self_made_human
C'est la vie
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
Friends:
I tried stuffing my friends into this textbox and it really didn't work out.
User ID: 454
self_made_human
C'est la vie
21hr ago
I am quite unusual at how much I look into where my money goes, but how you do not notice "tens of thousands of dollars" part?
I can easily see this being true. It's not unheard of for couples to have separate bank accounts. Presuming she has a career of her own, I think tens of thousands of dollars is an amount that someone can feasibly spend over 2 years.
ah, makes sense (motte breaks my sarcasm meter)
Some of that is on me. I have an uncontrollable impulse to sneak in jokes, obscure references and memes in even when Serious Posting.
self_made_human
C'est la vie
21hr ago
You, like many others, go too far. Changing your lifestyle does actually work; it's just that many people don't do it. There are a bunch of reasons why they don't do it, and that's okay. They may be perfectly fine using a drug. Nothing wrong with that. But don't tell people that changing their lifestyle doesn't work, because it does.
I'm not denying that lifestyle changes work! If they didn't, why would doctors feel obligated to recommend them?
While doctors usually feel compelled to tell their patients to watch their weight and diet, this almost never actually works.
What I'm saying is that advising lifestyle changes rarely works. I don't have firm figures at hand, but I suspect that the number of people I've recommended such eminently sensible things like losing weight, stopping smoking and going to gym grossly outweigh (pun not intended) the number who actually did anything about it.
If there was a magic pill that did nothing else but make people go to the gym, it would be one of the most revolutionary advances in medicine of all time! It would be Nobel Prize worthy. We now, thankfully, have a pill that, if not literally magical, meets the "sufficiently advanced technology" threshold when it comes to obesity. It certainly beats even the most sage advice in terms of practical utility.
self_made_human
C'est la vie
21hr ago
(note: how likely is that story is altogether faked?)
Given that it's an anonymous account, I can hardly be sure. But I wager it's far more likely to be true than not. There are a rather significant number of women who have a thing for crooks, and manage to get into prison romances.
Even if this particular tale ends up being a tall one, I feel that the scenario merits discussion as something that could happen.
outlawing extremely rare stupidity and legalizing common stupidity seems backward
That bit was a joke. It's a reference to this meme, which I've appended. But I think that in certain contexts, physical/corporal punishment has its merits, and is unfairly maligned.
self_made_human
C'est la vie
21hr ago
Crutches exist for a reason! There are stupid way to use them, I guess, but typical use of crutches is extremely useful in an obvious way!
Precisely. I'm not sure why that terminology even came into the picture, given that it's not a reference to malingering, which is the only other remotely plausible way to misuse a crutch.
I do not have problems solved by Ozempic as far as I know, but if I could pop a safe pill to solve procrastination issues I would do it!
May I introduce you to our lord and savior, prescription stimulants? Not sure how I'd have become a doctor without them.
self_made_human
C'est la vie
1d ago
DSM-5 diagnostic criteria for BPD:
A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) or the following:
-
Frantic efforts to avoid real or imagined abandonment (Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5) ✅
-
A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation ✅
-
Identity disturbance: markedly and persistently unstable self-image or sense of self
-
Impulsivity in at least two areas that are potentially self-damaging (e.g. spending ✅, sex ✅, substance abuse ✅, reckless driving, binge eating) (Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5)
-
Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
-
Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days) ✅
-
Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper ✅, constant anger ✅, recurrent physical fights)
-
Transient, stress-related paranoid ideation or severe dissociative symptoms
self_made_human
C'est la vie
1d ago
Is there a reason the counterproductive effect of leptin in the obese isn't more common knowledge?
Many things about basic biology aren't common knowledge! I don't see a specific reason for why this isn't better known.
Is there research being done on "fixing" leptin behavior? Or is semaglutide basically that fix?
There's a single drug called metraleptin, which was once considered immensely promising for treating leptin resistance. Didn't work, failed miserably in trials.
It does, however, work excellently in a rare genetic condition called congenital leptin deficiency, and is occasionally used for lipodystrophy. The difference is that CLD patients lack leptin in the first place, which is giving them the recombinant version helps, whereas obese people have bodies that ignore leptin levels, regardless of how much more we can throw in.
GLP-1 drugs sidestep the whole problem by using an entirely different pathway (I did say I was simplifying! Keeping my head straight about how exactly Ozempic works gives me a headache)
I know some people have been able to stop being obese via surgeries like stomach constriction, but that sometimes it doesn't work and they still feel compelled to overeat. Is there a separate mechanism in action for people where reducing stomach size also reduces inability to feel satiety versus those where it doesn't help?
We don't really know how bariatric surgery works.
I'm not kidding here, we genuinely are rather unsure about the mechanism of action. Most of the commonly advanced suggestions were found to be wrong or inadequate at best.
If they are hungry no matter how much they eat, does "fake" eating offer any help? Eating extreme low calorie high fiber foods? Chewing gum? I know another poster already said drinking water didn't help him
Yes, these do help a little bit, but nowhere near as much as Ozempic does.
Hunger is surprisingly complicated, and has multiple mechanisms behind it.
The act of chewing and tasting sends signals to the brain that prepare the body for food (this is the "cephalic phase response"). This can satisfy the "oral fixation" component of hunger, the simple desire to be chewing on something.
The stomach wall contains mechanoreceptors that sense stretch. When you eat a large volume of food (like a huge salad or a bowl of broth), these receptors are activated, regardless of the calorie content. Trying to fill yourself with low calorie food is an approach known as "volumetrics", and it works okay.
I don't think just drinking water would work as well, because you'd need an uncomfortable amount to fill your stomach, and the body would quickly realize that it's just water, without calories. The ancestral environment definitely had water, and didn't have diet coke (citation hopefully not needed). If starving people tried to keep themselves content by going to a pond, it was probably weeded out quick.
If it wasn't clear in my original post, I'm a willpower skeptic, I think it's profoundly stupid to assume obesity is a willpower problem, even if I don't know how to imagine the experience of what it feels like to fight the urge to eat without using willpower as a proxy for the challenge
My apologies for giving you the impression that was targeted at you. It was meant entirely for the people who think the usage of Ozempic is some kind of moral failing, and they're not an imaginary strawman, at least not on Twitter. I don't seem to recall much in the way of pushback against Ozempic here, barring people who still have reservations about its safety profile (it's remarkably safe, we have evidence for that claim, and loads of it).
self_made_human
C'est la vie
1d ago
My man, I dated a woman with BPD, who was arguably the love of my life. I was a doctor by that point, though I only really came to appreciate how many of the boxes on the diagnostic check list she ticked when I entered psych training. It can be very hard to tell when you start dating, including by the time you fall in love :(
Until that point, it's manic pixie dreamgirl paradise.
(To be fair, my own brother, and most of my family, did strongly encourage me not to date her. But that pussy game too strong for me, a man of the flesh.)
self_made_human
C'est la vie
1d ago
This article in particular presents people who lost weight, noticed immediate massive benefits in their life they're desperate to keep, and yet still can't keep the weight from coming back. It is just the satiety setpoint being set so high it's torture for them to not eat to the point of overeating?
Yes.
The mechanism via which the body "hungers" is somewhat complex, but can be usefully simplified down to the action of ghrelin, a hormone produced in the stomach which makes you hungrier, and leptin, which does the opposite.
Surprisingly, obese people have more adipose tissue, which produces leptin. However, it ceases to have the usual satiety inducing effect, as the body becomes resistant to its action. The way this is perceived is the body interpreting the lack of signal for being full as a sign of starvation.
And starvation sucks. Other than disease, it's probably what's killed the most humans in all of history, and you can imagine that it's a very unpleasant state that the individual feels compelled to rectify. The easiest solution being to eat more, till the pain goes away.
They're also being struck with a double-whammy. In lean people, eating causes suppression of the levels of ghrelin, in obese people, it doesn't. So they feel less full, with the same amount of food, as compared to those at a healthy weight. Hence they feel compelled to not just eat, but eat excessive amounts for the sake of relief.
I can only reiterate that starving sucks, and the body will drive you crazy in order to avoid that feeling. It's too dumb to know or care that you are, objectively, perfectly well fed. Waterboarding feels just as bad as actual drowning despite the ~nil risk of death.
While doctors usually feel compelled to tell their patients to watch their weight and diet, this almost never actually works. I consider myself a pragmatic one, and advice that isn't actioned in practise is about as useless as advice that doesn't work at all. I was on the Ozempic hype-train well before it was cool.
My mother is very obese, and has been for over half her life now. She's diabetic, and has developed fatty liver with hepatic fibrosis. Her own commitments to working out and dieting never held. She's a doctor herself, so she knows, on an intellectual level, what the risks are. She's been driven to tears by the scolding she gets from my grandpa or my dad who genuinely care for her and want her to lose weight, and after gentle suggestions failed, were driven to tough love.
None of it worked. She loved to eat, and reducing her caloric intake was pure agony. For a long time, I was resigned to the seeming inevitability that she'd head into cirrhosis, and I'd have to steel myself up for a liver donation. It's a nasty, nasty surgery, nothing like giving away a kidney. It leaves a grossly disfiguring scar, leaving aside the significant risk of death during and after the procedure. I'd do it for my mom, because I do love her.
Eventually, when Ozempic, or oral formulations of semaglutide, became available in the Indian market, I badgered her into seeing her endocrinologist and getting it prescribed. Despite the initial nausea and diarrhea, she eventually adapted, and lost the lost weight she's ever managed, and kept it that way. Right now, my priority is hounding her into going to that gent again and getting that dose upped, it's well overdue.
Exhortations to exercise failed. Asking her to watch her portion size and not snack failed. Driving her to tears failed.
The pill didn't.
When people get on their high horse and claim that using drugs to solve your problems is a crutch, it takes everything I have to not tell them to go fuck themselves with a rusty pole. It saved my mom, fuck you. Nothing you have to offer, including your empty words, comes close.
To hell with willpower. A world where we can power through our problems with pills is a better one as far as I'm concerned.
I'm a doctor for many reasons, but ranking highly among them is that I have an urge to find solutions to problems that actually work. Telling people to use their will to get over depression or diabetes doesn't, and the same is true for obesity. Claiming the moral high ground and virtue signaling? Doesn't beat adding years of healthy lifespan.
self_made_human
C'est la vie
1d ago
My dad was born into a peasant family in East Pakistan, better known today as Bangladesh, one of the youngest in 9 siblings. He had a loving family, with immensely strong kin bonds with his older siblings doing their best to look out for the rest, including after they were dispossesed and chased out of their homeland during a genocide.
These Russian peasants sound uniquely dysfunctional. I can assure you that that's probably not representative of child rearing and familial roles for most agricultural communities. I suppose I have to blame vodka for that, or the usual Slavic predisposition towards melancholy.
I ran into the following tweet (xeet?) over on X:
https://x.com/DaveyJ_/status/1942962076101603809
my brother's wife has been messaging with hundreds of different inmates through a dozen different apps for the last 2 years. she's sent photos, tens of thousands of dollars, shares her location, tells them where her kids go to school, living an entire second life.
when she got caught, she threatened to un@live, so she's been in the hospital getting treated, but while she's been in there her phone has been going off nonstop.
prisoners and ex-prisoners telling my brother "who TF is this? that's my girl!"
telling him when they get out they're going to be the kids' new stepfather. one even purchased a plane ticket.
she was just at my house, sharing her location, and sending pictures of my daughter at the beach to incarcerated strangers on the internet.
of course my brother is crushed, and my family is horrified at this person's ability to lie to everyone, but the biggest shock is her willingness to put her children in danger.
who knows how many men believe they are going to be responsible for those boys when they get released. they'll have to look over their shoulders for the rest of their lives.
my sister in law was going to watch my daughter for a few days while we moved, and it was the same week on the plane ticket that this inmate sent my brother.
my heart breaks for my brother, and his kids, but my ability to trust anyone around my kid has severely been damaged.
I would feel bad for simply posting this as a naked link, so I guess I have to add on some half-baked analysis and commentary on top:
This is horrifying. Rarely, so you see examples of behavior that is clearly "legal", in the sense that there's no clear crime being committed, but with so much potential for harm to unwitting bystanders. I'm unfamiliar with the scope of child endangerment laws in the US, but I'd be surprised if they covered this or, even if they theoretically did so, whether they'd be enforced in that manner.
(I don't claim to be an expert, but my understanding is that these laws typically require a prosecutor to prove that a guardian knowingly and willfully placed a child in a situation where their life or health was directly endangered. The behavior of the sister-in-law is profoundly reckless, but it falls into a legal gray area. A defense attorney would argue she had no intent to harm her children and that the danger was hypothetical and probabilistic, not immediate and direct. Proving a direct causal link between her online activities and a "clear and present danger" to the children would be incredibly difficult until, tragically, one of the inmates actually showed up and acted on his threats.)
At the same time, is it a problem worth solving? How do you reconcile that question with my earlier claim?
Well, that's a matter of impact or scale. Laws have costs associated with them, be it from the difficult to quantify loss of freedom/chilling effect, enforcement costs, sheer legislative complexity, or what I'm more concerned about, unexpected knock-on effects/scope creep where a desperate attempt to define the problematic action results in too wide a scope for enforcement:
What if it turns out to affect single moms looking to date again? Their new partners are far more likely to abuse their kids, but should such women thus be arrested for putting their kids at risk? Should people be forbidden from writing letters to inmates, or falling in love with them, or sex with them?
Is it worth it to specifically criminalize such behavior?
Despite my abhorrence for it, I'm not sure it is. I think the fraction of people who would be stupid or insane enough to act this way is small enough that the majority of us can treat this like a horror story and ignore it.
Another way to illustrate my intuition here would be to consider being a doctor or legislator reading an account of some kind of ridiculously horrible disease. Maybe it makes your skin fall off and your guts come out while leaving you in crippling agony (I'm like 50% certain there's an actual disease like this, but it's probably something that happens to premature infants. That, or acute radiation poisoning I suppose). Absolutely terrible, and something no one should go through.
Yet, for how horrible it is, this hypothetical disease is also ridiculously rare. Imagining it happens to a person every ten years, and makes medical journals every time it happens because of how rare it is. I would expect that doctor, or that law maker, to both be horrified, but if they were rational individuals considering the greater good, I would strongly prefer that they focus on more mundane and common conditions, like a cure for heart disease. There are lower hanging fruit to grasp here.
Now, the biggest hurdle holding back the poor family in the story I've linked to is a simple one: the Overton Window. If, for some unfortunate reason, the number of women crazy enough to act that way rose significantly, society would probably develop memetic antibodies or legal solutions. This might, sometimes, become strong enough to overcome the "women are wonderful" effect, if such women are obviously being the opposite.
Sometimes it's worth considering the merits of informal resolution systems for settling such matters, even if they have other significant downsides. For example, how would this situation be handled in India?
(I'm not aware of a trend of Indian women being stupid enough to act this way, though I can hardly say with any authority that it's literally never happened)
Firstly, the extended family would have much more power. This is the rare case where both the husband's side and the wife's own family would probably agree that something needs to be done, the latter for reputational reasons as well as concern for the kids. She'd probably end up committed, if she wasn't beaten up or ostracized to hell and back. The police would turn a blind eye, should she choose to complain, they'd be profoundly sympathetic to the family's plight and refuse to act against them. And if they weren't, they'd be even more sympathetic to the idea of their palms being greased. The most awful outcomes would become vanishingly unlikely.
As a wise mullah once said: "What is the cure for such disorders? Beatings."
This isn't necessarily an overall endorsement of such a legal framework, or societal mindset. I'm just pointing out that, occasionally, they tackle problems that an atomized, quasi-libertarian society like most of the West can't tackle. I'd still, personally, prefer to live in the latter. While it's too late for the gent in question, you can reliably avoid running into such problems in the first place by not sticking your dick in crazy. Alas, as someone who has committed that folly, it's an even bigger folly to expect people to stop...
self_made_human
C'est la vie
1d ago
You make it sound like I'm an upstanding civic contributor who coincidentally has HIV haha. Jokes aside, thank you, I appreciate it!
self_made_human
C'est la vie
1d ago
I just hung out with a dude who at least expressed some degree of belief in the claim that 9/11 was an inside job. About all of.. 2 hours ago.
self_made_human
C'est la vie
1d ago
I am 4 beers in on an empty stomach and this is beginning to sound convincing. Next thing I know, you'll tell me that Christ was a Jew.
self_made_human
C'est la vie
1d ago
I expect John Wick, Chapter 5: Head Cannon to come out. Featuring Keanu Reeves, and a .22lr pistol strapped to his skull. That's about the only uncharted territory left.
self_made_human
C'est la vie
1d ago
Hold up, new type of person just dropped. If they don't exist, I'd like them to, it would break up the boredom of bog-standard antisemitism.
self_made_human
C'est la vie
1d ago
I really have to wonder how much they're paying for more and more hitmen to crawl out of the woodwork, after John has already racked up triple digit kill counts over the last movie. All the monetary rates I can remember being quoted seemed grossly inadequate, I'd rather go work at a fast-food chain for minimum wage if the risk premium is that poor.
(I grant that the franchise runs on ROC. But there's only so much I can suspend my disbelief before it breaks my neck with it)
self_made_human
C'est la vie
1d ago
I would have to try very hard to suspend my disbelief, my understanding is that DB rounds are borderline useless in real life! But the idea of seeing Keanu break his hips rolling down a flight of stairs has some appeal haha.
self_made_human
C'est la vie
1d ago
It seems to me that every JW flick increasingly flanderized the core conceit to the point of self-parody. It would be sorta acceptable if the choreography kept up, but at this point I wouldn't be surprised if they started running on water and throwing qi balls at people.
I gave up on Chapter 4 before the bit with the Dragon's Breath rounds, presuming that's the right movie (even 2 and 3 are so forgettable that I genuinely can't be sure), but a fucking flamethrower?? That's so absurd that it loop around to being worth watching, in a so bad it's good fashion.
I didn't have any plans of watching the Ballerina, I have cynical views on the fates of franchises that seek to replace an existing character with a Strong Independent Female Lead, but perhaps I'll save it for when I get badly stoned and manage to switch my brains off.
self_made_human
C'est la vie
1d ago
That's a better reason than most, and one I share.
To me, a great deal of the attraction of The Motte is the opportunity to lock horns with intellectual peers. If my ideas can't stand up to scrutiny, I owe it to myself to find out.
self_made_human
C'est la vie
1d ago
I'm A) Jewish and B) Once did a shitload of ketamine and... well, describing the experience probably won't make sense to anyone who isn't Jewish and who hasn't done that, but suffice it to say I'm entirely convinced that the holocaust did happen roughly as commonly described in the broadest strokes -- that does fit the Pattern of Reality and, uh, ancestral memory that I encountered
It's the second time today when I semi-sincerely wonder if someone on this forum needs a psychiatrist. I'm very cheap, I even do it for free.
(I hope this is a joke and that you're not looking for historical insight from a dissociative drug. Might have cured any depression, if you had it.)
self_made_human
C'est la vie
1d ago
I'm not sure how feasible that would be. We don't have many mods, and activity varies widely depending on availability.
I can, however, tell you that we do our best to voluntarily recuse ourselves from moderation decisions where we have a conflict of interest. Usually because someone had exhausted our patience.
Case in point, when Hlynka flamed out, I chose to refrain from actively encouraging his ban. Never liked the guy, didn't see what others saw in him. He got banned by his fellow moderators (as an ex-mod himself), which I can't complain about. I know the others have similar stories.
At the end of the day, mods have a great deal of autonomy, should they choose to exercise it. Controversial decisions are hashed out behind closed doors.
From ordinary user perspective there seems to always be one or two mods who are way too trigger happy in non-obvious janitorial duties.
It's those "one or two mods" who actively hold down the fort. For example, I go long periods between officially donning the mod hat, even if I'm quietly doing spring cleaning and admin work in the background. We really don't have manpower to spare, and before you ask, during the last round of recruitment, we had lots of other candidates who turned down the offer because they simply didn't want to take on the burden. Jannies do this for free! That's a miracle! Give us money!
self_made_human
C'est la vie
2d ago
Ozempic Update:
I think I've been on it for over a month now. Down 3 kilos and change. No real negative effects noted. I estimate I eat at about a 30% caloric deficit, though I haven't been explicitly counting.
Unfortunately, it's been rather difficult getting back in to working out at the same time. I'm having a hard time eating enough, be it protein or otherwise, and the last time I went, I decided to try and beat my PR on the leg-press and almost passed out. Not sure whether to attribute that to slacking for the week prior, not eating enough, not hydrating enough, or skimping on the electrolytes. Lifts stalled too.
If I had to choose one over the other, I'm going to err on the side of losing more weight. In the meantime, I'm hoping the extra fat allows for some body recomposition despite the rather inadequate diet. I've been having creatine powder on the side, but irregularly.
Some have claimed that Ozempic helps with willpower in general. While I'm sympathetic to such, I can't say it's made any difference for me. It's certainly not going to replace the ADHD meds.
Y'all looking for a psychiatrist? I'm cheap.
Ahem. A position I semi-endorse is that most liberals tend to be more neurotic, and less likely to post here if the waters aren't welcoming. Plus, most of the internet is liberal-aligned by default, why would they be specifically drawn here? I imagine those who do are attracted by the quality of discourse, if nothing else.
I don't fit neatly into most political categories, on a political compass scale, I end up in the middle by virtue of multiple extremes canceling out. I'd call myself quite thick-skinned (a common trait in our most prolific posters), but I'd probably not engage at all if all the feedback I received was negative. So I can't really blame you for having some degree of dread. I've submitted comments where I was confident I was right, but I certainly didn't look forward to the task of wrangling all the people convinced otherwise. It's an acquired taste.
self_made_human
C'est la vie
2d ago
I'd call myself a gun nerd, and I'd say that the first John Wick treated firearms with respect. It all went downhill there after.
I don't care what your "bulletproof" suit is made of, if it's any durable fiber I'm aware of, it's not going to stand up to rifle caliber rounds. Kevlar? Aramid? Not happening. Not without looking more like a bomb suit with plate inserts, at the very least.
Guns became a matter of convenience later on. At just about the same point the blind assassin was up to his nonsense, you had bows and arrows versus guns. What.
Right now, it seems that John only gets hurt when it suits the plot. He doesn't feel like an ultra-lethal human operating within range of plausibility, he's just a superhuman with chronic constipation, which is why he doesn't seem to enjoy his prowess.
The choreography also went to hell. Everyone stands around waiting for John to act, more often than not. That visceral sense of fear, the impression that John was going up against competent foes and beating them through sheer skill? Gone.
While I agree with you, for the most part:
Despite what Western media reporting might have you believe, the rate of petty crime in India is surprisingly low. People rarely get pick-pocketed or robbed. Do you know why?
Because if caught in the act, the perpetrator would be rather unceremoniously beaten to a pulp, both by whoever caught them, and any civic minded individuals present. You can get a nice crowd going, it's fun for the whole family.
This is of course, strictly speaking, illegal. Yet any police officer, if asked to intervene, would laugh, shake their head and say the criminal deserved it. If the crook had the temerity to file charges, he'd probably be taken out back and given a second helping to change his mind.
As far as I'm concerned, this is strictly superior to prevailing Western attitudes regarding property crimes or theft. A shopkeeper who discovers someone shoplifting has very little legal recourse, the police rarely do any more than file a report and then give up on pursuing the matter. Giving them the de-facto right to take matters into their own hand and recover their property? The shopkeeper wins. Polite society wins, the only loser is the thief, and in this case the process is quite literally the desired punishment.
Before you ask, the number of false positives is negligible. I've never heard of anyone being falsely accused in this manner (at least with accusations of theft), and I've never had to have that particular fear myself.
I am, in general, against husbands beating their wives. Yet, in this specific scenario, I could hardly fault the poor chap should he be forced to resort to such methods to protect his own family. At the very least, I'd vote to acquit. It's a bit moot, because with prevailing Western norms, he likely didn't even consider a haymaker as a solution to his problems. In general, that's a good thing.
More options
Context Copy link