Comment by dalbasal | Hacker News Reader

Comment by dalbasal | Hacker News Reader

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To play devil's advocate (of sorts)... Maybe the pathology-treatment paradigm needs challenging. Dangers/costs exist for "neuro-untypical" people too, as well as benefits.

Anyone will concede that costs can outweigh benefits for some diagnosed (neuro-untypical/pathological) patients. Is it impossible that benefits outweigh costs in neurotypcal patients? My experience is that professionals are uncomfortable with that thought.

I was one of the kids prescribed stimulants in the early days, circa 1990. Even as a kid, I smelled wierdness.

One doctor prescribed the medication, and asked for teacher feedback. If the drug did its job, then I had ADD. The test was comparing behaviour on & off the drug. If I didn't have ADD, the drug wouldn't work. Later on, the doctor told my mother: "If you take it, it'll do the same thing. It boosts concentration in everyone." This was a slip, kinda. They prefer if patients (and professionals) pretend that "the drug only works if you have the pathology, and is very dangerous if you don't."

I think the medical system is uncofortable about "enhancement" generally. For something to receive treatment, it needs to be a pathology, untypical... I sympathize with the reasoning, "first, do no harm" and also the potential reality of such drug use becoming more common.

Often times, this gets abstract... "what is normal, man."

Anyway, I don't think ADD drug benefits or costs are, in reality, very closely correlated to your unmedicated baseline. Besides biilogy, a big factor is your job/school/environment, and what it takes to perform in that environment. If you're a football player or a film director, add drugs probably won't do much. If you're a chess player or ceo, they probably will, regardless of your unmedicated norm.

Agree with everything you said except for this last bit:

> If you're a football player or a film director, add drugs probably won't do much.

It's obviously not a useful data point, but my own personal experience is that my physical endurance is greatly increased on the days I've taken my Adderall prescription.

If you read up on amphetamines, it's pretty interesting. They known to provide significant physical enhancement in a number of dimensions. The trick is keeping the user from developing a physical dependence.

Interesting. It's been a long time for me, but I don't recall those sorts of effects.

What I meant was that the importance of concentration (or really any drug-enhanced something) varies a lot by activity. You might be add-as-hell, but in your daily life that's fine. OTOH, you might be "neurotypical" but up to something where any enhancement is felt.

>What I meant was that the importance of concentration (or really any drug-enhanced something) varies a lot by activity.

I think it's important not to undersell the universal utility of focus. Even if you ignore the obvious physical advantages afforded by PED-stimulant drugs, like decreased reaction time or increased endurance.

If you model decision making in a zero-sum adverserial context like football or chess as an OODA loop[1], then a drug that decreases your processing time and decision making time is going to grant you an advantage by shortening that OODA loop.

1: https://en.wikipedia.org/wiki/OODA_loop

Just to add another data point, I also felt like my physical performance in the gym was greatly enhanced during days I used Modafinil, to the point where I would schedule my Mod days with when I did a leg workout in the gym (which I otherwise despised). I've discussed this with friends and they all also agree. It could well be placebo, but that's not to say it still isn't an effective training enhancer.

Doctors won't prescribe enhancers just for enhancements, but all stimulants (except modafinil I guess) were OTC for at least a time, so we'd expect an enhancer (if safe) to be regulated as a supplement. Caffeine is "the one good drug" and I don't see that changing, and that's even though there are fatal overdoses on it and the side effects are pretty bad (but not psychosis bad), so it's not a terribly high bar to clear for a new compound.

It'll be interesting to see if new compounds have tolerance or withdrawal effects -- something that made you smarter for 4 hours but unable to tie your shoes for 2 days would be a non-starter, as would a smart drug that then permanently lowered your non-drug IQ and raised your chance of Alzheimer's. If anything if I remember my course on the subject correctly pretty much all psychiatric drugs have withdrawal effects that are worse or longer lasting than stimulants do, and while that's not something that would cause them to be made illegal, it would make doctors very reluctant to prescribe them "just to try" the way some have with ADD. (I also don't think a compound that has fatal withdrawals would be allowed as a food or supplement today, alcohol is pretty much grandfathered in.)

>If you're a football player or a film director, add drugs probably won't do much

FYI, the NFL considers amphetamines and substituted amphetamines to be performance-enhancing drugs. As does the International Olympic Committee.

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