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Such Mixed Feelings About Crazymeds is an excellent and highly informative site which I will never recommend to my patients.

It’s excellent because it gives mostly accurate and readable descriptions of the costs and benefits of every psychiatric medication. It has a laser-like focus on what patients will actually want to know and was clearly written by someone with an encyclopaedic knowledge of every treatment’s strengths and potential pitfalls.

This is important because the standard psychiatric response to someone who wants to know about a medication (when it’s not “shut up and trust me”) is to print out an information sheet from somewhere like or These sites at worst just copy paste the FDA drug information sheet, and at best list off side effects in a rote and irrelevant way that only a robot could love.

Here’s an excerpt from about the side effects of Prozac:

Get emergency medical help if you have any of these signs of an allergic reaction to fluoxetine: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

– blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;

– high levels of serotonin in the body–agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting;

– low levels of sodium in the body–headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;

– severe nervous system reaction–very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out; or

– severe skin reaction–fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common fluoxetine side effects may include:

– sleep problems (insomnia), strange dreams;
– headache, dizziness, vision changes;
– tremors or shaking, feeling anxious or nervous;
– pain, weakness, yawning, tired feeling;
– upset stomach, loss of appetite, nausea, vomiting, diarrhea;
– dry mouth, sweating, hot flashes;
– changes in weight or appetite;
– stuffy nose, sinus pain, sore throat, flu symptoms; or
– decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

If I ask a patient to read this, one of two things happen. First, they read the first few sentences and are like “Sure, whatever, I’ll read it when I get home” and then throw the paper in the trash can on the way out of the room. Or second, they get to the part where it says “agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting” and they’re like WHAT ARE YOU TRYING TO GIVE ME I’M NOT TAKING THIS GARBAGE!

Here’s on the same topic:

4.1  Typical Side Effects of Prozac (fluoxetine HCl)

The usual for SSRIs – headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido. Most everything will go away after a week or two, but the weight gain and loss of libido might stick around longer. Or permanently. Although weight gain is a coin toss.

4.2  Not So Common Side Effects of Prozac (fluoxetine HCl)

Rash, ‘flu-like symptoms, anger/rage.

4.3  Prozac (fluoxetine HCl) Freaky Rare Side Effects

Bleeding gums, amnesia, anti-social reaction (oh, come on, like we’re not anti-social already), herpes (again, blaming the med for an STD), excessive hair growth, engorged breasts (a.k.a. porno boobs), involuntary tongue protrusion (according to the PI sheet / PDR one 77-year-old woman stopped sticking her tongue out at everyone after they stopped giving her Prozac (fluoxetine hydrochloride)).

This is readable, complete without being overwhelming, gives you a good idea how likely everything is, and, dare I say it, funny. It tells you which things to expect, how long to expect them to last, and even mentions that they’re “usual for SSRIs”, which is pretty important for someone using the side effects to decide whether they want to take Prozac vs. another drug.

I also am eternally grateful for them mentioning how some people blame the medication for their STDs – the FDA has this thing where if someone reports something they take it seriously, and it ends up with drug leaflets including anything that’s ever happened to someone while on a drug as a “possible side effect” (“My pet turtle died when I was on Prozac, I demand you warn customers that one side effect of Prozac is ‘increased mortality for associated chelonians’!”) calls them out on this.

Everything does is like this. Well-written, funny, mostly accurate (with the occasional mistake but no more than you’d expect from an individual effort), and precisely targeted to what patients really need to know.

And I still don’t recommend it to my patients, and probably never will. Why not?

Well, for one thing, it’s called

Most psychiatric patients have no problem with the word “crazy”. Either they don’t think of themselves as crazy, or they jokingly call themselves crazy and are happy to let other people in on the joke, or they self-identify as crazy as matter-of-factly as they’ll tell you the time of day, or they just don’t care.

But some psychiatric patients care about it a lot. Either they’re moderately neurotic people who are scared that if they accept psychiatric help with their mild depression it puts them in a category of “total lunatic” from which they will never escape, or they’re social justice types who are watching like hawks for any sign that their psychiatrist is a privileged ableist oppressor trying to use slurs to trivialize their concerns and victim-blame them for their problems.

I can usually tell which category a given person is in pretty quickly, but the chance of accidentally slipping up and recommending to someone from the second category a site called is too horrible to contemplate.

And it’s not just the name. Somebody is going to say that the reference to “porno boobs” is objectifying women or trivializing the problems of people with gynaecomastia. Someone will point out their misuse of the term antisocial and their seemingly flippant dismissal of social phobia. Someone will definitely have something to say about the issues raised by selling crazymeds-brand mugs saying “Medicated For Your Protection”. This isn’t just a couple of slipups here or there. It’s the entire ethos of the site.

Alyssa Vance introduced me to the idea of “negative selection”. It’s when you don’t care how good something is, you just want it to definitely not be bad. For example, when you’re hiring fast food workers, you’re not looking for someone with a Harvard degree in fast foodology who will revolutionize what it means to work at McDonalds for generations to come, you just want someone who you’re really sure isn’t going to show up late or commit any crimes.

Likewise, medicine involves some heavy negative selection. If I become the best, most likeable, most respectful, most intelligent psychiatric resident in the country – well, I’d still get paid exactly as much as I do now. On the other hand, if even one patient lodges a complaint against me – let alone a lawsuit – that’s probably a hospital investigation and a stern talking-to from my boss and his boss and a discussion of why a site called talking about how psych patients are “Medicated For Your Protection” is Not Appropriate and really you’re a second-year resident shouldn’t you know things like that already maybe you need some Remedial Communication Skills Classes.

Side effects of may include agitation, aggression, and job loss. I think I can predict pretty well which patients will and won’t appreciate this kind of message, but all I need is one misclassification to get screwed over. So, with apologies to the many patients who could be helped by something like, I’m giving this particular minefield a wide berth.


But there’s also a part of me that accepts they probably have their reasons. I’m not sure it’s possible to make a site as good as without it being as offensive as Remove every single flippant statement and optimize for complete unobjectionability, and you’re most of the way back to I mean, there are certainly some simple improvements that could be made on, and there’s probably a market for a site like that, and maybe that site already exists and I just haven’t found it. But crazymeds is something special. It’s inspiring trust through countersignaling. In a field where almost everyone is a dry, scientific person who won’t give you a straight answer about anything or treat you like a human being, crazymeds’ business strategy is to make it super obvious they’re the exact opposite of that. They’re human, and I think that’s precisely why a demographic who wouldn’t trust anybody else trusts crazymeds.

Athrelon writes about social technology, structures and institutions that allow the maintenance of trust and order with a minimum of fuss. Crazymeds is an item of social technology that draws people who would normally be unwilling to learn about the psychiatric system into an engagement with it and an ability to understand and manage their own care.

Athrelon also writes about the breakdown of social technology in the face of certain modern social norms. And I talk a lot about “political correctness” and so on. And one retort I sometimes get is “political correctness just means being nice and not going around offending people. How could you possibly be against that?” And I have had vague feelings that it probably does something bad and have just mumbled something about how I’d look for an example and let you know when I found one.

Well, this is an example. I’m pretty sure there are a lot of people who would benefit from crazymeds, or at least from straighter talk than the carefully hedged neutral statements on, or at least from a little bit of humor or conversation in a register associated with normal healthy human relationships – but as long as I’m not 100% certain no one will be offended, and as long as that one offended person can cause me more grief than the hundreds of satisfied customers can possibly make up for, I’m going to keep printing handouts, and explaining while mentally facepalming that no, the hallucinations and agitations don’t happen to everyone.

On the other hand, you guys have taken much worse from me and I’m still here, so I recommend it to you without hesitation. Obvious caveats (eg don’t do anything without talking to a doctor first) are obvious.

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131 Responses to Such Mixed Feelings About Crazymeds

  1. Matthew says:

    Missing the word “died” in “My pet turtle when I was on Prozac, I demand you warn customers that one side effect of Prozac is ‘increased mortality for associated chelonians’!”

    Also, you wrote instead of at least once.

  2. prasad says:

    Isn’t this the standard objection to sensitivity training? That the system gets designed for the people most likely to make trouble?

  3. Why not make copies of the relevant pages, edit out the questionable terms and print them for your patients?

    • Anonymous says:

      Not trying to speak for Scott here, but… I’ve read a few of their entries now, and the pages each drug has have a *lot* of information that is mixed extremely well with the offending bits, and furthermore there are a *lot* of drugs covered. Editing each one is a nontrivial task and editing them all starts to look like a more-than-one-person-spends-several-months sort of job, and keeping them all up to date with new research and new drugs would probably be a full-time position in and of itself. Doing them on the fly is a nonstarter as well. Also the whole copyright thing…

      You might get some utility out of taking the most commonly prescribed and effect-heavy drugs and creating something similar to these, if much less readable and fun, but even then if you ever make a mistake or have a patient with some sort of ‘side effect’ thing you removed for being too obviously wrong come down with the problem even in a unrelated manner (such as the drug giving the patient an STD), it might land Scott in hot water.

      • LRS says:

        How many psychiatry practitioners/instructors/students/patients are there who would be willing to pay some money to have this information in a clear, concise, and readable form, with a human touch, but without the most offensive elements of Enough to support a couple of researcher/writer/editors doing this as their full-time job?

        Maybe when Scott finally opens his own practice, he can get some pre-med summer interns to do it.

  4. suntzuanime says:

    I know Scott is sworn not to say anything against the interests of his guild, but I am sort of sick of being told not to do anything without talking to a doctor first. When I have to wait a week to see my doctor, who’s just going to shunt me off to a specialist I have to wait two weeks to see, and I have to wrangle public transportation to try to figure out how to get there because apparently the hospital is not an important facility to hook up with a bus route, I’d like to be able to wipe my ass without going through all of that.

    • His guild ostensibly has its members take an oath to not harm patients through their work, or at least minimize that harm. Even if we’re cynical about that oath, Scott doesn’t want bad things to happen to him professionally. The sort of stress that causes leads to a lifestyle for him for which I’m assuming he’ll be publishing fewer blog posts because, holy crap, his future career is being critically threatened. Not that I mean to fight Scott’s battles for him, but I and lots of my friends want Slate Star Codex to keep happening as much as possible because this is the one of the best informal, personal blogs we’ve ever read. Thirdly, Scott might be using this post to signal to his colleagues in the medical community who read his blog that is an interesting website to discuss among themselves off the record, but that he knows he or they shouldn’t and won’t actually refer patients to

      Anyway, you can make your own choices without a doctor, but you can’t hold others accountable if something goes wrong, i.e., sue them. I wouldn’t be surprised if there is some space on the Internet where you can get advice without needing to take a blasted, already annoying, trip to see a healthcare professional. I don’t know of them, though. Does someone else have such suggestions for suntzuanime?

      • suntzuanime says:

        You’re right. I wrote that comment out of frustration with the healthcare system, but it’s not Scott’s fault, and I regret making it. I wish I could retract it, but the time frame has passed. I call upon such gods as may be listening to delete my post.

      • gattsuru says:

        There are also some legal risks to giving medical advice. Most people won’t need to care about them, because it’s surprisingly hard to start an interstate lawsuit, but even then many forums have blanket bans on medical or legal advice just to avoid being caught in the middle of these risks. Doctors and some other professionals are at even greater risk, because even if they’re not targeted in a formal court, their respective licensing counsels have very strong incentives toward keeping doctors from being the target of complaints (for both good and bad reasons). Repeating the importance of medical advice for matters that require neither a PhD nor Gwern-level knowledge, but merely some moderate research, are a natural and nearly unavoidable result.

        Unfortunately from the outside, this looks exactly the same as being told you need to talk with a doctor because incorrect usage will give new and exotic cancers.

    • Anonymous says:

      Unlike the ancient, the modern hippocratic oath does not explicitly require protecting the guild.

      • RCF says:

        It also does not prohibit abortificants.

        • David Hart says:

          An interesting compare-and-contrast. I’m a little bit irked at the modern version’s “Above all, I must not play at God.” My instinctive reaction, on hearing anyone complaining about ‘playing God’ is: Well, someone has to.

      • Anonymous says:

        Or … a surprising number of things, in fact.

        In fact, I’m not entirely sure it prohibits anything but knowledge-hoarding.

    • maxikov says:

      Aside from the liability perspective, which has been outlined by other commenters, there’s also a genuine question of whether it’s a good advice (say, if Scott was giving it over I2P).

      I suppose that the average reader of this blog is fairly unlikely to do anything obviously stupid with their health. And I’m sometimes rather annoyed myself by the overprotectiveness of the First World health care systems. Like why do I have to schedule appointments for Acyclovir and Finasteride refills? Leave alone the fact that the former is over the counter in many countries, and Acyclovir ODing doesn’t seem to be a problem anywhere, nothing is gonna change in my life that affects my need for these meds, people won’t be taking any of them to get high, and for those who want to harm themselves there are already tons of more dangerous substances easily available. I don’t understand why several topical Lidocaine-based medications are over the counter (1, 2), while others are prescription only (3, 4). I totally feel your pain.

      On the other hand, I know more than one person with college-level education whose first reaction upon feeling back pain is not to go to a doctor or to take Ibuprofen, but rather to go to a chiropractor. I know educated people who believe in homeopathy and acupuncture. Nearly everyone who has ever advised me about what to do with cold was suggesting some “folk remedies” – that’s probably the most sensible thing among this list since there’s no evidence-based treatment for common cold whatsoever (and there are even doubts that common cough suppressants like DXM (really? People sell DXM over the counter but not Acyclovir?) actually suppress cough) – but they actually seem to believe that it’s supposed to help.
      So, even educated middle-class people do stupid things with their health alarmingly often. That makes “go to the damn doctor!” seem a generally good heuristic, unless there’s a massive amount of well-analyzed evidence suggesting otherwise.

      • suntzuanime says:

        Is a chiropractor actually the wrong place to turn for back pain? I was under the impression that seeing a chiropractor for back pain was like learning meditation from a Buddhist: their worldview contains a lot of hooey but their traditions contain valuable stuff that you don’t have to believe in their worldview to benefit from.

        It’s not like your doctor’s going to do a lot for your back pain anyway, right? They have surgeries they can maybe do but that’s really drastic and definitely more dangerous than a visit to the chiropractor. Otherwise all they’ll probably be able to do is give you pain meds with poison (acetaminophen) mixed in.

        • Baby Beluga says:

          Whoa. Acetaminophen is poison? Can you elaborate?

          • Thomas Eliot says:

            It’s quite bad for your liver. Significantly worse than alcohol. More people die from acetaminophen induced acute liver failure each year than do from alcohol induced liver failure.

          • Wirehead Wannabe says:

            It’s mostly only a problem if you take it with alcohol, though overdose can be a problem too.

          • Anonymous says:

            STA is probably referring to products like Tylenol 3 which are a mixture of codeine and acetaminophen. One reason for including acetaminophen is to discourage taking multiple doses, which is why codeine is scheduled, but the combination requires at most a prescription. But there are also legitimate pain relief reasons for combining them.

          • suntzuanime says:

            Acetaminophen probably wouldn’t be OTC if it had to go through approval today. It is very easy to overdose on acetaminophen and destroy your liver. So people had the brilliant idea of putting acetaminophen in all the prescription pain medications so that if people tried to take too many of them they would die. This seemed like a good idea to them, because they are evil, and people like my aunt who died after being careless with her pain medication are acceptable casualties to them in the War on Drugs.

          • Nornagest says:

            I saw this in a newpaper infographic at my dad’s house over the weekend, which as sources of information go is just below “I read on the Internet” and about half a step above “some guy on the last BART train out of the city told me”, but apparently accidental drug overdose kills enough people that it’s comparable with auto accidents. I expect much, maybe most, of that is acetaminophen overdose.

          • Douglas Knight says:

            Nornagest, this came up on LW recently. Yes, accidental drug deaths are comparable to car deaths. But only about 225 each year are attributed to X40, which includes nonopoid analgesics. About half of the deaths are street drugs. About 10k are attributed to legal opioids. These might really be acetaminophen ODs, but I doubt it.

        • maxikov says:

          It looks like chiropractice does a little bit better than physical therapy but at the same time can possibly be linked with complications (I know, this one’s not a stunning example of good methodology).

          In a perfect world, medicine would accept everything that is evidence-based, and people won’t need to choose.

          • William O. B'Livion says:

            The biggest problem with PT is follow through. I’ve been to 3 different PTs (on 2 continents) and all three were surprised at my (in their eyes high) level of compliance with the exercises. Given that I didn’t feel that *I* did all that well, I suspect that PTs problem is that most people what a pill to let them sit on the couch 11.5 months a year and ski like champions over christmas break.

            Life ain’t like that.

          • maxikov says:

            Well, life ain’t like that just yet. Whatever biochemical response is triggered by exercise, it can theoretically be triggered by chemicals too. We just have to figure out which ones.

        • William O. B'Livion says:

          Most [citation needed] back pain resolves itself within a month with no treatment. ( here: ).

          And yes, a chiropractor IS the wrong place to turn at first. There is no “spinal manipulation” that will significantly alter a pulled muscle. If you have a significant herniation it a Chiro can’t do much and may aggravate the problem.

          And almost *everything* is a poison, it’s not the molecule it’s the dose. Alcohol is a poison, but there’s plenty of evidence that a glass of red wine or two a day are beneficial. Acetaminophen is one of the wonder drugs, it is *relatively* safe, effective within it’s use cases.

          Yes, you can take too much, and yes, washing 1000mg down with a couple shots of scotch, while it may make you feel better in the short term, will f*k you up over time.

          But the same is true of almost every drug, heck almost every *molecule*. Try breathing pure oxygen–no, actually do not.

          Tylenol 3 is OTC, or at least w/out a prescription in other countries with similar regulatory regimes. I’ve taken it (in Australia) with no problems.

          Many drugs we are fortunate enough to have available wouldn’t be w/out grandfathering, but this is mostly the result of a rather risk averse regulatory regime and of people–like our host notes–who throw the paperwork in the trash on the way out the door.

          Your health is your responsibility, not your doctors, and not the drug companies.

          We’re not *all* special snowflakes, but we’re all a little different and react differently to things.

          I’ve got an uncle who spent the better part of 30 years taking Acetominophen, then Ibuprofen, then Naxproxen-Sodium for over-use injuries to the neck and shoulders (plumber back when that meant shoveling a lot). Things were so bad for him at times he had to have his wife zip his pants in the morning. Without those “toxins” he’d have not been able to function *at all*.

          • houseboatonstyx says:

            Replying to two posts at once here.

            There’s quite a difference between skiing like a champion, and doing normal activities without a back pain at every step. And it’s very convenient when this painful spot clears immediately at the chiropractor’s, instead of resolving itself within a month or more of curtailed activity, or longer if you can’t curtail it far enough.

      • Vulture says:

        Back pain is one of the few things that acupuncture is well-supported for, as I recall.

      • Is it possible that one reason people turn to alt medicine over traditional is that alt medicine distributes homecare instructions fairly freely, while traditional medicine gives you hints and then tells you to see a doctor?

        • William O. B'Livion says:

          The most probably reason is that *usually* Alt. medicine types do three things that science based medicine is bad at:

          1) Give you an explanation at a level that is understandable, even if it’s boloney. “Your energy flows are interrupted” is a lot easier for someone with a high-school education to understand than “You had an uncontrolled growth of some abnormal squamous cells in your upper epidermis that has metatastized and spread to your lymph system”.

          They also spend time and lay hands. Unless you’re in for surgery (at least IME) it’s hard to get a MD or Surgeon to spend more than 5 or 10 minutes with you. The nurse does the basic workup, films are taken (most of my interaction with the health care field are bone/joint/spine related. I’m not careful enough) and tests are run and reviewed, and there’s not a lot left. Pills for inflammation or infection, Diet and exercise advice takes a short time, and his time is (at least to him) valuable, so he does what needs doing and goes onto the next.

          Chiros and other Alt Med times talk to you more. They lay on hands. They (at least good Chiros) might have films taken, but at the end if the day they touch and feel and present as if they care about you (and they very well might). This makes people feel a lot better about their treatment.

          And finally much of their advice or prescriptions (usually) are relatively inexpensive.

          A significant number of injuries and illnesses resolve on their own, from colds and influenzas to soft-tissue injuries and the like. No medical system, east, west or whatever can cure a cold or make you feel significantly better, but send 100 people to each of a Chinese Herbalist, a western ER and an Accupuncturist.

          The Herbalist and the Acupuncturist will give you a treatment they are (or at least seem) confident will fix you right up. The ER will tell you rest and fluids and if it gets worse after 5 days come back.

          One is being honest and charging you 150 for it. The others will charge a lot less and make you feel better about it.

          Oh, and tell the another 100 to just stay home, drink fluids and rest.

          Then at 1 day and 5 days test for symptoms. If there’s a greater than statistical variation in any of the 4 groups I’ll eat my hat.

          • maxikov says:

            > The ER will tell you rest and fluids and if it gets worse after 5 days come back.

            Hmm, it makes me think that from the social engineering perspective, the regulation in Russia that you can only get sick leave if you present a form issued by an outpatient service of a hospital may be a good idea. Whatever you believe, you’ll have to go to a real doctor. And then self-licensing kicks in, and people won’t go any farther. On the other hand, the doctor will probably give you some shit like Arbidol, so there’s that too.

            And I really hope that DRACO will work. Cold sucks.

          • houseboatonstyx says:

            (Blue tribe here)

            At the ER or a GP’s, you have a long wait in a large room with people with contagious diseases and crying babies, and music required by HIPAA, often radio with commercials. And a television. Acupuncturists see you at the appointed time, with nice music or none. Chiropractors have a short wait in a small room with perhaps one other patient. (First, the wait does no harm.)

          • youzicha says:

            > music required by HIPAA

            What does this mean?

          • potatoe says:

            HIPAA requires that you keep patient information confidential. This includes keeping it from other patients at the same office. Thus, the doctor’s office plays elevator music so that Catholic Patient A doesn’t hear that Catholic Patient B has an IUD and potentially run off to gossip to all their friends about what a terrible sinner B is. Or so that my coworker who hates soldiers doesn’t hear that I have PTSD from Iraq. The theoretical (I’m pretty sure this was a joke) music is to prevent people from overhearing things they oughtn’t.

        • nydwracu says:

          Another possible reason is the placebo effect.

          I don’t know if my use of mineral water for basically every minor ailment is placebo or not, but it appears to work, so the only reason I should stop using it is if there’s something that works just as well and is cheaper.

          (It might actually not be, since the most common minor ailment is a sore throat — don’t sand things without a dust mask, y’all. Seltzer works just as well as mineral water for that, and both are acidic, as are the other folk remedies I know. Maybe that’s the relevant thing? But you’re not supposed to drink orange juice with a sore throat, so this could be wrong.)


          My ophthalmologist once recommended me two brands of eye drops: one normal, one homeopathic. Same stuff in them — the homeopathic eye drops were normal eye drops with added marketing value. But people preferred the homeopathic ones.

          Does better marketing juju strengthen the placebo effect? Someone must have researched this, but I don’t have the time or the institutional access to dig through the literature.

          • vV_Vv says:

            I should stop using it is if there’s something that works just as well and is cheaper.

            Using nothing at all is cheaper and will probably have the same effect.

          • anon1 says:

            “Nothing at all” doesn’t provide whatever psychological benefits you get from a placebo.

          • vV_Vv says:

            You can think of your immune system as a “drug”

          • Loki says:

            Yes. I don’t have links to the actual studies but I know they were referenced in Ben Goldacre’s Bad Science. They found that people reported better results from a placebo in flashy brand-name packaging than one in plain packaging, and better results from the actual drug in brand-name packaging versus the same actual drug in generic packaging.

      • anon1 says:

        Plenty of folk remedies help when you have a cold. Mint tea or honey actually do make a sore throat feel better for a while, and comfort food like chicken soup makes you feel a bit less shitty. And from a typical human point of view, when you have a cold you want your throat to stop hurting, your nose to stop running, and your whole body to stop feeling like crap, and fixing those things is much more relevant than making the virus go away.

        • Thomas says:

          And many home remedies (tea, soup, orange juice) involve drinking water-based fluids, which are almost always useful to sick people.

    • Tracy W says:

      This concept crops up elsewhere, it’s even gotten a name: “warning pollution”. Adding a warning, like “talk to your doctor first” or “be careful: crumbling cliff edge” , but as more and more warnings are added they add less and less information, so people start ignoring them, and thus ignore the really important likely warnings as well as the CYA warnings.

      Another example apparently is chemical safety sheets. In the long-ago time when my granddad was doing chemistry (in a real lab, this is not coding for something else), warnings about chemicals, eg “don’t let this one get wet, don’t let this one get on your skin, don’t let this one eat after midnight” were passed around by word of mouth. This system was a bit unreliable. (“A good chemist needs both physical and intellectual capability. The physical to be on the other side of a good solid wall in under 5 seconds and the intellectual to know precisely when to exert the physical.”)
      So, about the time my Dad was doing his chemistry degree, people started introducing chemical safety sheets. But, when one of my uni friends was doing her chemistry degree, the safety sheets had gotten so loaded down with warnings that in order to get anything done she would just ask her chemistry professor what was really dangerous.

      • eqdw says:

        Another example: California Proposition 65

        Virtually every building I walk past in a given day has a sign that says “this product is known to the state of California to cause cancer and reproductive harm”. The drug store has a scary warning with a laundry list of about 20 specific things on the front door. Every cafe has a sign warning that roasting coffee creates acrylimide, which causes cancer. Virtually every consumer good comes with this warning. My landlord gave me a prop 65 warning sheet when I moved into my apartment.

        I’m sure the people behind Prop 65 had noble intentions, but in practice they’ve just slapped a meaningless warning label on everything, that people ignore. And that’s dangerous!. When I walk past a coffee shop that will give me cancer every day, I learn to ignore cancer warnings. When, later, my landlord gives me the same warning on my apartment, I don’t bother to read it and note that “lead paint. Do not drill or sand the walls without breathing protection”.

      • suntzuanime says:

        What we should do is, every time someone gets hurt because they disregarded a warning, everyone who had a less-important warning in the same place is liable for damages.

        • William O. B'Livion says:

          Yeah, when I see a problem the first thing I think is “Getting lawyers involved will make this better”.

        • Decius says:

          There’s already supposed to be a hierarchy: Danger, Warning, Caution, Notice.

          Notice: Wet Paint.
          Caution: Slippery when wet.
          Warning: Disconnect electrical power before opening.
          Danger: Confined space: Entry may be fatal.

      • Anonymous says:

        The excessive litigiousness of American society is the problem here. Now everything must be adapted to the worst case scenario, even if it is costly or harmful in other cases. Courts should be more willing to throw such lawsuits out as frivolous. Maybe government should issue some sort of guidelines that if a persons harmed himself in a way that the reasonable person wouldn’t, his lawsuit would be thrown out. It is not reasonable to get offended very easily. It should not be normalized.

      • Luke Somers says:

        In some good news, I was recently allowed by a certifying body to take some warnings off of a product since the actual hazard wasn’t severe enough to warrant a warning.

        Baby steps…

    • Purple Hayes says:

      I believe this is called Irony.
      Your statement is still certainly valid, I am not dismissing your experience.

  5. I’m surprised Scott is even posting about thus, considering he has already endured troubles with someone dragging his, uh, ‘doctor name’ through the mud, and the previous slander in question wasn’t even about psychiatry, or directly related to his work. So, kudos, I guess, to him for initiating discussion about an interesting and potentially useful website when he doesn’t stand to gain from the ensuing discussion.

  6. Emily H. says:

    The SJWish people I know, talking amongst themselves, have no hesitations about saying, “Yeah, I know, XYZ are problematic about, but it is the only site that gives useful information about psychiatric meds.” But I do think that’s the kind of thing that’s a lot easier to hear from a trusted peer than a not-necessarily-trusted doctor.

    I will say, when I was in a bad place, I read the “Am I messed up enough to need medication” article and concluded that I was an awful malingering person because I was capable of going to work every day but I also felt anxious and miserable too much of the time. I don’t know if the page was changed since I last read it, or if I was experiencing the depressive perceptive filter where everything means ‘you’re an awful person.’ It seems much more sensible now to read it as ‘Psych med side effects are pretty lousy, try something else first if you’re pretty functional’ than as ‘Meds are for people with REAL problems, not YOU, YOU have to tough it out.”

    This is the kind of thing I can calibrate for better now that I understand about bravery debates (and now that I am not extremely depressed), but it’s not the advice that I needed at the time.

  7. gattsuru says:

    I’m genuinely surprised there isn’t more motion to improve the FDA labelling process. It’s a regulatory rather than statutory matter, there have been a number of high-profile cases urging reform, and the high-power groups involved all express discontent in a similar way. Instead, the included documentation does not adequately separate likelihood and severity of symptoms in a human-readable format, while the online documentation is on a website that insists on the terrible PDF format and is a nightmare for the inexperienced to navigate and starts with the chemical structure of the drug because that’s ever so helpful.

    This suggests I’m missing something important.

    • William O. B'Livion says:

      This suggests I’m missing something important.

      You’re focusing on helping people. They’re focusing on satisfying regulatory requirements and avoiding getting more lawyers involved.

      If you list every last potential side effect, even the “gives you herpes” ones, then you transfer more of the liability to the prescribing doctor and the patient. This may not actually *help* the patient, but it lets your lawyer stand there in court and tell the jury that lycanthropy was in fact listed ON THE PAPER as a possible side effect, so the company bears NO RESPONSIBILITY in the eating deaths of those people, and that the person who did the eating should have known to lock themselves up on a full moon.

      This shouldn’t actually stop them from writing it in a useful and intelligent manner, but I’m sure that some lawyer specializing in risk reduction disapproved of it.

      And this makes it sound like I’m down on Lawyers, I’m not really, one of my best friends is a Lawyer. Of course my other two best friends (by that metric) are a Special Forces operator and former Mercenary (sort of) turned Physicians Assistant. So it’s sort of a balance of power thing 🙂

      • Deiseach says:

        Lawyers are bad, but insurance companies are worse 🙂

        I wonder how many of those “This product may in certain circumstances turn the user into a lich” warnings are at the behest of insurance companies that don’t want to pay out?

        Heard about a peach of an example yesterday; tenants can purchase social housing under a particular scheme (or they used to be able to do so; the old scheme is in abeyance at the moment). People need to take out mortgages to do so, and to take out a mortgage you also have to take out insurance (so if you default for whatever reason, the bank/council won’t be at a loss).

        Couple apply, get the paperwork done, purchase their house, start paying off mortgage. Wife dies a couple of years later from breast cancer and husband is unable to continue paying mortgage. No problem, that’s what the insurance is for, right?

        Insurance company refuses to pay. On the grounds that, about seven years before her death, the wife had a mammogram on the foot of an abnormality in her breast. And even though this gave her the all-clear, and even though this was four or five years BEFORE taking out the insurance policy, well – she knew there was something wrong with her health and she lied about “pre-existing conditions” on the form so they were not going to pay.

        Just to show that not all local government bureaucrats are heartless paper-pushers, the section head of the time fought this in court and made the insurers pay out – not because she cared about getting the money, but because she was not going to screw over the widower by saying “Company won’t pay out, too bad, we’re repossessing the house and kicking you out when your wife is not cold in her grave”.

        If lawyers are bad, and insurance companies are worse, what does that make lawyers for insurance companies?

        • William O. B'Livion says:

          If I were declared supreme fascist dictator of the world (which would be GOOD for the world), I’d decree that insurance companies had some specific fixed amount of time to investigate a client and return the premiums not consumed by that investigation. After that, unless they could prove deliberate fraud they were on the hook for their contract.

          Then I’d hang the first two or three that complained, because what’s the use of being Supreme Fascist Dictator of the world if you can’t hang people like that?

  8. Anonymous says:

    Haha nice try I’m suing you for posting this.

    • Panflutist says:

      I must have missed the memo about this “k out of n” stuff, what is it?

      • Emily H. says:

        The comment policy is that comments should be “true, kind, and necessary” — at least 2 out of 3.

    • Vulture says:

      I thought it was funny and relevant, and obviously intended in a friendly way, which is 2/3. Yall are on a hair-trigger.

    • Muga_Sofer says:

      It’s a joke, and not the mocking sort. Light-hearted and cheerful. Strikes me as “kind”.

      I’m not even really sure what “necessary” means, and it’s neither true nor false as such.

      So … 1.5/3? I think that’s enough not to be deleted.

    • Anonymous says:

      Rating your post out of three

      True: 0/1, post you’re replying to is not 0 for 3 IMO

      Kind: 0/1, obv

      Necessary: 0/1, don’t see how telling people their post is 0/3 when it isn’t is necessary


      I strongly encourage replies that rate this post out of three. In fact I think every post should have a long, long string of comments of people rating posts out of three, in order to make clear how wrong even the most well thought out forum rules can go when the little shits who ran to the teacher about everyfuckingthing back in kindergarten get their hands on it.

      By the way this isn’t a well thought out rule, obviously, because if you disagree with what someone is saying you’re clearly not going to think it is “necessary,” very very very few people are “kind” when disagreeing with someone (and they aren’t in every post), and obviously the disagreement part knocks out “true.” So it’s completely, utterly meaningless. It just says “we’ll warn/ban/delete if enough people get pissed off or the wrong person gets really pissed off, and we think you’re wrong.” Which is fine, it’s how every forum works, but don’t glorify it by saying you’re following “rules.”

  9. Nesh says:

    The extreme risk adverse nature psychiatry has been something that’s bothered me for some time now. While there are numerous reasons for caution in pharmacology there is also a norm bad incentives leading to minimizing harm of action rather then total harm. Ideally a expert in psychiatry would not have any undo bias towards view the action of natural chemical neurotransmitter action as intrinsically safer then external chemical neurotransmitter action after taking into account things like metabolites and uncertainty or the details of the pharmacological profile of the drug. It Just seems like there isn’t good thorough pharmacological advice in-between a practice of psychiatry so dogmatic and institutional, it might as well be the catholic church and Someone really needs to fix this.

    end short rant

    • David Hart says:

      I initially misread the tail end of that as referring to an institution being functionally equivalent to the Catholic Church and simultaneously. Now that’d be a religion I could get behind.

  10. Sam says:

    This sounds like a ridiculous market inefficiency, which of course means an opportunity for a new business to pop up. Some ideas that range from small to big changes:

    (1) Give patients the option to sign a waiver saying they won’t be offended by what they read and then giving them the info. Isn’t the only problem that they’ll be offended? It’s not like it’s giving bad medical advice, right?
    (2) Set up an alternative medical practice that promises to be completely data-based but completely informal. The doctor’s allowed to make jokes like this and patients sign some waiver saying that’s okay with them.
    (3) Get a coalition of doctors to band together and give advice like this, covered by some group malpractice insurance against offensiveness. Ask patients who appreciated this to donate to this coalition to cover the cost of insurance.

    This might seem like making a bigger deal out of this than it deserves, but isn’t the medical world big enough to make this market inefficiency be able to fit some new business?

    • RCF says:

      Medicine is only loosely rule by market forces. As a previous post noted, hospitals are not allowed to complete for emergency patients on any basis other than proximity. There are massive information assymetries, subsidies, and regulatory capture. Any new way of doing medicine would have to navigate onerous regulations, and have to either subsist on people willing to pay for it out of their own pocket, or try to get insurance companies and government agencies to recognize them as valid care.

      • AlphaCeph says:

        “Medicine is only loosely rule by market forces.”

        – Understatement of the year competition, 2014. I think we have a winner!

  11. lmm says:


    I sometimes feel that way about this very site. Like, I’ve lost count of the number of times I wanted to link /In Favor of Niceness, Community and Civilization/ because that post makes an important point better than I could with my own words… but I know the other people would call out the use of fictional evidence, even though it’s only there for a stupid joke about ants.

    • suntzuanime says:

      I think for a layperson-oriented philosophy/sociology blog like this, you want a pretty heaping spoonful of sugar to help the medicine go down. It’s pretty easy to look at a long post like In Favor… and think “wow look at all these words I’m never gonna get through” if it’s not providing you with a steady drip of happy-juice while you read it.

    • Deiseach says:

      It depends, I suppose, on how people react. If I ever break down and admit I bloody well need medication for the raft of hereditary neuroses in my paternal genetic line, I would definitely be looking up side-effects on the internet.

      And I think I’d appreciate the black humour, ‘you may as well laugh as cry’ tone of a site calling itself ‘crazymeds’, inviting people to find a grain of sardonic humour in the situation rather than all-grim all-the time, and having a poke at the attitudes to mental health (come on, “medicated for your protection” is exactly the attitude you see after every shooting in America, when some commentator in the media laments why the person wasn’t seen by a doctor and put on medication that would have prevented the tragedy).

  12. RCF says:

    You could try reverse psychology. “Here’s the URL to You should get your information there, and definitely not go to You may have heard that gives accessible, lighthearted information, but its irreverent attitude is offensive to many.”

  13. zz says:

    Porno boobs aren’t that big; the average porno boobs (34B) are smaller than the average American woman’s boobs (34DD or 36C, depending on the source).

    • ozymandias says:

      Yes, but porn stars are significantly thinner than the average woman, and fat women tend to have bigger boobs.

    • The average boob size in America is that large? Where are all these large-breasted women? Where I live, it looks to me that the average woman is roughly a B.

      • zz says:

        As Ozy mentioned, large American breasts are mostly a result of corpulence; earlier data (i.e. before America got fat) indicates that the average American’s woman’s bra size was… 34B, just like the porno boobs.

        So, to answer your question, where all these large-breasted American women are is Weight Watchers. Notice that the population where you live is the one that more closely resembles the population of women paid to be looked at naked.

        • I don’t think that I live in a place with more thin people than average (rather the opposite, if statistics are accurate), but rather I think I was subconsciously discounting for obesity. IOWs I’m looking at obese D-cup women and estimating them to be a B. I wasn’t even aware I did this until this thread came up.

          • not my usual topic says:

            Bra nerdery incoming:

            D-cup isn’t actually that big, and there is only 1″ difference in bust measurement between each cup size. A correctly-measured 34B has a 34″ underbust and 36″ bust. For a 34DD, it is 34″/39″, and a 36C, 36″/39″. (Size of boob depends on cup size and band size–a 32DD has the same boob volume as a 36C.)

            Pictures of DD cups at various band sizes:

            Bra sizing is a mess–correct band sizing is supposed to be the actual underbust measurement (which in most women ranges from near the same as the waist to 5-6″ greater; it may be several inches smaller on someone whose waist is large), but many are still using the underbust +4. Most average-size women should probably be wearing 28-34 bands; I’d imagine that porn stars would be on the smaller end of that. Basically: DD is not actually that big, most women are still buying sizes that do not fit well, and I wouldn’t trust self-reported bra sizes as proof of anything except “which size bra is most commonly bought”.

            (I am female. I usually buy F-G cup bras, and you would not look twice at me on the street.)

          • Jadagul says:

            Not my usual topic: thanks, that website is excellent. I learned about proper bra sizing years ago, but since I’m male no one ever believes me when I try to tell them that. (It doesn’t help that Wikipedia claims the underbust+4 is correct). And then they come back three years later really excited and tell me how much better their new bras fit….

          • zz says:

            I’ll just leave this here (Literotica, but from the “How To” section, so mildly NSFW):

          • TIL that I knew almost nothing about breasts and bra sizing.

  14. Peter says:

    On the very vauge subject of psychiatry and the internet, I got into work this morning and I had an open window with in it – it’s not exactly Scott’s side of the pond, but might be of interest.

  15. Ornithopter says:

    Scott, remember when you were a teacher and you made the lessons fun and interesting and the students hated it and got confused and asked if this was going to be on the test? Keeping information as dry and boring as possible is what people expect. Which is sad.

  16. Alex says:

    Oh come on Scott, SURELY there are dozens of clever ways for you to put your patients onto without risking your career.

    You could give your patients a long list of websites to check out, where all but the crazymeds url have subtle typos.

    You could give your patients a self-destructing url that redirects to crazymeds.

    You could tell your patients NOT to check out

    You could give your patients search terms to type into google that just happen to have come up at the top.

    You could create a mirror of crazymeds with a more respectable url and a big disclaimer at the top.

    You could create an entirely new website with just the names of the drugs and links to one or two different “more info” external sites, where all but the crazymeds link is broken, and when you click through it warns you that “you are now visiting an external site for which we take no responsibility etc etc…”.

    • Lambert says:

      You would have to be exceedingly subtle, or the System (courts, regulators etc.) would accuse you of recommending crazymeds. The System may be stupid as a whole, but that is often only because it is much less than the sum of its many clever parts.

      Scorning crazymeds may be most effective as the people most likely to ignore the reverse-recommendation complement those most likely to read the official info.

    • Watercressed says:

      If one was thinking of doing these things, they would probably not put them in a blog post while saying “this is how I’m going to create plausible deniability about crazymeds referrals”.

  17. jeff says:

    unfortunately crazymeds – as good as it is – leaves out the most important “side effect” risk with prozac- worsening or bringing out bipolar disorder, often with dysphoric mania, agitation and increased suicidality. also, very very rarely, it will cause repetitive thoughts of suicide in people who had not been experiencing them, and that in people who are NOT bipolar.

    i haven’t looked at other write ups there, but that omission leads me to think the site still needs some better clinical input. in the absence of good clinical data, it cannot be recommended to patients. [i have no problem with the “humor,” and think a mild heads-up to patients that it is written in an informal and intentionally provocative way would be sufficient to immunize people from over-reaction.]

    • coffeespoons says:

      I was on prozac for a couple of years in my early 20s and I had the mania side effect (especially when I mixed it with alcohol for some reason). I also self harmed and had suicidal thoughts for the first time ever. I haven’t been prone to mania since I stopped taking it, nor have I self-harmed (the self-harm wasn’t severe and hasn’t left any lasting scars). Occasional suicidal ideation has continued, though :(.

      OTOH, I quite enjoyed the mania side effect. The first year of taking prozac was one of the most fun years of my life, though I was very unproductive. I wish MDMA were legal so I could get a similar effect when I want to have fun.

      ETA: I’m still on citalopram which doesn’t seem to make me manic/self-harm.

    • Scott Alexander says:

      There is a view in psychiatry – I can’t say whether it’s minority or majority exactly, and I haven’t investigated enough to have a strong opinion on this myself – that this isn’t really true and the earlier studies that found this were confounded. See for example here.

      Probably I should look into this more, but since antidepressants don’t work for bipolar depression anyway I’m not super concerned about the distinction between “don’t give it because it doesn’t work” and “don’t give it because it doesn’t work and has side effects”.

      • coffeespoons says:

        Hmmm, it really feels like I became manic after starting to take prozac, and stopped being manic when I stopped taking it, but maybe there are other explanations.

  18. Dan Tobias says:

    The situation with that site is just one more case of the unfortunate way the whole world seems to be going, what with just about anything anybody says that might in some way be construed as reflecting a company or organization they’re involved in has to be thoroughly vetted to be politically correct and cover everybody’s butt against all possible liability issues and be consistent with the organization’s marketing image (even if that’s totally divorced from the real world) and not offend sponsors, donors, political pressure groups, regulators, and so on and so forth and comply with all the laws and regulations and policies of every country, state, county, city, company, and organization that’s involved in any way… by the time anything gets through all of this it’s totally bland and bureaucratic and has meaningless feel-good slogans and stock photos of happy people of a PC assortment of ethnicities, genders, and handicaps, with an asterisk and lots of fine print that’s totally unreadable.

  19. Dan Tobias says:

    As I read the statement in this post, the voice in my mind switched unavoidably to the style and tone of the voiceover announcers in any number of commercials for medications.

  20. LilaJ says:

    What do you need to know in order to lodge a complaint against a doctor? How does it differ for doctors at hospitals vs doctors at family practices? What kinds of complaints are most likely to be taken seriously?

    Any info on this that anyone can help me with would be welcome.

    • Scott Alexander says:

      I’m not sure.

      I’m a resident, which means I’m carefully supervised by other doctors. It would be very easy to lodge a complaint with one of them.

      If you have a complaint about a fully-qualified doctor, and they work at a hospital, your best bet would be to ask the hospital for their complaints policy. Most hospitals will have one. That having been said, if it’s something simple like “was very brusque and unhelpful” it’s unlikely the hospital will do much.

      If they work at a family practice clinic type place, usually the doctor will own the clinic or be a partner, in which case you can’t do much. Other times they’ll be the employee of a larger medical group (example: Kaiser Permanente). They may or may not have complaint procedures.

      If it’s extremely unethical or unprofessional, like them being drunk on the job, sexually harassing you, or completely failing at medicine, you can look up how to report them to a fitness to practice committee. I think the procedure varies by state, but good terms might be “fitness to practice”, “medical board” “licensing board”, et cetera.

      If they made some spectacularly incompetent medical failure that caused you or someone you know to become unnecessarily sick or die, then get a lawyer and sue for malpractice.

      And for littler things, the simplest thing you can do is write a bad review on something like healthgrades or ratemds

  21. Josiane says:

    I believe you have a reasonable point. However, they have a contact info. I would suggest you to send your recommendation to them. They will probably want to keep their website as is (they have promotional stuffs). But you could suggest them to create as well a more serious version with the same information that would be recommended by doctors. Who wouldn’t want the double of benefit with almost the same amount of work?

    • Fadeway says:

      The point of the post is to provide an example of objective harm caused by political correctness, not to recommend a way to fix crazymeds. And Scott already said that to “fix” the articles would require much more than no work. Can you even rewrite the articles such that they remain humorous and useful while removing the causes for complaint from easily offended people? No, but even if you could, it would take about as much time as writing them from scratch. And even then they would still not be recommendable, because they don’t meticulously list all the 0.01% side effects, so Scott could get sued if someone’s pet turtle died because of Scott’s prescription and the site he recommended as authoritative lacked information about that possibility.

      • William O. B'Livion says:

        I’m fairly certain there is no way one can do humor and not offend *someone*.

        That is the problem with ““political correctness just means being nice and not going around offending people. How could you possibly be against that?” …”

        The problem is that there is always someone more thin-skinned out there, and PC only works *one* way, there’s no one standing up for the “look, sometimes people say stupid, thoughtless things, so before you get all sand-in-the-Vaseline over this, stop and think, did they ask to touch your hair because they’re racist, oppressive h8ters, or because they’re utterly fascinated by it and have never been close enough (physically/socially/emotionally) to anyone else to ask? Did they tell you that that dress looked nice on you because it *did*, and they thought you’d appreciate the compliment, or because they have fantasies of you in a PVC mini-skirt changing the oil on their harley?

        Being socially considerate of those around you is polite. Striving to avoid offense in all things, especially in the modern world, is very, very stressful.

  22. Shenpen says:

    @Scott your quality of blogging was always excellent but lately you upped the quantity so much that I wish you could do this for a living. I have no idea if you would want to do this for a living, or if this would result on more utils than you working as a doctor, but since I cannot action ways to pay you a living for blogging it is a moot point anyway.

    Howver, I am seriously considering if you want to invest time X to blogging, I could find a way to pay you (or, possibly, offer other kinds of reward-category incentives to) to research and blog about things I care about would be actionable.

    However, I think your willingness to invest time X depends on how much you are interested in the topic, so the math is (topic you find interesting + potential rewards) vs. (time to spend on doctoring, life, and other hobbies).

    Given that I hardly even have any discretional income (well, I do, but as a new father anything not invested into my childs future requires extra special justification) I have concluded my best bet is to make you interested in the stuff I am interested in.

    What is the best way to do that? On the media/channel side, inserting a comment here in amongst the hundreds of comments is ideal? On the content side, how high do you rate the following factors, or feel free to add other ones: 1) utils 2) contrarianism 3) chance to demonstrate rationalist methods 4) easily researchable online 5) in the fields you already know a lot about 6) exoticness 7) others.

    I could offer a lot of 6) exoticness – if that is interesting. The point is, I think, currently the exoticness of India or Africa has been beaten to death for Westerners. While Romania, Hungary or Estonia are less exotic to Westerners, can they be interestingly exotic because their exoticness was very, very little used in an American or Irish culture? They are not so worn and never really made into a plasic pop culture exotic, so to speak? So in this sense more interesting?

    For example a subject I may try to recruit you into researching and blogging – how the sweet fuck is it even possible that we Eastern Europeans consider being depressed entirely normal and not to talk to a doctor about, not even notice it because life is not supposed to be happy anyway, simply not even thinking being depressed is somehow wrong and needs changing, not even thinking we deserve better, and while we think our primary difference with Western nations is wealth, how the fuck are even poorer nations than us in Latin America are much, much more joyful and less depressed? How and why can they find fun in poverty while we are not only depressed but even find being depressed entirely normal and not even think about changing it? What factors lead to find bearing poverty harder?

    • houseboatonstyx says:

      + The part about depression sounds fascinating.

    • We clearly need to Kickstart a book from Scott. ‘Much More Than You Wanted To Know: An Aspirationally Comprehensive Encyclopedia of Whimsically Precise Surveys of the Extant Scientific Evidence for Personal and Social Policies, Such As It Is.’

    • Scott Alexander says:

      Thank you, but if I could control what sorts of things I was interested in and motivated to write about, this would be a very different blog.

    • nydwracu says:

      I could offer a lot of 6) exoticness – if that is interesting. The point is, I think, currently the exoticness of India or Africa has been beaten to death for Westerners. While Romania, Hungary or Estonia are less exotic to Westerners, can they be interestingly exotic because their exoticness was very, very little used in an American or Irish culture? They are not so worn and never really made into a plasic pop culture exotic, so to speak? So in this sense more interesting?

      Look at what the internet is doing with Serbia.

  23. INeedAGoodName says:

    I would love it if you would give us Kava: Much More Than You Wanted To Know”

    Is it the perfect cure for anxiety, the miracle drug to make alcohol obsolete, or just a weird-tasting way to blow up your liver?

  24. eggo says:

    I think you’re missing one of the big reasons why people create things that way: to make it clear that it’s not by or for the medical profession, including you.

    Deliberately putting the site out of the pale of medical culture and making it by and for people who know they’re crazy gives them a way to talk about medications that isn’t dominated by professionals.

  25. Alejandro says:

    This highlights how much better things would be, as Scott argued once, if it became ubiquitous social practice to use trigger warnings for the things decried or lauded (depending on the side) as “offensive” or “politically incorrect”. It just seems like a natural Schelling point for society to navigate these issues: Scott can suggest crazymeds with a trigger warning for ableism/sexism/whatever, and then if someone looks at it anyway they have no grounds to accuse him.

  26. Error says:

    So, I looked at crazymeds, and note that:

    1. it is amusing and useful, and

    …Am I the only one that finds the site design so painfully bad that it’s difficult to read?

    • zz says:

      You’re not the only one. Although, when I posted a link to the prozac article to my fb with commentary about “porno boobs” to see if it would draw any feminist ire (so far nothing), the Crazy Meds thumbnail looked quite nice.

  27. Linda says:

    I found this post because I didn’t type in the full crazy meds site name when I was pulling up a link to refer it to a friend. This was top of the google search today (good job). It feels like the feedback of a patient who actually uses the site is lacking so I thought I would chime in as a random stranger.
    I found crazymeds (back when it was many years ago when I got my first psychiatric drug prescription. I now recommend it if I run into anyone who is facing that same experience. Its a good site in addition to my other resources. When I get a new medication I talk to my doctor, read the PI sheet, check wikipedia and then run off to crazymeds to see what it says. And more often than not, I get some side effect mentioned on crazymeds that I missed on the other sites and I know to try and stick it out my internal 3 months to see if it gets better.
    I usually find the offensive pieces funny. I believe that this is because the name, and the flippancy (which could offend some people) builds trust for me. Any patient who takes medication and might want to go to knows in their heart that if their secret was discovered there is at least one person they know would label them crazy. Some of us pretend to shake it off, some are obviously deeply troubled by it but we all know there is a taint of stigma on us with the medication. Yeah – that line we have all heard “its a disease that needs to be treated like any other such as pick one“, doesn’t really fly since in our hearts we know we would just get labeled nuts by some of our closest friends. So I see all of the hoopla at the site as a pirate flag telling everyone who reads it that the site isn’t supporting drug companies. This is someone yelling out that horrible truth we know in our hearts. “Do I think I’m crazy ? No, I’m me. Does the world ? If they knew. Do these meds label me as crazy ? Oh yea!”
    Still, should a doctor be telling their patients to read “Crazy meds” ? No. Its written by folks like me. It opens up liability. More than that, it almost says “trust them not me”. Trust is important because it takes a level of belief in your doctor to swallow a pill each day that makes you feel stupid, or tired, or agitated in the hope that in one month or three you will be saner or happier. But patients should be highly encouraged take responsibility for the drugs they are taking, to research them and discuss their research with their doctors to make the right decision (and if they do, they will find crazymeds on their own like I did).

  28. Anthony says:


    Because then they won’t be held liable for anything, because they can say “hey, blame the doctor who told his patients to go to a site called ‘crazymeds’, not us. We’re obviously not a serious resource; we just want to sell coffee mugs.”.

  29. RKG says:

    Hey, this might have been covered below…

    Have you thought about showing this article to the person in charge of that site? It seems to me that they might be able to come up with a workable solution on their own.

  30. Anon Coward says:

    Apropos of high yield, online, casual language, psychiatric resources, you may find this interesting, Scott.
    Discussed in a Guardian article here:

    The short (excerpted from the above article) version is this:

    “”Star Wards – one of this year’s nine Guardian/Observer Christmas appeal charities – was set up eight years ago, after Janner was sectioned with borderline personality disorder. “Being sectioned was soul-destroying – soul-annihilating, actually,” she says. Part of Janner’s frustration stemmed from her issues with the hospital staff, who – despite their good intentions – appeared underused and crippled by overzealous governance. This observation compelled her to write a list of all the little things that could have been improved in her ward. Nothing huge – making sure that all the board games had the correct pieces, encouraging patients to support each other – but enough to run to 65 points.”

  31. Pingback: Reminder: “Psychiatric Medications: Promise or Peril?” Fall 2014 Felician Symposium | Policy of Truth

  32. Loki says:

    I love crazymeds. And yeah – it couldn’t be what it is, and make people like me feel so very understood in the throes of crazy and dealing with the goddamn system, while being the sort of thing a psychiatrist could recommend. In fact, given the way it is a wonderful haven from their carefully-hedged wordings and lack of time and inclination to get frank with you, it almost wouldn’t work if it was recommended by a shrink.

    edit: is there not a potential workaround wherein a mental health self-advocacy group could recommend the website and leave pamphlets in your offices for patients?

  33. Purple Hayes says:

    I really enjoyed reading this article. Good for you for raising many important topics.
    I am a fan of It speaks in volumes and in lay-woman/man’s, The experiences of taking many medications for mental health and neurological issues.
    I understand not everyone shares a similar type of humour, but each medication is well researched and explained thoroughly.
    If anyone is wanting to read an alternative to “safe” literature, than this site holds no bars.
    Mental illness is serious, but don’t take life too seriously 🙂

  34. Monica says:

    This is a very late reply but oh well. I have used Crazy Meds for many years, back when Mouse was around. I don’t find them offensive and the advice is remarkably sound. They are my go to site for drug information. In my worst moments I have posted questions and Jerod has been very kind in responding. I’m glad he’s still around.

  35. Bangla Choti says:

    excleent article,  love crazymeds. And it couldn’t be what it is, and make people like me feel so very understood in the throes of crazy and dealing with the goddamn system, while being the sort of thing a psychiatrist could recommend. In fact, given the way it is a wonderful haven from their carefully-hedged wordings and lack of time and inclination to get frank with you, it almost wouldn’t work if it was recommended by a shrink.perfectly composed.