Drugs are prescribed based on a cost-benefit analysis. In general, the medical establishment is pretty conservative (there’s little benefit to the doctor if your problem gets solved, but if they hurt you they’re liable to get sued). In the usual case for amphetamines, the cost is the risk of side effects and the benefit is helping someone manage their ADHD. For you, the cost is the same but it sounds like the benefit is much bigger. So even by the standards of the risk-averse medical establishment, this sounds like a risk you should take.
Though the most successful founders are usually good people, they tend to have a piratical gleam in their eye. They’re not Goody Two-Shoes type good. Morally, they care about getting the big questions right, but not about observing proprieties. That’s why I’d use the word naughty rather than evil. They delight in breaking rules, but not rules that matter. This quality may be redundant though; it may be implied by imagination.
Sam Altman of Loopt is one of the most successful alumni, so we asked him what question we could put on the Y Combinator application that would help us discover more people like him. He said to ask about a time when they’d hacked something to their advantage—hacked in the sense of beating the system, not breaking into computers. It has become one of the questions we pay most attention to when judging applications.
I’d recommend avoiding Adderall as a first option. I’ve heard stories of people whose focus got worse over time as tolerance to the drug’s effects developed.
Modafinil, on the other hand, is a focus wonder drug. It’s widely used in the nootropics community and bad experiences are quite rare. (/r/nootropics admin: “I just want to remind everyone that this is a subreddit for discussing all nootropics, not just beating modafinil to death.”)
The legal risks involved with Modafinil seem pretty low. Check out Gwern’s discussion.
My conclusion is that buying some Modafinil and trying it once could be really valuable, if only for comfort zone expansion and value of information. I have very little doubt that this is the right choice for you. Check out Gwern’s discussion of suppliers. (Lying to your doctor is another option if you really want to practice being naughty.)
In general, the medical establishment is pretty conservative (there’s little benefit to the doctor if your problem gets solved, but if they hurt you they’re liable to get sued)
If they don’t give me what I want after I say the correct sequence of words I won’t be returning to them.
It’s easy to find a doctor who will work with you.
I do notice that the idea of trying modafinil does not result in the nearly the same degree of automatic internal ‘no’ as amphetamines. That would suggest my inhibitions are somehow related to the relative perceived potency, or potential health effects… or I’m disinclined to do something that could signal ‘drug abuser’, which I associate much more strongly with amphetamines than modafinil. Hm.
I’ve also been going around and asking the more conservative people in my circle about this situation as well, to try to give a more coherent voice to my subverbal objections. So far I’ve found that they actually support me trying things, which suggests I really should try to recalibrate those gut reactions a bit.
Upon reflection, I think I could actually get modafinil completely legitimately. I feel a bit dumb for not resolving to do this sooner, given that I was fully aware of modafinil- even to the point of very nearly purchasing some a while ago, before I knew it was schedule 4- and given that I was fully aware of what modafinil was often used to treat. At this point, the choice is pretty massively overdetermined.
Amphetamine is officially more dangerous than modafinil (for good reason), but doctors actually respond worse to patients asking for modafinil than asking for amphetamine because it’s weird. The easiest way to get modafinil is probably to start with amphetamine and later ask for modafinil because it’s weaker and safer.
Yes, I’m sure that narcoleptics are referred to sleep specialists who know that it is on-label for narcolepsy. Probably that makes them more likely to prescribe it off-label.
But few people go to sleep specialists. Scott Alexander has written many times about how as a psychiatry resident he sees patients who need a stimulant, but can’t take amphetamine. He brainstorms with his supervisor and suggests modafinil and even in this perfect setup, he gets pushback.
But I wasn’t talking about sleep problems, which includes the approved use of modafinil. I was talking about using it in place of amphetamine for ADHD, which is further off-label.
Drugs are prescribed based on a cost-benefit analysis. In general, the medical establishment is pretty conservative (there’s little benefit to the doctor if your problem gets solved, but if they hurt you they’re liable to get sued).
The idea that doctors who describe Adderal to ADHD patients are conversative about prescribing it seems to be an extraordinary claim.
How many doctors do you think get sued for giving patients adderal?
There a lot of money from drug companies who lobby that drugs like Adderal don’t get perscribed in a conservative fashion.
How many doctors do you think get sued for giving patients adderal?
I’m assuming you think the answer is “not many”. If so, this shows it’s not a very risky drug—it rarely causes side effects that are nasty enough for a patient to want to sue their doctor.
From what I’ve read about pharmaceutical lobbying, it consists primarily of things like buying doctors free meals for in exchange for using the company’s drug instead of a competitor’s drug. I doubt many doctors are willing to run a serious risk of losing their career over some free meals.
From what I’ve read about pharmaceutical lobbying, it consists primarily of things like buying doctors free meals for in exchange for using the company’s drug instead of a competitor’s drug.
The makers of prescription painkillers have adopted a 50-state strategy that includes hundreds of lobbyists and millions in campaign contributions to help kill or weaken measures aimed at stemming the tide of prescription opioids, the drugs at the heart of a crisis that has cost 165,000 Americans their lives and pushed countless more to crippling addiction.
The drugmakers vow they’re combating the addiction epidemic, but The Associated Press and the Center for Public Integrity found that they often employ a statehouse playbook of delay and defend that includes funding advocacy groups that use the veneer of independence to fight limits on the drugs, such as OxyContin, Vicodin and fentanyl, the narcotic linked to Prince’s death.
If so, this shows it’s not a very risky drug—it rarely causes side effects that are nasty enough for a patient to want to sue their doctor.
That argument assumes that only side effects that can be proven in court to be bad are meaningful to worry about. Giving that establishing causation of drug effects usually takes millions of money to run well controlled studies that get published in leading medical journals that allow the drug companies that publish the studies that don’t follow best standards of science that the journals pledged to honor (the CONSORT standards), it’s not easy to prove all causation.
Drugs are prescribed based on a cost-benefit analysis. In general, the medical establishment is pretty conservative (there’s little benefit to the doctor if your problem gets solved, but if they hurt you they’re liable to get sued). In the usual case for amphetamines, the cost is the risk of side effects and the benefit is helping someone manage their ADHD. For you, the cost is the same but it sounds like the benefit is much bigger. So even by the standards of the risk-averse medical establishment, this sounds like a risk you should take.
You’re an entrepreneur. A successful entrepreneur thinks and acts for themselves. This could be a good opportunity to practice being less scrupulous. Paul Graham on what makes founders successful:
I’d recommend avoiding Adderall as a first option. I’ve heard stories of people whose focus got worse over time as tolerance to the drug’s effects developed.
Modafinil, on the other hand, is a focus wonder drug. It’s widely used in the nootropics community and bad experiences are quite rare. (/r/nootropics admin: “I just want to remind everyone that this is a subreddit for discussing all nootropics, not just beating modafinil to death.”)
The legal risks involved with Modafinil seem pretty low. Check out Gwern’s discussion.
My conclusion is that buying some Modafinil and trying it once could be really valuable, if only for comfort zone expansion and value of information. I have very little doubt that this is the right choice for you. Check out Gwern’s discussion of suppliers. (Lying to your doctor is another option if you really want to practice being naughty.)
If they don’t give me what I want after I say the correct sequence of words I won’t be returning to them.
It’s easy to find a doctor who will work with you.
Thanks for the links.
I do notice that the idea of trying modafinil does not result in the nearly the same degree of automatic internal ‘no’ as amphetamines. That would suggest my inhibitions are somehow related to the relative perceived potency, or potential health effects… or I’m disinclined to do something that could signal ‘drug abuser’, which I associate much more strongly with amphetamines than modafinil. Hm.
I’ve also been going around and asking the more conservative people in my circle about this situation as well, to try to give a more coherent voice to my subverbal objections. So far I’ve found that they actually support me trying things, which suggests I really should try to recalibrate those gut reactions a bit.
Upon reflection, I think I could actually get modafinil completely legitimately. I feel a bit dumb for not resolving to do this sooner, given that I was fully aware of modafinil- even to the point of very nearly purchasing some a while ago, before I knew it was schedule 4- and given that I was fully aware of what modafinil was often used to treat. At this point, the choice is pretty massively overdetermined.
Amphetamine is officially more dangerous than modafinil (for good reason), but doctors actually respond worse to patients asking for modafinil than asking for amphetamine because it’s weird. The easiest way to get modafinil is probably to start with amphetamine and later ask for modafinil because it’s weaker and safer.
That’s… pretty goofy. I would hope sleep specialists, at least, would tend to reach for modafinil before amphetamines.
Yes, I’m sure that narcoleptics are referred to sleep specialists who know that it is on-label for narcolepsy. Probably that makes them more likely to prescribe it off-label.
But few people go to sleep specialists. Scott Alexander has written many times about how as a psychiatry resident he sees patients who need a stimulant, but can’t take amphetamine. He brainstorms with his supervisor and suggests modafinil and even in this perfect setup, he gets pushback.
But I wasn’t talking about sleep problems, which includes the approved use of modafinil. I was talking about using it in place of amphetamine for ADHD, which is further off-label.
Glad I could help :D
The idea that doctors who describe Adderal to ADHD patients are conversative about prescribing it seems to be an extraordinary claim.
How many doctors do you think get sued for giving patients adderal?
There a lot of money from drug companies who lobby that drugs like Adderal don’t get perscribed in a conservative fashion.
I’m assuming you think the answer is “not many”. If so, this shows it’s not a very risky drug—it rarely causes side effects that are nasty enough for a patient to want to sue their doctor.
From what I’ve read about pharmaceutical lobbying, it consists primarily of things like buying doctors free meals for in exchange for using the company’s drug instead of a competitor’s drug. I doubt many doctors are willing to run a serious risk of losing their career over some free meals.
No. It also consists of lobbying the relevant politicians to make it hard to sue doctors and generally policies to reduce harms caused by drugs. Drugmakers fought state opioid limits amid crisis:
That argument assumes that only side effects that can be proven in court to be bad are meaningful to worry about. Giving that establishing causation of drug effects usually takes millions of money to run well controlled studies that get published in leading medical journals that allow the drug companies that publish the studies that don’t follow best standards of science that the journals pledged to honor (the CONSORT standards), it’s not easy to prove all causation.