site banner

Culture War Roundup for the week of May 20, 2024

This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.

Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.

We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:

  • Shaming.

  • Attempting to 'build consensus' or enforce ideological conformity.

  • Making sweeping generalizations to vilify a group you dislike.

  • Recruiting for a cause.

  • Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.

In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:

  • Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.

  • Be as precise and charitable as you can. Don't paraphrase unflatteringly.

  • Don't imply that someone said something they did not say, even if you think it follows from what they said.

  • Write like everyone is reading and you want them to be included in the discussion.

On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.

8
Jump in the discussion.

No email address required.

other than one infection, at which point the doctor was just a hoop to jump through to get the antibiotics I knew I needed

Personally, I despise having these kind of gatekeepers. An MD is the magic licence which will let you get anything (aside from controlled substances) from a pharmacy with a minimum of paperwork. Anything less than that -- even having studied pharmacy -- will get you nothing over a random person in the street.

A better system would allow amateur level qualifications which allow you to get a larger selection of drugs (like anything you had been prescribed before for a chronic problem, like thyroxine) over the counter.

Or just allow anything (possibly excepting controlled substances) OTC, and let natural selection sort it out.

Naturally, antibiotics are a special case because humans pay a collective price for irresponsible individual use (multiresistant organisms), so it makes sense to regulate that. Perhaps give licensed amateurs the right to buy one treatment of a first level antibiotic treatment per three years, plus the right to buy an appropriate specific antibiotic after lab tests show it their bacteria will respond to that. (Of course, the last line of antibiotics should be administered in insulation wards where you will either leave negative or feet first (if the bacterium develops a resistance).)

A number of degrees and licenses have prescribing rights in the U.S. right now (including NPs and PAs in most states).

Keep in mind that an overwhelming fraction of the population will prescribe themselves into bad outcomes if given the ability to do so, and often demand that their providers do so (with variable success).

Antibiotics as you note, is the classic example. People will demand antibiotics for viral infections. They will demand antibiotics when they don't need them. They will demand stronger antibiotics. They'll blow up their tendons or give themselves C Diff or one of any other number of things.

People will take thyroid medication wrong, or even easy to avoid fucking up things like most blood pressure medication. They'll take two medications that are fine alone but will fuck up your kidneys together.

Patients are idiots. That includes high education, high intelligence patients because they have a lot of overconfidence (just as doctors have overconfidence in domains outside of medicines).

But most people aren't high education and high intelligence anyway and you'll get a ton of people killed and cause extremely expensive, avoidable morbidity if you take the guardrails away.

You can just order from Petmeds and sketchy foreign pharmacies, like the rest of us.