm going to venture that someone who is being described as a pill-pusher whose job was to get all the FTX and Alameda traders hyped up on stimulants is not going to admit in an NYT interview "Oh yeah, they were all frothing at the mouth crazy, I just wrote the scripts as they asked for them" especially in light of all the allegations of fraud and embezzlement and swindling, but rather rush to give an account about "Why yes I was there but only as a kind of life coach and goodness gracious me I had NO IDEA that kind of malarkey was going on!" as a way of trying to keep out of the mud.
As to bleach, I have no idea how much you'd need to drink for a suicide attempt. A mouthful is bad but probably will only make you sick; half a bottle will likely do damage:
As to the drug use, here is where we slap ALLEGED ALLEGED ALLEGED all over any comments we might make, but again - "judicious" is not what comes to mind in this context of over-ambition, over-confidence, and over-reaching themselves, especially in Bankman-Fried's case.
The dopamine I felt when I saw was posted was off the charts
Just here to say, great use of "marit ayin."
From what I know of the facts, FTX had nothing resembling a system of internal financial controls or compliance. These things are vital to the safe operation of any financial business, but they are hard to do and not necessarily intuitive. Furthermore the incentive structure of the business always motivates sales and trading personnel to shortcut or ignore them. Financial regulators are constantly sanctioning and fining well known major entities for violations.
I doubt that anyone in the crypto arena knows or cares very much about controls and compliance. The FTX disaster noes not require drugs to explain it, just ignorance and a lack of regulation.
Bernie Madoff didn't use drugs.
Wanted to comment briefly on the testimony thing:
Life's too short to be an expert witness on anything but as a former attorney, I can say you did a great job. The point of the defense attorney's questions was to ruin your credibility no matter what you said. He'd paint the answer "You can drink a little bleach and live" to mean "I am recommending drinking bleach" and the answer "If you drink a little bleach you'll die" to be absolute proof that no bleach was drunk.
"Probably you can drink some bleach and not die but I can't be sure and that's not really the point of my testimony" was 100% the correct answer.
There's some evidence that MAOB does not play a large role in the degradation of dopamine in vivo.
If true, deprenyl actually works by inhibiting the synthesis of astrocytic GABA (which is done by MAOB), increasing dopaminergic tone by releasing the inhibition exerted by GABAergic interneurons.
Also though, inhibiting MAOB most definitely increases Beta-phenylethylamine and other trace amines, some of which are basically endogenous forms of amphetamine
Morgan Housel's insight seems worth considering with Lord Acton's preceding as a more direct explanation of events.
LA: "Power corrupts"
@morganhousel, 3:03 PM · Nov 12, 2022
"Re-watched the Enron documentary with @bethanymac12 a few weeks ago and a thing that sticks out is how much you can get away with when you tell investors what they want to hear. Very few people asks questions when the numbers are going up."
"If you pretend to make other people rich those people become 10x more gullible than they assumed they were."
"It’s why so many frauds are shockingly unsophisticated."
Recovering stim-addict Hunter Biden made his first public appearance yesterday, in a Twitter spaces about the FTX scandal, but didn’t comment on it directly.
So, FTX deserves some credit for making a crisis so big, it serves as an opportunity for others.
Others who have begun the process of rehabilitating their image by implicitly comparing themselves to SBF include the people behind the crypto blowups that precipitated the FTX collapse: Do Kwan of Terra/Luna, Su Zhu of 3 Arrows Capital; and also Martin Shkreli, the guy who went to jail for hiking the prices of old drugs, among other things.
From the outside, it did look like that Sam had a penchant for stims. If you see him in TV/youtube interviews, his body physically shakes.
Now, how commonly do stims get used as performance enhancing drugs in tech? Impossible to exactly measure, but stereotypes exist for a reason. In the hiphop world, to be “geeked” or “geeking” means to be high on uppers.
> If you want real sound crypto, you have some good buying opportunities here. Mid 2024 we will go through the ups again. Ignore all the morons saying this time is the end. I've heard that every crash since 2010.
This sounds like the perfect opportunity for a prediction market!
Since we know SBF is a subscriber here, I’m wondering if he read this article and is now second guessing his decision to mix the drugs.
We can also assume Matt Levine is a subscriber, since he quoted a subscribers-only post the other day. I wonder if any of this will make it into his newsletter if this angle on the FTX story comes up.
"The best I can say for him is that he’ll probably get away with it, because the only injured party is Sam Bankman-Fried, and I assume Sam’s lawyers are busy right now."
Don't psychiatrists have a professional association or trade organization with a mandate to investigate stuff like that regardless of what the victim might want, and dole out serious punishment up to and including the removal of the ability to legally practice?
FWIW, n=1. Many years ago I was for a good long while on an ordinary therapeutic dose of venlafaxine (Effexor) for depression. It worked well for that. But I ended up going through the unexpectedly difficult process of getting the hell off venlafaxine because I came to believe that it was causing me to take unwise risks and also to be callously unconcerned about other people (both of those things being, I think, symptoms of a more general “don’t dwell on negative consequences: just do the thing” effect). I don't think either of those effects would have been easily measurable, and it was only the cumulative experience of many months on the drug and some sustained self-examination that teased it out for me. I continue to wonder to what extent small effects like these, multiplied by the many people now on drugs like these, may have prudence- and consideration-eroding effects at the societal scale.
> He claims this is okay, because he was just a “performance coach” for the company, who happened to, additionally, be a psychiatrist who was treating many of the company’s employees.
"I'm not a therapist; I'm a therapy *horse*!"
(line from Bojack Horseman)
>neuroscientists investigate how modafinil shifts some technical parameter in a risk curve; usually these don’t replicate
Additional anecdotal data: during use of prescription modafinil, I actually had minor reduced risk taking as I had more energy to actually address known risks. I imagine same or opposite effect could be seen in folks that had risk-averse or risk-taking activities/tasks that they already wanted to do but simply didn’t have enough energy to participate in/complete. I would not be surprised at all if this explained the outliers/non-reproducible cases. (Naturally, a crypto-trader may also fall under the umbrella of “wanted to do more risky crypto-trading the whole time and now has the time and energy to do so”.)
>Because ADHD is so poorly defined that the official standards basically boil down to “it’s hard for them to do their job without Adderall”, there is a giant loophole where bosses can just make jobs that are hard to do without Adderall, and then psychiatrists can prescribe the Adderall.
While this is a very serious loophole, please please avoid generalizing it, as there are many software jobs that appeal to people with a “number brain” (mode of thinking that is related to ADHD-adjacent and autism-adjacent traits in complicated ways but also allows rapid flexibility & high engagement when Poking Those Tiny Numbers All Day), and thus software jobs will attract many employees that suffer from attention problems in all aspects of life and regardless of what job they are working.
Oftentimes, the attention problems even follow specific patterns of “I can focus extremely well on the work itself but put me in an under-stimulating meeting that for some reason is required five times a week of software engineers, and I will be completely useless”. (My source for this is observation of colleagues in multiple software jobs and in software club work. Almost nothing got done in any meetings unless a non-engineer was directing the meeting. Hence, regardless of medication level, I recommend converting these meetings into other formats that are easier for the engineer to digest rather than assuming it’s their problem for not listening well. It’s simply more effective.)
> I quit my job and tried to contribute what little I could to the ongoing campaign of all reasonable people to destroy the New York Times. This was the correct, ethical thing to do!
I pray that one day you will be able to forgive a newspaper rather than let this grievance define your entire politics.
I've recently started taking Biphentin (canadian methylphenidate) and I was wondeing about the interaction with 1/ coffe and 2/ weed.
I couldn't find anything interesting online and was wondering if you could point in the right direction.
Maybe the problem was not the use of drugs.
One thing I find not true: " if a good doctor carefully chooses the right drug and dose, you’ll mostly get what you want."
Would say the evidence suggests "might"rather than usually
This could almost have qualified for a "Sam Bankman Fried's Drug Habits: More Than You Wanted to Know" title, but hey, I read the whole thing, so I guess it wasn't more than I wanted to know.
I must say, also, that this post has inspired me to make the following vow: if I'm ever the CEO of a medical supply company, I will not name random product offerings after my progeny. I can't imagine there aren't better ways to publicly demonstrate love and devotion to one's offspring than to name a particular MOAI Delivery device after them, especially since the life cycle of the product is probably limited to the patent length, anyway, and in the meantime, shady, pseudo-intellectual finance bros are abusing it to scratch out a few extra basis points in their ponzi crypto schemes. I have to think a son of mine would be almost as equally unexalted to be informed one future day that a new enema kit had been branded the Gordon Tremeshko Jr. Buttflush 3000 in his honor.
> Bitcoin is the only cryptocurrency you should hold. Maybe ETH.
This is a little extreme, there are other useful projects. BTC Maxis are behind the times. I do agree exchange tokens and probably 95% of other coins are pointless scams, but there are legitimate projects with ecosystems worth participating in.
Anecdote regarding footnote 5): I have diagnosed ADHD and something that happened to me was that when changing from methylphenidate (Concerta) to Lisdexamfetamine (Elvanse) some social triggers + heightened ability to "withstand social risks" + heightened (bodily) anxiety cracked my transgender egg in an extremely quick way (few weeks of discussions with some peers led me to 10% confidence hypothesis, then I reduced and later stopped the stimulant usage, thoughts / changed beliefs stayed, now I Have some 80% confidence of being in some way non-cisgender). (There were minor "signs" in earlier decades of my life, and I don't doubt it would have come up at some point, but it might have taken many more years otherwise.)
Thank you for writing about this.
A surprising number of botanical supplements are MAOI's. I just discovered I have occasionally mixed a MAOI and a dopaminergic stimulant. I'm glad I did not die.
List of common examples in the table of this article. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9268457/
I stopped in the middle of reading just to add this
"A significant fraction of the finance industry is on Adderall - I know because they keep trying to make me prescribe it to them. This hasn’t degraded performance so much that managers have noticed or made rules against it. And for all I know, maybe the medicated mental risk curves are better for trading than the unmedicated ones."
Kind of off topic but I confirmed with a big market making firm that making money as a market maker in 2021 was crazy easy. The claims that Alameda became unprofitable at that then don’t pass the smell test. “Not especially competent at running a trading firm” doesn’t match many of the facts and is an overly convenient explanation. There was obviously fraud and some massively bad decisions but losing their edge wasn’t the reason for the losses.
On stimulants and risk-taking:
I did notice an increased tendency to take risks (i.e. quitting a miserable corporate law job to do a software bootcamp) as well as a tendency to be more direct and honest in social situations. After conferring with friends on this, especially if I was becoming mean/insensitive, the consensus was that I was, in fact, doing more stuff without overanalysis. But also that relative to the norm, for me "doing more stuff without overanalysis" still meant overanalyzing considerably.
The main thought I had reading this excellent writeup (Thank you. Scott Alexander) is the mistaken notion that FTX would somehow not have occurred if <insert X drug(s)> were not being used.
This is thoroughly invalid, IMO.
Whatever you think about cryptocurrency - the reality is that the entire space has been a veritable Tortuga of scammers and grifters as well as your more typical one-trick pony, one and done trader.
And to be more clear: the one-trick pony, one and done trader is that guy who goes all in on exactly the most foamiest trade during an up cycle of risk, but literally has no trading skills whatsoever. Much as a stopped clock is right twice a day, SOMEBODY is going to make the perfect trade at any given time, even if it is just by coincidence/luck.
Combine a modest amount of criminogenic accounting savvy with $1b of venture capital, a soupcon of utter shamelessness, a dollop of woke virtue signaling and a totally unregulated sector - and an FTX was inevitable.
The nootropic dude's comment was the funniest: clearly another one-trick pony trader failing to recognize the fundamental sea change represented by short to medium term risk-off due to escalating interest rates - doubly ironic because the brilliant coders and masterminds behind literally every big name Silicon Valley startup in the past decade have yielded nothing more than minimum wage circumventing, washing each other's laundry, fundamentally financial garbage "unicorns".
Hm, this does not seem like gambling behavior to me. It looks like this was one single decision by SBF to bail out Alameda by committing fraud. I guess one could see it as taking a risk and gambling that he would not get found out, and the pharmaceuticals he was on could have influenced his decision. But something tells me he would have made this decision no matter what drugs he was on in order to save Alameda, since most of his wealth was tied in it.
If lack of sleep is the main mechanism by which stimulants cause psychosis, then modafinil and amphetamines should cause psychosis at similar rates. If anything modafinil should be worse, since it seems to more effective in specifically suppressing the urge to sleep. So why is it that amphetamines have a much worse reputation?
Add me to the list of bay area software engineers who have never taken Adderall or anything like it. Heck, I don't even drink coffee!
Does anyone else find it strange that we have an economy that rewards people so disparately depending on their abilities? There's so much talk about "hard work", "deservedness" and "talent". But if there are pills that can make you work crazy hard, doesn't that prove it's all just brain chemistry? And "talent" is also just a bunch of heritable things like IQ.
It really seems like your lot-in-life is entirely rng dependent on what genes you're born with, where your dopamine baseline gets set, intelligence etc. Reading stuff like this makes me feel very Rawlsian.
I'm tempted to link this to a recent famous story about someone telling people to drink bleach, but I don't really want to end up in yet another slapfight about motivated stopping.
My personal experience with Prozac is that it makes me a better card counter and a worse trader. Card counting is just executing an algorithm robotically, and prozac gives me the audacity to go do that in a casino. But trading requires more judgment calls and the medication seems to shift the risk curve.
A decade ago when I suggested taking an herbal MAOI (rhodiola) together with the 10mg prozac I was already taking, my psychiatrist was immediately like "ok, fine, no problem, I've done this before with several patients and nobody ever got serotonin syndrome"
FTX shrink says executives were ‘undersexed,’ denies rampant amphetamine use By Thomas Barrabi November 16, 2022
The in-house performance coach at FTX claimed Tuesday the doomed crypto firm’s headquarters in the Bahamas was a “pretty tame place” — despite rampant speculation about its executives’ sex lives and alleged substance use.
Online gossip alleging the group lived in a “polycule” — or network of polyamorous relationships — surged after CoinDesk reported the executives “are, or used to be, paired up in romantic relationships with each other.”
Dr. George K. Lerner, a psychiatrist, reportedly served as a therapist to disgraced FTX CEO Sam Bankman-Fried and an adviser to many of the firm’s employees. Bankman-Fried and his ex-lover Caroline Ellison were reportedly part of a 10-person group that ran FTX and its sister cryptocurrency trading firm Alameda Research from a “luxury penthouse” in the Bahamas.
“It’s a pretty tame place,” Lerner told the New York Times. “The higher-ups, they mostly played chess and board games. There was no partying. They were undersexed, if anything.”
“They were working way too much,” he added. “It would have been healthier if they did have more healthy dating relationships.”
The personal habits of Bankman-Fried and other executives are under the microscope following reports that at least $1 billion in FTX client funds is still missing. FTX, Alameda Research and more than 100 affiliates filed for bankruptcy last week.
Lerner also addressed viral rumors about the alleged use of stimulants by FTX executives. Ellison, the CEO of Alameda Research, admitted to “regular amphetamine use” in an April 2021 tweet, while Bankman-Fried has openly discussed his experimentation with Adderall and other stimulants.
Lerner told the Times that while some FTX employees may have had prescriptions for ADHD medications, the “rate of ADHD in the company was in line with most tech companies.”
He was such a different person while on the medicine. I don't think he really has access now to who that person was.
My reading is this: Gambling is exciting. I think that anyone who is exposed to gambling has to exert will power to stop. Maybe not much willpower, but some. Before the medicine, he never lacked for willpower. What changed with the medicine was that the excitement was able to override the willpower.
I read an interesting long form article about dopamine agonists causing compulsive and risk taking behavior that people may find illuminating: https://theamericanscholar.org/the-degradation-drug/
Absolutely hilarious in your last footnote about testifying, as a colleague, yep, I HATE the court, they make physicians who are testifying for the sake of patient care and the safety of the community out to be the villains, even the lawyers who are there to be supporting you do a shit job in doing so.
Forensic psychiatry can be boiled down to one comment: make sure you get paid first!
And if not paid, get the F out of having to go!!!
*tongue in cheek*
Oh, taking selegiline meant he couldn't eat tyramine? There's the problem! Without tyramine, his rudimentary telepathic complex stopped working, leading to worse performance and then failure.
Having read this, I have reached the conclusion that the tech/crypto/EA nexus is completely out of control and needs a jolly good talking to.
Wait, is transvestite now considered to just be an old and offensive term for transgender? I thought they were different things. I can certainly imagine a universe where "people who identify as a gender separate from their sex" and "people who like to wear clothes that don't conform to their gender" both exist.
> I want to back off from saying it’s omnipresent, because commenters are telling me it’s not, but I’d be interested in finding firm numbers
I believe it's omnipresent in highly competitive industries, like Big Tech A.K.A FAANG, probably finance etc. I can comment about Google - while I worked there I was under the impression half of people were on Adderall or other medication.
Knowing SBF came from Jane Street, Addie was probably very popular there.
I really hope people start openly talking about Adderall abuse - it's like doping in white collar industries. And the problem is that most folks on Addie force this crazy workstyle on the rest of us.
An equally fun Psychopharmacology fact: the discoverer of Barbiturates named them after his girlfriend - Barbara.
Did anyone put a gun to SBF's head and force him to take drugs? No? Then I don't care in the slightest if he did what he did because of drugs or because he was a bad person. We are all responsible for our actions, both on and off drugs. I don't get away with murder just because I was drunk while committing the crime. Abusers of illegal drugs are even less deserving of leniency.
Dr. Lerner has some really problematic and questionable reviews, that further the case for potential malpractice. Reported to the CA Board, making a proposition towards a client, etc. See this tweet for more: https://twitter.com/AutismCapital/status/1592659580081016833
24 7 trading hours in
Poor sleep hygiene is a glaring dangerous side effect of stimulant use.
Impaired judgement living on 5 hours of sleep mixed with any stimulant
I worked the majority of my life in Canada and Japan where most prescriptions are written by a gp and very few have access to a psychiatrist.
Canada and Japan culturally accept weak corporate governance and dismal enforcement records.
At the height of Japan 1990s when I was in Japan shareholder meetings were held on the same day and Police showed up 10000 strong Companies used to coordinate to hold their shareholders meetings on the same day to reduce the risk of “sokaiya” corporate racketeers from showing up.
Canada doesn't even have a National Market Regulator to regulate their market and it is very whistleblower unfriendly.
Can you write an article about the possibility of asperger syndrome and the inner circle of FTX story ;
I know you've already summed up your thoughts on what dopaminergic medications do to risk assessment (negligible if used appropriately), but because I work in a notably high consequence industry (consequences round the neighbourhood of Exxon Valdez or Piper Alpha) where doing risk assessments is a pretty big part of the job, I'm going to ask anyway:
Is this risk of compromising risk-based decision making big enough that I should bring it up with my own doctor? Should I just be aware that it's possible (particularly on sleep deprived days), adjust my behaviour, and move on?
I might be in the minority, but I'd like to gently suggest that you reconsider using footnotes. I found that they broke the flow of the narrative, and clicking on them was quite unwieldy on my phone. Or perhaps it might be possible to have them appear in a sidebar?
I wonder if he was trying stimulants for weight loss? The guy is pudgy (and before anyone steps in to accuse me of fat-shaming, I'm no sylph myself. Just as it's okay for rappers to use the n-word, so can People Of Amplitude talk about "lookin' a bit porky there, mate").
What brings this type of consideration to mind is this interview, or rather Twitter conversation, that Kelsey Piper has up at Vox with him:
The depressing part is that he does not accept any responsibility at all in a meaningful way. He talks about "I fucked up" but then he goes into what is plainly going to become the story he will tell himself from now on, in denial of the facts - he could have fixed it all, but he was led astray by bad advice from the people who told him to declare bankruptcy. If he hadn't done that, he could have (magically, miraculously, somehow) raised the funding to make it all okay and pay everyone back in a month or so.
Typical behaviour of someone in denial of reality and spinning a story around their own victimhood: it wasn't me, it's all the fault of other people. It's the fault of the people who told me to file for bankruptcy, it's Gary's fault, it's Nishad's fault for not standing by me:
"SBF: I fucked up. Big. Multiple times. You know what was maybe my biggest single fuckup?
SBF: The one thing *everyone* told me to do. Everything would be ~70% fixed right now if I hadn’t.
KP: I’m trying to guess but I have no idea.
SBP: Chapter 11.
KP: Like, should’ve just rode it out and kept trying to make the $8 billion back?
SBF: If I hadn’t done that, withdrawals would be opening up in a month with customers fully whole. But instead I filed, and the people in charge of it are trying to burn it all to the ground out of shame. I might still get there. But after way more collateral damage. And only 50/50.
KP: I’d take the under on that.
SBF: Basically we get there if both:
a) EITHER Gary OR Nishad comes back
b) we can win a jurisdictional battle vs Delaware
KP: Gary and Nishad are gone?
SBF: Yeah, scared. Or Gary is scared, Nishad is ashamed and guilty.
KP: Ashamed and guilty because all the customer deposits are gone?
KP: People I’ve talked to have said Nishad was much more into the ethics/not being sketchy stuff than you were.
SBF: Yeah. It hit him hard. I mean it hit all of us hard. But it hit him HARD.
KP: It seems like you have more of a sense of yourself to fall back on, more of a sense that you are only wrong if you lose and he was more like “wow we stole money from people who trusted us”.
SBF: The world is never so black and white."
As to Delaware, good luck with that one. FTX is incorporated in the Bahamas, so I don't know if he means FTX.US, or if he's trying to shift incorporation from the Bahamas to Delaware. Either way, given that he kept moving headquarters to get out from under regulatory bodies, I don't think Delaware courts will be too lenient about alleged fraud.
This conversation also explains something that puzzled me, the sponsorship of sports teams and buying stadium naming rights. I couldn't figure out why FTX was doing that, given all the noise Bankman-Fried was making in interviews about doing good and donating to worthy causes. Publicity, sure, but why sports?
But this report clears it up for me. He was never about ethics/ethical altruism, he was always about *popularity*. Saying the right things is a way of getting people to like you, and when they like you, you win. And it's all about winning.
So sports is a way of getting popularity. Part of it might have been "what do other billionaires invest in, oh I see a lot of them have sports teams and sponsor stadia", but let's face it: he was probably a chubby nerd in high school and in college, and who are (allegedly) the popular ones in high school and college? The jocks. Colleges have sports teams and invest a lot in them. That explains to me why he went for buying the naming rights for UC-Berkeley sports arena (rather than getting a building named after him or endowing a chair as the usual way for STEM/business types). This was a way to get in on that mass appeal popularity and be the cool guy that he never could be as a chubby nerd:
"KP: So the ethics stuff – mostly a front? People will like you if you win and hate you if you lose and that’s how it all really works?
SBF: Yeah. I mean that’s not *all* of it but it’s a lot. The worst quadrant s “sketchy + lose”, the best is “win + ???”, “clean + lose" is bad but not terrible”.
KP: You were really good at talking about ethics, for somoene who kind of saw it all as a game with winners and losers.
SBF: Ya. Hehe. I had to be. It’s what reputations are made of, to some extent. I feel bad for those who get fucked by it. By this dumb game we woke Westerners play where we say all the right shibboleths and so everyone likes us."
So he learned off the jargon that was current in a particular circle he moved in, and he's still spouting it ("woke Westerners" etc. is the right thing to say about 'we white liberals have all this privilege' when trying to shift the context from 'you stole money from your clients' personal guilt to 'the guilt of Western society fall upon us all' collective and nebulous blame - like systemic racism, what can you, single white person, really be held accountable for if it's all in the water and all are to blame?)
There's other stuff that I don't believe, because if it's true then this lot shouldn't have been in charge of a lemonade stand let alone a trading firm and exchange. If a disgruntled and lower-level ex-employee can hack your systems for millions of dollars that mysteriously went missing after all this shit hit the fan, then what the hell were you doing? What justifies you being in charge?
It's a mess all around and sadly it looks, so far, as if Bankman-Fried has settled into his comfortable little groove of denial: sure he messed up, but his intentions were good, and he could have fixed it all were it not for bad advisors and cowardly colleagues.
The real issue:
Never seen ‘such a complete failure’ of corporate controls, says new FTX CEO who also oversaw Enron bankruptcy
Published Thu, Nov 17 2022
Newly appointed FTX CEO John Ray III scorched Sam Bankman-Fried for a total absence of trustworthy data and lack of financial safeguards.
Ray, who led the restructuring of Enron, said that FTX lacked adequate human resources, cybersecurity, accounting and auditing teams.
Ray disclosed that he had no confidence in the balance sheet statements of Alameda, FTX, or their subsidiaries.
"Please don’t rush out to abuse drugs just because you read about them in an article on how they contributed to a $10 billion bankruptcy."
According to a friend who works on Wall Street, the Alameda Research trading strategy could be summed up as "frontrunning, performed using FTX customer money".
*IF* that is accurate, how clueful can these people be, if they went bankrupt because they screwed up a game rigged in their favor? It's like losing all your money playing poker, when you are the only one at the table who secretly knows what the next turn of cards is going to be and you also can gamble using the other players' money.
This is totally anecdotal, but I've actually been on Emsam. I have treatment resistant depression and after many SSRIs and SNRIs I wanted to try an MAOI. But I was worried about the side effects, so I heard the patch would work better for that. Luckily I had good insurance at the time that actually covered it, so instead of over a thousand dollars a month it was $30.
I also started transcranial magnetic stimulation around the same time, so it's hard to distinguish the effects of the two.
I struggle with impulse control, but I didn't notice it any worse with the Emsam. I worked up to the highest dose as well. I did notice that I couldn't sleep. I was absolutely wired, I was seriously sleep deprived and unable to sleep. I was taking two months off between jobs because my poor impulse control had me hating myself so much for my performance at my last job. So it wasn't a huge deal. But it was very uncomfortable. My doctor eventually gave me temazepam, but I was worried about that and didn't want to use it much. So after a couple of months I went off the Emsam.
Oh, I did have an adverse food reaction once. It was rather scary, I broke out in a cold sweat, shakes, had to lie down on the floor and was debating if I should crawl over to the door and call out for our receptionist to call 911. It eventually passed. This was shortly after I started at the lowest dose, and I had had some trail mix and didn't realize that things like raisins and walnuts were on the naughty list.
I still think the sleeplessness was due to the Emsam and not the TMS. I was on TMS for a while after stopping the Emsam and it wasn't as bad. Although I'm trying maintenance now and struggling with sleep, but it's been a while and that could be due to many other reasons.
TMS was one of the few things that worked, but it wore off fairly quickly after some major life events kicked me in the ass.
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RE: FTX and "where were the auditors in all this?", the Chapter 11 filing is highly entertaining reading (if you're not personally affected by 'this bastard took my money', 'this bastard has blackened the name of crypto' or 'this bastard has blackened the name of EA' or 'this bastard was a friend of a friend and now everyone thinks I'm dodgy too'):
"The audit firm for the Dotcom Silo was Prager Metis, a firm with which I am not familiar and whose website indicates that they are the “first-ever CPA firm to officially open its Metaverse headquarters in the metaverse platform Decentraland.”
Even Zuckerberg is getting dragged into this disaster! 🤣
Somehow I imagine Mr. Ray the Third, after the first couple of days wading through the burst sewerage pipe that is this train crash, sitting down with a bottle of whiskey which he's glugging straight from the bottle and writing up this declaration because "Fuck it, I don't care any more, what are they gonna do - fire me as CEO of this dumpster fire? I wish!"
Why take Adrafanil over Modafinil? Doesn't that just get you extra kidney strain and side effects? Does the Prodrug-> Drug-conversion even work consistently? Is there some kind of galaxy-brain reasoning, that says that Adrafanil + Selegiline, is easier for your body to regulate than straight Modafinil + Selegiline? I've never heard of anyone preferring Adrafanil, when real Modafinil (or Armodafinil for that matter) is an easy option.
I feel like you've missed the best part:
"I am Sam. I EMSAM. Sam I am."
> Otherwise, choose 2d4 random side effects from the appropriate side of the table.
"2d4"? Optimist. I'm pretty sure there's at least one 12 sider in there.
> I’m sorry to use the old offensive terminology, but I do so deliberately here.
For whatever reason, I dislike the use of "sorry" not to mean regret but... acknowledgement (?)
> But a lot of Wall Street is on stimulants of one sort or another, and most of them don’t act like FTX did
Actually, from what I am reading about financial history, a real lot of them act or try to act like FTX/SBF did. Only traditional finance has levels of circuit breakers - including the Fed and the Congress ready to deploy literally trillions of dollars - to dispel situations like that from affecting the system, and frequently to bail out the participants from the consequences of their insane risk taking. At least that's what I gathered from reading a bunch of books on last 50 years of financial history and the litany of financial crises that happened. Just in crypto, it's ok to let the FTX explode. If it were a bank, there would probably be a recapitalization/takeover deal brokered by financial regulators, and we'd never hear about it unless we dig up technical reports and can parse fedspeak they are written in. If you peer into the lawcraftian depth of financial system, you'd find entities much more scary than SBF - but nobody but highly trained professionals armed with infinite money supply do it anymore. Crypto is small, so we can see all the tempest in the teapot and imagine it is scary. Truly scary, trillion-size things aren't for us to see.
Yet another programmer with ADD on stimulants. (As are at least 2 of my coworkers, probably more.) I’m not sure if ever would have become a programmer in the first place if it weren’t for stimulants. But it seems to be a great job for me.
Also, I might still manage to keep in shape, but I doubt I’d be as much fitness junkie as I am.
Good and probably under appreciated point that some of consequences/side-effects are actually results of sleep deprivation. I suspect the same is true of drinking. Sleep is super important, and if you care about your physical and mental health, you should be trying to optimize it. Listen to Andrew Huberman!
Modafinil in my experience interferes with sleep way more than other stimulants. It can make it impossible for me to sleep 16 hours after taking it.
It used to be trumpeted as some kind of miracle drug that gives you super powers and makes you not need to sleep. AFAICT, it’s just another stimulant, better in some ways, worse in others.
In high doses, it seemed to trigger a state that was a bit like mania. Although I was usually also drinking at the time.
Ritalin also had bad interactions with alcohol for me too. It made me feel anxious and in DESPERATE NEED of alcohol IMMEDIATELY. Then I got more euphoria from drinking, but was able to appear to function and not be impaired even after lots of shots. Until I couldn’t... and felt like I needed more Ritalin. Honestly, it’s a miracle I survived.
Interactions with drinking and Adderall weren’t as bad, but I did notice that it made me more likely to unintentionally creep people out for reasons I didn’t understand.
I don’t drink at all anymore. And even if you don’t have a major problem or have a family history of alcoholism like me, I’d urge you to again listen to the Huberman podcast episode on the subject. It’s super-bad for you. I now think “moderate” drinking is like moderate smoking. Not as bad, sure, but still bad.
But I think stimulants, especially long acting ones like Adderall XR and Concerta, can be used safely as part of a healthy lifestyle. Anyone who’s like, “OMG, DRUGS? I’d never do that!” But consumes alcohol with any regularity, I mean like 7 or more drinks per week even... I think your perceptions of actually safety/risk is out of touch with reality due to being influenced by what is socially considered normal, and you should really look into it if you want to live a long, healthy life and/or optimize your brain functioning.
If you are not at all involved with EA (my sympathies, lads and lasses), rationality (ditto), crypto, or put any of your money into what he was doing (ouch), then the FTX/Bankman-Fried saga continues to be primetime entertainment.
Forbes magazine is plainly mad as hell and out for blood, because like everyone else they thought the sun shone out of his backside and were putting him and his friends onto their "Thirty Under 30" lists and writing hagiographic articles about them.
Well, no more! Recent Forbes articles have been more full of salt than a Silesian mine, and they've done one now on Caroline Ellison (who seems to have enough brains to keep her mouth shut, say nothing to anyone, and refuse to be contacted). Along the way, they take a swipe at another online article:
"Prominent FTX backer Sequoia Capital was also caught in the gravitational pull, publishing a now-deleted 14,000 word paean to Bankman-Fried that likened him to fictional protagonist Jay Gatsby. (“Is crypto the new jazz?” the author wondered, apparently not considering that the titular Gatsby earned his fortune through crime.) This week, Sequoia wrote down its $213 million FTX investment to $0."
Now-deleted? Not if Forbes have any say about it! And so they helpfully provide a link to the Wayback Machine storage of the piece, and boy is it a doozy in the genre of "had I but known" tales. Published in September of this year, but that might have been aeons and empires ago:
You really should read this. If you're EA-adjacent, you'll probably wince at the heavy-weight names being dropped all through the piece, but holy hannah does it repay reading. Here's the ending, to whet your appetite:
"After my interview with SBF, I was convinced: I was talking to a future trillionaire. Whatever mojo he worked on the partners at Sequoia—who fell for him after one Zoom—had worked on me, too. For me, it was simply a gut feeling. I’ve been talking to founders and doing deep dives into technology companies for decades. It’s been my entire professional life as a writer. And because of that experience, there must be a pattern-matching algorithm churning away somewhere in my subconscious. I don’t know how I know, I just do. SBF is a winner.
But that wasn’t even the main thing. There was something else I felt: something in my heart, not just my gut. After sitting ten feet from him for most of the week, studying him in the human musk of the startup grind and chatting in between beanbag naps, I couldn’t shake the feeling that this guy is actually as selfless as he claims to be.
…The FTX competitive advantage? Ethical behavior. SBF is a Peter Singer–inspired utilitarian in a sea of Robert Nozick–inspired libertarians. He’s an ethical maximalist in an industry that’s overwhelmingly populated with ethical minimalists. I’m a Nozick man myself, but I know who I’d rather trust my money with: SBF, hands-down. And if he does end up saving the world as a side effect of being my banker, all the better."
Let's hope that Mr. Fisher did *not* make Bankman-Fried his banker after all.
Right now, I think the Forbes piece on Ellison is more interesting, given that we've had copious analysis of Bankman-Fried to date but little to nothing about the others involved. Forbes cannot resist kicking the guy even in this piece, but it still does tell us something:
"Behind both Alameda and FTX was Bankman-Fried, a bloviating then-billionaire founder, who had founded the FTX two years after Alameda to build what he considered a modern cryptocurrency exchange. When Bankman-Fried decided to step away from Alameda to focus full-time on the fast-growing FTX, Ellison, a quiet and quirky child of MIT economics professors, took over as co-CEO.
...In recent days, Ellison has faced a barrage of particularly nasty criticism from crypto boosters who blame her for overseeing the downfall of Alameda. But amid the vitriol she has found some defenders in an unlikely group of people who have celebrated the musings about race science and imperialism on a blog she allegedly wrote in college. Some of her defenders, who call her “Queen Caroline,” are followers of Curtis Yarvin, a neoreactionary political theorist and far right darling. Many of the people who have flocked to Ellison’s defense gather on Urbit, a peer-to-peer platform created by Yarvin, one of her online supporters told Forbes. They think Ellison was set up to be the fall person, and claim that former co-CEO Sam Trabucco, who they derisively call “Sam Tabasco," is behind Alameda’s implosion. Trabucco didn’t respond to multiple requests for comment.
“I definitely think she’s innocent,” one said. “I think Caroline can be saved.”
I have *no* idea if the Yarvin Connection is true or not, but this entire rabbit hole just goes deeper and deeper. I expect a healthy selection of conspiracy theories to be dragged in at some time by somebody as the next development.
Hi Scott, thanks for this piece, which I read with interest. You have done an admirable job (as far as I can tell) summarizing what we (don't) know about how dopaminergic medications might shift your risk curve and so contribute to altered risk management. But what most of these discussions seem to leave out is the fact (as I understand it) that a certain percentage of folks who get put on stimulants will become manic, which generally involves gross distortions of risk curves, grandiosity, and overt, visible, poor judgment. And when I say "most of these discussions" I am thinking in particular of the frequent discussions about the wisdom of putting so many school children on stimulants. As a fellow psychiatrist, I will also try to shy away from public opinions on diagnosis. This week we've seen what many laypeople might join me in thinking is a combination of grandiosity and manifestly poor judgment at Twitter, and I have no reason to suspect that mania has anything to do with it. On the other hand, reading SBF's Vox interview a reasonable person might come to the conclusion that there is more going on there than insufficient risk aversion. So I am curious about your opinion on the possibility that mania of some form might be a piece of this picture. PS I appreciate your clarity on how, uh, problematic the DSM categorical approach to ADHD diagnosis is. PPS If you think I am overstepping the Goldwater rule--which I generally support--please tell me and I will try to edit accordingly.
It always amuses me when people insist that every cryptocurrency except for Bitcoin and maybe Ethereum are scams and ponzi schemes.
It never occurs to them that both Bitcoin and Ethereum are obvious Ponzi schemes, designed with FOMO in mind.
If you assume that literally everything in crypto is a scam of some kind, you'll have a much better understanding of the market.
FTX imploding isn't surprising to me because it is, like all of these things, a scam based on things that aren't actually worth anything and whose price is entirely a construct of fraud. Tether is fraudulent, and 95% of the run up to bitcoin's ATH was due to fraudulent non-economic trading.
All the money in these markets is fake except the fraction that real people put in, and the fraudsters take out.
Wow. I honestly was unaware of all of this. Thanks for sharing!
The moral of this story is that people shouldn't do drugs.
RE the expert witness story: Before I went to jury selection, I did not anticipate the level of social pressure that you (or at least I) experience when being questioned in front of 100 people. My plan beforehand was to give my honest opinion that, by a plain reading of the law, juries on criminal cases are legally obligated to always vote Not Guilty because the epistemics of a court are never good enough to overcome the "beyond reasonable doubt" standard, and therefore I would vote Not Guilty no matter what, and this answer would disqualify me. But when actually questioned, I felt really silly about saying this and was afraid it would attract a lot of probing follow-up questions, so I said something boring instead, and ended up getting selected, so I had to endure 5 days of jury duty because I didn't want to look weird for a few minutes.
Pretty lame. Effective altruism turns out to be mostly effective at allowing sociopathic nerds to commit crime on a massive scale. Write something about that, or stop writing at all.
Scott, you shouldn't be afraid of or hesitant to give expert testimony. I read this entire post carefully. It was informative. I felt the most emotion while reading your footnote 9 at the very end. I felt empathy for your situation with the bleach drinker. You are much wiser and more knowledgeable now though!
(MAOIs are contraindicated when taken with almost everything, or so it seems to me from reading drug inserts. I am a statistician not an M.D. so I will believe what you say. I try to stay far away from them myself though.)
I hate being the Senior Regional Manipulator Of Tiny Numbers. It's very stressful.
Some more info has come to light about Dr. Lerner. See: https://twitter.com/daniiicloud/status/1602852140552159232
Does that change any of your opinions?