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Comment by Aurornis | Hacker News Reader

> Being diagnosed doesn't immediately mean you should be accommodated.

This is the loophole. Universities aren't the ones diagnosing, they're the ones accommodating.

The current meta-game is for parents and students to share notes about which doctors will diagnose easily. Between word of mouth and searches on Reddit, it's not that hard to find doctors in any metro area who will provide diagnoses and accommodation request letters to anyone who makes an appointment and asks nicely.

There are now also online telehealth services that don't hide the fact that this is one of their services. You pay their (cash only, please) fee and they'll make sure you get your letter. The same thing is happening with "emotional support animal" letters.

Once it becomes widely known that getting a diagnosis is the meta-game to getting housing priority, nicer rooms, extra time on tests, and other benefits the numbers climb rapidly. When the number is approaching 38%, the system has become broken.

It's a real problem for the students who really need these accommodations. When 38% of the students qualify for "priority" housing, you're still in competition with 1/3 of the student body for those limited resources.

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> There are now also online telehealth services that don't hide the fact that this is one of their services. You pay their (cash only, please) fee and they'll make sure you get your letter. The same thing is happening with "emotional support animal" letters.

This used to be a thing with medical marijuana as well (maybe still is?).

The answer is for schools to grab their share of this money by selling each of these accommodations directly, or perhaps via some kind of auction. Acceptance to such a school will be the “basic economy” of attendance. If you want to pick your seat, you can pay to upgrade.

Or just operate so that everyone gets the academic benefits.

My roommate in the 90s was ahead of the curve, he memorized the Cosmo quiz “do you have ADD” went to the student center, got a script that he sold or snorted, and got to take his test in a comfortable room at a time scheduled centrally.

Just randomize assignments to rooms all over campus.

That’s actually impossible (everyone gets the same benefits).

You’re talking about a lottery, which randomly distributes them - which is only fairer in the sense it’s unpredictable, not that anyone that actually needs it would get what they need.

It’s typical gaming of the system, and shortly it’s going to have to switch to punishing those gaming it or it will spiral even more out of control.

You’re overthinking it. The accommodation is a quieter room with a more generous time limit. Just provide that and use a lottery to distribute slots. I had classes that had take home finals.

My son runs into the phony accommodation game in middle school. The latest BS is to get a dyslexia diagnosis, which lets you have more time and take a 90 minute break (where they look up the answers). 9 kids discovered that they have this condition in 8th grade. Performance impacts eligibility for placement in some programs in high school.

If the kids didn’t know it, I wouldn’t have an issue with it. But they do, and abusing accommodations and gamification of zero integrity behavior undermines society in a small way.

Oh wow snorted? Did you keep in touch how well is he doing now? I suspect he's not doing so well with the brain damage and the likely switch to other substances.

Why would snorting be so much worse than just swallowing the pill? The goal is to get the chemicals in the blood. Snorting apparently works quicker, giving you a stronger but shorter lasting effect. But the difference is not night and day.

A lot of people do recreational drugs while at college and go on just fine. George W. Bush, for example, is alleged to have taken cocaine.

I think that’s a good argument against using cocaine.

It's not really worse, but you can get a lot more in your bloodstream a lot quicker, so you've got to be careful with the dose.

Snorting will also shoot your tolerance through the roof, so taking it orally will no longer be as effective. Definitely not a road I recommend going down

> George W. Bush, for example, is alleged to have taken cocaine

And basically any big name in the financial industry has almost certainly used loads of cocaine. They’re mostly not suffering any horrible consequences.

But of course there’s a world of difference between cocaine use and addiction. An addict might start their day with a line, every day, but that’s far from typical use.

> Why would snorting be so much worse than just swallowing the pill? The goal is to get the chemicals in the blood.

When a pill is swallowed it is gradually released into the bloodstream. Some drugs are also partially degraded by the digestive system, meaning you don't get 100% into the bloodstream. For some drugs, as much as 90% or more can be destroyed in the stomach, but this is accounted for in the dosing. Your stomach contents also go through your liver, which does first-pass metabolism depending on the drug and can reduce overall concentrations.

When someone snorts a drug, it bypasses all of that. It has easy access to the brain. It spikes the concentration the brain sees far in excess of what you would get from taking the drug orally.

This spike is where the damage is amplified. A sudden spike to very high values can overwhelm the brain's protection systems, for example.

Dopamine degradation produces neurotoxic metabolites. The brain is normally decent at cleaning these up, but when you consume drugs that spill that dopamine out at excess rates and disrupt its storage in vesicles then you can also overwhelm the brain's ability to clean up safely.

The sudden spike also causes rapid downregulation of the affected receptors, leading to deeper withdrawal effects that can last for a long time.

The sudden spike is also more euphoric. Combine that with the deeper withdrawal and it's why taking a pill through the nose is far more addictive than taking it orally.

We talk every once in awhile, I actually thought about it because I bumped into him at a conference recently.

He was one of those people who are able to contain their hedonism and self-abuse to their frat-boy era. Now, he’s a grey-ish beard tech dude with an awesome wife and family.

Snorting adderall does not typically cause brain damage, and the list of substances rich white kids (I’m guessing here) would typically upgrade to is pretty much just cocaine.

Typical cocaine use also does not result in meaningful harm.

The financial industry chugs along just fine despite approximately everybody using these drugs.

I’ve used cocaine regularly at social events since I was a teenager. The vast majority of people I know, whether they’re 25 or 65, will not say no when offered. In my whole life I’ve known two people from my circles to have developed an actual coke problem, and I know a lot of people.

At this point coke is just the cigarettes of the upper classes, but likely less harmful.

> Snorting adderall does not typically cause brain damage

"Brain damage" isn't a binary yes-or-no thing that happens to you.

It's not even clear that regular as-prescribed usage of amphetamine is without some harm potential. With regular doses and route of administration it's obviously limited or negligible, but someone insufflating (snorting) it routinely is exposing their brains to much higher concentrations and much faster onset.

Note that dopamine itself is toxic when metabolized normally, but your body is equipped to mostly handle that. Using drugs that disrupt dopamine flows in high doses can overwhelm the systems designed to keep dopamine metabolism from doing damage.

> Typical cocaine use also does not result in meaningful harm.

The works "typical" and "meaningful" are doing a lot of work here. One of my friend groups has a lot of ER nurses. They see a non-trivial number of people coming to the hospital from casual cocaine use. These cases are generally waved away as other conditions by drug users (e.g. heart attacks, etc) and therefore they don't "count" in some people's minds. Yet it's a common finding for them on blood workups for people, including young people, arriving with cardiovascular problems.

> The vast majority of people I know, whether they’re 25 or 65, will not say no when offered.

Significant drug users often don't realize how much of a bubble they're in. Also, the goalposts for having a drug problem tend to be moved around a lot when everyone you know is using drugs regularly. Typically, being unable to say no when offered a drug is a sign of having a problem.

My "I do not have an actual coke problem" shirt is generating a lot of questions answered by my shirt.

I think we can probably agree that people using cocaine at social events once or twice a week are generally not the problem users.

Similarly, I don’t think you could reasonably suggest that someone who has a couple of glasses of wine during such events has a drinking problem.

> Significant drug users often don't realize how much of a bubble they're in. Also, the goalposts for having a drug problem tend to be moved around a lot when everyone you know is using drugs regularly. Typically, being unable to say no when offered a drug is a sign of having a problem

Personally, I’d consider someone who uses cocaine on a daily basis to have a problem. I’d also like to suggest that it’s pretty hard to have a cocaine problem and not use cocaine on a daily basis.

OTOH, someone who infrequently shoots up cocaine probably isn’t addicted but would be engaging in some seriously risky behaviour unless they’re able to very precisely measure their dosage. I’ve never heard of anyone doing that though, it’s certainly not a common activity among the upper socioeconomic classes.

> The works "typical" and "meaningful" are doing a lot of work here. One of my friend groups has a lot of ER nurses. They see a non-trivial number of people coming to the hospital from casual cocaine use. These cases are generally waved away as other conditions by drug users (e.g. heart attacks, etc) and therefore they don't "count" in some people's minds. Yet it's a common finding for them on blood workups for people, including young people, arriving with cardiovascular problems

To my knowledge there exists no evidence that anything less than massive cocaine use could result in new cardiovascular issues. Of course it may trigger an existing condition, but someone who has a heart attack during normal casual use of cocaine would probably be prone to have one during exercise also. The stress on the heart from cocaine usage is not particularly different from fairly normal day-to-day activities of people who do not use cocaine.

Yeah, somehow despite everyone doing cocaine at even the highest positions for many decades without any real problems, and the plethora of medical research about the effects of cocaine and how minimal all its long term side effects are and how low addiction rates really are, all below common alcohol, people still act like cocaine is this super serious life-ruining drug. The only significant life-ruining part of cocaine is law enforcement's reaction to it, unless of course you have a lot of money in which case you can just pay to lawyer your way out of it.

The biggest danger to cocaine? Using cocaine to stave off the over-dose effects of other longer-lasting drugs, and then running out of cocaine before you run out of the other drugs and then dieing from alcohol poisoning or opiate over-dose. Cops and politicians will pretend cocaine killed those people, but anyone who knows jack shit about drugs or gets to see the actual toxicology report knows better.

> This used to be a thing with medical marijuana as well (maybe still is?).

Yup. A few years ago in California, go to a weed store in Napa. "Oh, you need a medical card" "Oh, sorry". I get handed a business card, no worries, just call this doctor here, it'll be $x (can't remember) and you can get a medical card and just come back in. I had my medical card within 5 minutes on the phone on the sidewalk outside the store.

Was having stress related ED issues a fews ago. Hit up Hims, fill out the questionnaire. Physician reviews it in our online chat. "If these are your answers, I would not be able to prescribe for you. If your answer to Q3 was x, Q5 was Y, then I would. Would you like to review your answers before re-submitting?"

The deeper I read into this thread, the more it verifies the Key and Peele sketch.

https://www.youtube.com/watch?v=_8JtnUpkP0s

Conversely, you get the cancer patients like my mother, who waited until her second cycle of chemo to explore cannabis, which is apparently the best antinausea medication we have, with the right strains embarrassing the best that the pharmaceutical industry has to offer. She was told that medical card approval needs to go before a state board and it takes 1-2 years; She's be dead or off chemo by then, so we gave up. It ended up being the latter.

A few years later, we've got a "walk-in clinic" a neighborhood over which advertises how easy/fast it is to get cannabis cards specifically; By this time there is no approval wait.

A few years later, recreational is legal.

Poland recently had the famous "receptomats", mostly for medical mariuana, but also a bunch of other things people wanted.

You'd pay online and quickly receive a PESEL (local equivalent of an SSN) + a 4-digit prescription code, which is all that is needed to redeem a prescription there.

> The answer is for schools to grab their share of this money by selling each of these accommodations directly, or perhaps via some kind of auction. Acceptance to such a school will be the “basic economy” of attendance. If you want to pick your seat, you can pay to upgrade.

I don't think you can charge more for accommodations for the disabled.

Presumably the University could do their own assessment to see what is appropriate? Not just rely on a note?

They rely on the note in order not to do their own assessment. It's outsourcing.

Admin staff or teachers of the university are not entitled to assess that.

That would mean the university hiring doctors, or at least paying a doctor to do the test.

The US is a ridiculously litigious country. It could end up being very, very expensive if they did their own assessments, even if they hired doctors to do so.

It is more litigious than the UK, but UK universities have Special Educational Needs specialists. It would be very very unusual for a family doctor (what we would call a General Practitioner) to be willing to make a diagnosis on this, they would insist on referring you to a specialist, although in many cases that may not be a medical doctor at all. ADHD, Nuerodiversity, Dyslexia are all assessed by specialists. In all professions it is considered unethical to act outside of your area of competence...

As a 100% blind person, I am schocked to read this. In a sense, my hunch that DEI is a big fucking scam has just been confirmed yet again. Besides, I wish a real, life-changing disability onto all of these faking people. The children, and their parents.

What a weird take. What does this have to do with DEI?

Well, if everyone and their dog gets special status due to DEI, it apparently makes even more people want to join in on the fun. Isn't that obvious?

No? "DEI" has nothing to do with the ADA.

Wow.

Great to know we're basically raising an entire generation without any integrity.

Can't wait to be in a nursing home where all the staff are trying to meta-game for lowest amount of responsibility rather than caring for the elderly.

And believe me, I'm the last person to disparage the truly disabled or those down on their luck. But 38% in a developed country is just straight up insane. Not to mention that if you have a "disability" that is treatable with medication, should you still be accommodated?

We’re a society of assholes. The comment above suggests selling accommodation requests.

Better yet, many of the graduates will become politicians, journalists, or prominent tech figures who will be pontificating about morality and regulating it for others.

I think about this quite a lot. I’ve come to the conclusion that in the past acting with integrity was rewarded and lacking integrity was punished.

In 2025 it seems integrity is meaningless, “winning” is all that matters. Particularly, you are not punished for acting without integrity but definitely “punished” for having it.

That's what you get in a world where damn near everything is measured against some objective criteria, analyzed by a 3rd party or tracked by the government or someone at the behest thereof

None of these things measure "not an asshole". They measure results. The incentives from there are obvious.

The business owners who treats employees, customers, vendor, everyone like shit in his quest to produce the most widgets, juice every stat, is the one who gets the attention from investors and the one left alone by the government.

Someone has never heard of a medieval peasant. Or take your pick of ancient slave...

Maybe your theory is that if you weren't alive in the past to see "an asshole" for yourself, then the prudent conclusion is a sort skepticism about their very existence.

I wonder how you envision the past then... a vacant landscape? Perhaps you actually believe human nature has radically changed just in the past few decades? The odd thing is I think an actual analysis might contradict your claim, that is if the measurement is simply who is "an asshole". Perhaps we would find more surveillance actually reduces "asshole" behavior generally. Like how confrontational people often change their behavior when confronted by a camera, .etc

Are you under the illusion that greed and selfishness is a vice unique to the 21st century? You would think someone with an internet connection would know better. Humanity has always been this way. In most contexts where the concept "integrity" is evoked it carries with it at the very least a tacit acknowledgement of the strong temptation to do otherwise, that is part of the reason it is recognized as a virtue.

I really find these "in 2025" takes tiresome. There is no golden age, only your own personal nostalgia masquerading as analysis.

Has the cultural attitude towards shame perhaps shifted?

There was a gilded age in the early 20th century and we appear to have entered another gilded age - do you think something structural or cultural has changed? I have a hard time a president like Trump getting elected in past elections - certainly he models himself after Nixon and even Nixon was a very very different kind of president both in temperament but also being less about self aggrandizement.

Yep, shame is the cornerstone of civilization and the scoiety right now seems to be more and more shameless.

Yeah people don't realise this, but shame and guilt (and fear) are our 2 society building emotions. Each society has it's own mix of these, and there are also "themes" depending on which is the dominant one.

Shame has practically been thrown out the window in certain places and we can see the effects of that - people scamming each other, lying in the streets, etc. Guilt is also being eroded across the west, leading to things like rampant criminality and punishments that are less than a slap on the wrist.

Fundamentally these emotions are designed to keep us in check with the rest of the group - does this negatively affect some: yes. But at the benefit of creating high trust societies. Every time I encounter this topic I can't help but think: Don't throw the baby out with the bathwater.

> do you think something structural or cultural has changed

Obviously it has? For one thing, we have billions more people on the planet. For another, we have far more constrained resources -- from the environment to education to everything else -- even for a constant number of people, never mind for the ever-increasing population size. (And there are more factors, but these are more than sufficient to get the point across.) These make competition more intense... in every aspect of life, for everyone. And it's only natural that more cutthroat competition results in more people breaking the norms and rules.

It would be shocking if this didn't happen. If there's a question at all, it's really around is when this occurs -- not if it does.

We've also been rebelling against traditional values for over fifty years and even celebrating it in song and movies. We've adopted a utilitarian ethic in lieu of the traditional values we've rebelled against. I think those are more salient probable causes than over-crowding, especially since the reasoning given for over-crowding as a reason uses a utilitarian ethic (people are only good because they can afford do be). A large part of virtue is doing the good thing regardless of hard times or good times.

Trump got in because he was an actual change from the normal establishment politicians. People want real change, and they did get it...

> I really find these "in 2025" takes tiresome

exactly. This isn't a new problem. But what has been new is the recent growth in funding to "help" those who are deemed helpless - at someone else's cost (it could be taxpayers, it could be, in this case, other fee paying students).

The problem isn't the grift - it's the lack of any real oversight, and the ease with which such help is given lately (i would call it overly-progressive, but that might trigger some people). It is what makes grift possible.

> overly-progressive

I think if you capitalise the P it's fine. It's not actual progress, but the Progressive movement has pushed it. Because that philosophy has a naive view of people, and assumes the best. So their policies and spending allow tests with 100% sensitivity and 0% specificity.

> Are you under the illusion that greed and selfishness is a vice unique to the 21st century?

That's a strawman. I'm pretty darn sure they're not claiming it never happened in the past. Only that it is becoming significantly more widespread than it used to be.

I think you're going to have an incredibly hard time making a compelling case that no such trend exists, given the statistics (even on this particular issue in the article, never mind other issues) would very likely strongly suggest the opposite.

Yup - and just look to the leadership of the country as a classic example of this.

The ‘winner’ is he who scams the hardest without getting consequences.

I have bad news for you about existing nursing homes.

It's not 38% of the entire population/generation, it's 38% of a tiny group who have gotten into an elite, highly selective school, and have the massive resources (not just education) to do so. But as someone else said, these are probably people who are much more likely to get placed into positions of power and authority.

No. It might be much much worse than 38% outside of these elite schools, but a little bit different. This is in fact one of the reasons public education falls off the cliff. I've seen a teacher leaving elementary after she found out that 19 kids out of 24 in her class had some kind of learning disability needing special treatment, special help, assignments specially designed for them etc. In her own words all of them were completely normal kids except maybe 1 or 2.

Is it really gaming to get a doctors note to say a pet cat will make you happier?

My stepdaughter just started college. She told the tale of a boy and a girl who tried to claim that a cat was an ESA or service animal for both of them. The one cat. For both people. Just so happened that they were a couple in high school, and this was their effort to game the system to get assigned to a dorm together (the university generally wouldn't allow a co-ed dorm assignment like that, and had rules about relationship "overnights" in the dorm.

Why would the university not allow coed dorm assignments like that or have rules about relationship overnights in the dorm. Kids going to college are adults why should those restrictions be there in the first place?

If you treat students like children, it's not surprising if they try to game the system

Because a dorm is not an apartment building, it's a place with communal spaces like bathrooms and showers so you have to share some intimacy with people living at the same floor as you. And many people are not comfortable doing so with people from the opposite sex.

Being not comfortable with it is not the same as banning it school-wide. It's perfectly reasonable to have some single-sex spaces that people can choose if they're uncomfortable. But requiring that all dorms be single-sex makes it sound like there is some other religious/conservative nonsense at play.

Regardless, this isn't Victorian England. Men and women mix and live in shared spaces. There are plenty of adult living spaces in the world where people have their own apartment/room, but share bathroom space. That's also common in lower end hotels/hostels for travelers. Requiring that college students live in gender-separated living situations is a bad way to prepare them for the real world.

Most of those dorms are not single bed. Yes, there are hostels. But you're not going to expect that it's going to be common to say "yes, I have no issue getting undressed/naked/dressed in front of my opposite sex dorm mate on a daily basis, or having to go to a bathroom and to do so within a stall" (because the dorm mate (plus whatever other dorm mates of either sex are around).

I get it - and at my stepdaughter's school there are co-ed dorms of different styles. But what they don't offer, and in this case is what the students hoped to achieve was "give us our own dorm with one bed", effectively.

The issue then also comes down to "well, college relationships aren't always the most durable things" - what happens when they break up? Who has to move out? It's not one person's space. Now the college is also on the hook for ensuring that there's sufficient vacancy (wasted) to handle these situations in other dorms.

Yes, that's a bit odd, perhaps it's a religious or otherwise conservative university?

At my (secular) university, we did have a few single-sex dorms (optional for people who were uncomfortable with a mixed-sex dorm), but all others were co-ed, though some were separated into all-male and all-female hallways where they'd share a single-sex bathroom.

IIRC even the female-only dorms had no rules about overnight stays (though males had to be escorted around the building by their female host). A university not allowing people to stay overnight reeks of puritanical values.

It's a state university, and I said that they had "rules about relationship overnights", not that they were forbidden.

Essentially it's one night a week. So, if both students, effectively two nights a week.

I don't disagree. I think it would be disrespectful to your dorm mate if your partner was just living in that space (which is already small for two, let alone three) most of the time. And you have to imagine that's at least part of the reason why such things are rules now, not suggestions.

So there are a variety of options, but my stepdaughter is in a pod/suite setup. There are four dorm rooms, each with two people, and the four share a communal/interconnected bathroom set up.

So you need to have respect for your dorm mate, and your suite mates. And you know that, unfortunately, while "be respectful and adult" should be the expectation, there's always someone that ruins that, and the next thing the college has to set rules and say "this is why you can't have nice things".

And I expect there's a bit of liability minimization on the college's part - I'm not saying I agree, but the college probably has concerns of "it's mid term, and an allegation of inappropriate behavior happens, what do you do?" (and I think there's multiple issues with that, like it's not like that can't happen in same sex dorms, but I'm just trying to think about why the college might see it that way).

> Is it really gaming to get a doctors note to say a pet cat will make you happier?

If that takes away a limited resource from someone else (e.g. dorm space) or makes it worse for others (e.g. people don't want animals in a dorm), then yes. Absolutely.

Older generations have no more integrity. Just look at the last US presidential election results - older generations were more likely to vote for Trump than younger ones. I don't think a person with integrity is likely to vote for such an openly corrupt conman.

Nah, the reality is that people have always been greedy and selfish, gaming the system where they can.

There are a lot of people around who are playing victims to get benefits. And relentlessly pushing their agenda.

> I don't think a person with integrity is likely to vote for such an openly corrupt conman.

As far as I understand, it was precisely because of situations like the one described in the article that people voted for him.

In practice, you don't need to be honest and incorruptible to win an election. You just need to be more honest and incorruptible than your opponent.

>>>> Great to know we're basically raising an entire generation without any integrity.

Are you talking about the generation of doctors writing the disability assessments?

Most young people are still fine. Neither of my kids ever claimed to be disabled.

I agree with your overall point about lack of integrity, but just to clarify this bit:

> Not to mention that if you have a "disability" that is treatable with medication, should you still be accommodated?

I know people with incredibly severe ADHD, who are on medication, but in their case the medication is only able to make them reasonably functional. They still have difficult day-to-day issues.

But yeah, in general I'd say if you have something that is entirely fixable with medication, you don't need an accommodation.

The problem is that the ADA is worded such that businesses and organizations can't dig into these sorts of details, so they err on the side of accommodating in order to avoid lawsuits.

To me this is just the logical end result of capitalism where the only thing that really matters is profit at any cost. Many people would be fine with being an average person living moderate life, but capitalism is always incentivizing people to exploit and abuse others in the name of profit and the average person is constantly getting screwed and everyone knows it. And there are only 2 real solutions to escaping that problem, eschew modern society and live a subsidence life, or find a way into the top percentage of society so you have more money than you need so you can ignore most of those problems.

Shitty boss/job? Having extra money lets you tell them to fuck themselves and move to another job at any time. If you don't have extra money, well you are not going to be able to tell your shitty boss to shove it unless you want to risk becoming homeless and destitute. Legal trouble? Well money is the solution, which is why poor people are so often screwed over by legal trouble because they can't lawyer their way out. Etc etc

universities should have their own experts who give final diagnosis and are unapelable and thats it, all the psychopathic circus which is abusing real disabled people would be out

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