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Speaker 1: Bloomberg Audio Studios, Podcasts, Radio News.

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Speaker 2: Hello and welcome to another episode of The Odd Lots podcast.

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Speaker 3: I'm Jolle Wisenthal and I'm Tracy Alloway.

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Speaker 2: Tracy, I was gonna ask you a question, but I

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Speaker 2: already know the answer to it. I was going to say, like, oh,

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Speaker 2: have you ever tried adderall? But I already know you're not,

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Speaker 2: so I don't want to like fake the intro whatever,

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Speaker 2: but I'm just curious, like, what percentage of our colleagues

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Speaker 2: do you think use some sort of stimulant adderall something,

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Speaker 2: some sort of performance enhancing workplace.

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Speaker 3: Drug like coffee, No, something a little stronger than college. Okay,

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Speaker 3: We've had this conversation before, and I think it's such

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Speaker 3: an interesting one because, as you know, I have never

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Speaker 3: tried adderall. It is a complete cultural blind spot for me.

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Speaker 3: But I am one hundred percent sure that you and I,

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Speaker 3: in the context of this podcast and our day to

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Speaker 3: day lives, have absolutely spoken to people who have been

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Speaker 3: on adderall. In fact, a very famous one springs to

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Speaker 3: mind right now. I don't know who you're talking about,

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Speaker 3: SBF Sam been Free, There you go, there you go,

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Speaker 3: but it is an interesting thought experiment. To think about

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Speaker 3: the proportion of people around you, you know, sometimes highly

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Speaker 3: productive people who may or may not be on adderall

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Speaker 3: or something similar.

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Speaker 2: So here's my thought, which is that, like, my big

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Speaker 2: fear with adderall is like, I'm not maybe against trying

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Speaker 2: it because I don't think I have the most focused

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Speaker 2: brain in the world. In fact, I know I don't,

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Speaker 2: and I get scartered. I'm worried that I would be

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Speaker 2: really productive on it and then for the rest of

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Speaker 2: my life be faced with this choice of do you

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Speaker 2: want to stay on this drug forever or do you

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Speaker 2: just want to go back to your old self knowing

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Speaker 2: that you have this other potential state in you. Yes,

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Speaker 2: that's my big fear.

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Speaker 3: I feel the same way. I am deeply concerned that

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Speaker 3: I would start writing a book and be successful at it. No,

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Speaker 3: that's a joke, but I think, like to me, it

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Speaker 3: opens up kind of interesting questions about fairness and access

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Speaker 3: and if someone next to you is getting an edge

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Speaker 3: because they either have a prescription that maybe they don't

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Speaker 3: need or maybe they do need it, and we can

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Speaker 3: get into the degree to which adderall actually is needed

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Speaker 3: by the population, or they're accessing it illegally. In one

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Speaker 3: way or another. It just opens up like interesting questions.

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Speaker 3: But then again, I mean, the person next to you

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Speaker 3: can drink ten cups of coffee and that's allowed, right,

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Speaker 3: Like you're allowed to do that.

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Speaker 2: Yeah, I mean, this is not the Olympics. We're trying

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Speaker 2: to all maximize our performance here in the corporate world.

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Speaker 2: So I first heard about adderall when I was in

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Speaker 2: high school. I graduated in ninety eight, and I wasn't

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Speaker 2: like a great student. I got bored a lot in class.

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Speaker 2: I've just been scattered. I couldn't focus and such, And

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Speaker 2: I feel like I was probably in a slightly different environment.

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Speaker 2: Maybe if I had been born a couple of years younger,

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Speaker 2: I might have been prescribed it. I think maybe not

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Speaker 2: because my parents were hippies and so they didn't really

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Speaker 2: believe probably and prescribing drugs for that sort of thing.

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Speaker 2: But then you know, sort of this cultural thing. It's like, oh,

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Speaker 2: they're giving all these boys.

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Speaker 3: Yeah, predominantly boys. I think this is a big issue

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Speaker 3: that a lot of women weren't diagnosed when they were young,

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Speaker 3: and there are a lot of people right now in

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Speaker 3: their thirties and forties who are getting late diagnoses because

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Speaker 3: all the symptoms that people were looking out for, were,

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Speaker 3: you know, hyperactive boys basically.

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Speaker 2: Totally, and so it went from a hyperactive boys in

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Speaker 2: high school thing, and then I sort of forgot about

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Speaker 2: it for a while. Then I went to college and

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Speaker 2: I found that to be a little easier, and then

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Speaker 2: like I forgot all about adderall. And then over the

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Speaker 2: last several years, what we've seen is prescriptions for adderall

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Speaker 2: absolutely explode much more adult use, as you say, people

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Speaker 2: finding out later in life that they're diagnosed with ADHD,

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Speaker 2: which of course has also led to shortages, which have

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Speaker 2: a variety of reasons, some relating to the DEA and manufacturing,

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Speaker 2: some just related to the absolute booming in demand. And

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Speaker 2: so adderall is just sort of an omnipresent topic of

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Speaker 2: conversation and an angst in its owne right.

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Speaker 3: Yes, And I am just going to emphasize this again

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Speaker 3: cultural blind spot for me. So I'm very interested to

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Speaker 3: hear how you know, how it works, what the impact

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Speaker 3: might be, and what's driving the boom in usage as

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Speaker 3: you mentioned.

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Speaker 2: Well, I'm really excited to say we do, in fact

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Speaker 2: have the perfect guest, someone I've wanted to talk to

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Speaker 2: for a long time on the show. And you know

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Speaker 2: someone who recently wrote about it, And so there was

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Speaker 2: this great set of essays collected by pioneer works talking

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Speaker 2: about the adderall phenomenon from various phenomenons.

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Speaker 3: I read all of these in one sitting without the

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Speaker 3: use of adderall. They're very, very good.

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Speaker 2: They're very good. Everyone should read all of them. But

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Speaker 2: I'm really excited. We're going to be talking to one

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Speaker 2: of the contributors, Danielle Carr. She's an assistant professor at

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Speaker 2: the Institute for Society and Genetics at UCLA, and she's

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Speaker 2: a history storian of science and psychology. So hopefully we're

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Speaker 2: going to understand how did we get to this point

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Speaker 2: and what is widespread adderall consumption? How is it rewiring

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Speaker 2: our brains or if not, society. So, Danielle, thank you

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Speaker 2: so much for coming on odd lots.

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Speaker 4: Thank you so much. It's wonderful to be here.

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Speaker 2: Describe your work in general. You had a great New

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Speaker 2: York Magazine cover story last year, But talk about like

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Speaker 2: sort of your from an academic perspective, like what is

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Speaker 2: your focus? How does adderall fit into your broader research

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Speaker 2: and work over time?

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Speaker 4: So I guess I should say that adderall and tension

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Speaker 4: deficit diagnoses are not my specific realm of expertise. My

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Speaker 4: dissertation work and now my first book is looking at

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Speaker 4: the rise of neural implants a la Elon Musk's neuralink

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Speaker 4: to treat psychiatric disorders such as anxiety depression PTSD and

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Speaker 4: so on. But I guess more generally my line of

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Speaker 4: work is looking at the political, economy and historical emergence

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Speaker 4: of different types of experimental psychiatric treatments from the twentieth

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Speaker 4: to the twenty four century.

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Speaker 3: I have a really basic question to start out with,

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Speaker 3: what happened to Riddlin? So no, but honestly, so if

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Speaker 3: we had been having this discussion in like the nineteen

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Speaker 3: nineties or the early two thousands, I don't think we'd

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Speaker 3: be talking about adderall. We'd be talking about Riddlin.

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Speaker 4: Yeah, I think that that's absolutely right. I mean, one

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Speaker 4: of the interesting things to note about the sort of

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Speaker 4: cluster of names for this behavioral disorder that is, you know,

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Speaker 4: currently called ADD or ADHD, is that there have been

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Speaker 4: since nineteen oh two about twenty different names for this

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Speaker 4: kind of cluster of syndromes. And so Riddlin emerged as

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Speaker 4: it's methyl fenidate rather than an amphetamine, so it's slightly

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Speaker 4: different pharmacologically, And it was formulated in the mid nineteen

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Speaker 4: fifties as what was hypothesized to be a less addictive

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Speaker 4: alternative to amphetamines, which were at that time being used

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Speaker 4: to treat children with what was being called hyperkinesis Concerta,

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Speaker 4: by the way, is just methyal fenatic x are. But

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Speaker 4: there was a period basically in the nineteen seventies when

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Speaker 4: and I'm sure we'll get into this, there was a

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Speaker 4: sort of widespread panic over the enormous prevalence of infitamines,

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Speaker 4: especially to treat children, and riddlin was sort of preferred

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Speaker 4: as an alternative that had fewer side effects allegedly and

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Speaker 4: was less addictive allegedly, which accounts for the prevalence of

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Speaker 4: Riddlin through the sort of mid nineties, at which point

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Speaker 4: there's a switch when Shire Pharmaceuticals acquires Obatral, which is

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Speaker 4: rebranded as Adderall, and that's really when the Adderall craze hits.

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Speaker 5: Tracy.

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Speaker 2: I'm glad you asked that, because I had forgotten all

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Speaker 2: about Ridlin. But now that you say it, that's what

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Speaker 2: people were talking. They weren't talking about adderall yet when

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Speaker 2: I was in high school, but I was aware that

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Speaker 2: this was the thing, and like CNN and stuff would

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Speaker 2: talk about all these boys being described Ridlin. So I

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Speaker 2: mentioned Danielle, I was in high school in the mid nineties.

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Speaker 2: What was going on then that suddenly there seemed to

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Speaker 2: be this, you know, the first wave, or maybe the

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Speaker 2: way you describe it, the second wave of this phenomenon

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Speaker 2: of let's get all the boys on Ridlin.

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Speaker 5: Yeah.

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Speaker 4: So I guess we can start the story in media

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Speaker 4: res as it were in the mid nineties. But really

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Speaker 4: the work of a historian named Nicholas Rusmussen has I

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Speaker 4: think done a very magisterial job in showing that the

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Speaker 4: twentieth century was defined in many ways by recurrent waves

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Speaker 4: of infatimine use. The first wave really began with the

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Speaker 4: rise of infetamine use during the Second World War, and

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Speaker 4: we can talk about that if you guys would like.

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Speaker 4: But by the mid nineties, one of the major things

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Speaker 4: that had happened was a panic in the nineteen seventies,

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Speaker 4: a sort of moral panic over the extraordinary prevalence of amphetamines,

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Speaker 4: mostly dexidron and benzydrin, that were being prescribed without any

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Speaker 4: sort of federal control. It was extraordinarily prevalent across the

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Speaker 4: US population, and there really were not very many controls

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Speaker 4: at all in terms of how doctors needed to report

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Speaker 4: these prescriptions to any sort of federal data collection. And

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Speaker 4: so in nineteen seventy one you had Congress tasked deda

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Speaker 4: with reclassifying amphetamines as being a schedule to substance, that is,

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Speaker 4: prescriptions needed to be reported to a central government administration,

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Speaker 4: and there were limits and quotas placed on the quantities

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Speaker 4: of mphetamines that could be manufactured and then distributed to

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Speaker 4: pharmaceutical companies, and so used to have this sort of

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Speaker 4: moral panic around that that actually led to a congressional

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Speaker 4: investigation in nineteen seventy and there was this sort of

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Speaker 4: broader crackdown both legally in the nineteen seventies and also

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Speaker 4: culturally where you had like the sort of countercultural figures

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Speaker 4: decrying speed freaks, which had also you know, there was

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Speaker 4: this discourse in this narrative that for instance, like the

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Speaker 4: heighth Atsbury sort of summer of love had been that

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Speaker 4: had been destroyed by speed freaks and so on and

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Speaker 4: so forth, and so in the nineteen seventies you have

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Speaker 4: a movement away from amphetamines proper, which a creates the

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Speaker 4: conditions for the rise of things like ritilin, which is

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Speaker 4: a methyl feenadate, which is you know, it's pharmacologically quite similar,

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Speaker 4: but it was not subject to exactly the same controls

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Speaker 4: as emphetamines. And secondly, I think the thing, the very

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Speaker 4: important thing that happens is that one of the few

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Speaker 4: medical uses for which amphetamines are going into the late

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Speaker 4: nineteen seventy is still allowed to be prescribed are child

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Speaker 4: behavioral disorders. Now, prior to nineteen seventy and fetamines had

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Speaker 4: been used off label for everything from weight loss to

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Speaker 4: mood to just like a variety of off label prescriptions.

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Speaker 4: But you have this sort of concentration after this crackdown

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Speaker 4: by the DEA to focus amphetamine use medically specifically on

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Speaker 4: this you know, small cluster of childhood behavioral disorders. This

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Speaker 4: sets us up for, by the time we get to

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Speaker 4: the nineteen nineties, the sort of growing market for childhood

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Speaker 4: applications for m ffetamines. And I guess like the third

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Speaker 4: intervening factor here would be that in nineteen teen eighty

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Speaker 4: there was the third publication of the Diagnostic and statistical Manual,

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Speaker 4: which is the DSM, which is widely described as psychiatry's

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Speaker 4: diagnostic bible. This is essentially the list of diagnoses held

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Speaker 4: to be medically viable that insurers will agree to cover,

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Speaker 4: that clinical trials will investigate, and so on and so forth.

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Speaker 4: And add attention deficit disorder is installed in that version

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Speaker 4: of the DSM, and so I think this really sets

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Speaker 4: the stage for the rise of ADD as a clinical

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Speaker 4: diagnostic entity that receives a lot of research funding in

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Speaker 4: the nineteen eighties, such that by the nineteen nineties, once

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Speaker 4: adderall comes onto the market, the stage is set for

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Speaker 4: a very wide sudden uptick in adderall prescriptions for children.

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Speaker 3: So talk to us about what adderall actually does. And

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Speaker 3: here I have to confess. In preparation for this conversation,

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Speaker 3: I walked around Union Square in New York and ask

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Speaker 3: people why they take adderall.

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Speaker 4: No.

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Speaker 3: I asked some people that I know about adderall, and

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Speaker 3: someone explained it to me as this idea that if

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Speaker 3: you do have ADHD, then you don't have the normal

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Speaker 3: level of dopamine in your brain, or your brain handles

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Speaker 3: it slightly differently, and so adderall basically helps to normalize

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Speaker 3: dopamine and bring it closer to what a neurotypical person

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Speaker 3: might have without medication. Could you maybe explain exactly what

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Speaker 3: adderall is doing on someone's brain and the differences between

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Speaker 3: someone who's maybe taking it to boost their productivity versus

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Speaker 3: someone who's taking it because they have been diagnosed with

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Speaker 3: ADHD or something else and they have an actual prescription

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Speaker 3: from a doctor.

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Speaker 5: Yeah.

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Speaker 4: So I think the question of what adderall is and

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Speaker 4: what it does neurologically is very connected to the very

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Speaker 4: contested and open question of what ADD and ADHD are neurologically.

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Speaker 4: So maybe I'll start with what is ADD what is ADHD. Now,

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Speaker 4: what you have to understand is that with the emergence

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Speaker 4: of the DSM three in nineteen eighty, this was a

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Speaker 4: document that was created essentially to bring together a bunch

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Speaker 4: of different stakeholders under a very large tent. These stakeholders

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Speaker 4: included insurers, clinical researchers, formalcological companies of course, and of

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Speaker 4: course patients and doctors. And the DSM describes clusters of symptoms,

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Speaker 4: that is, syndromes that tend to occur together. So, for instance,

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Speaker 4: here's a list of ten to twelve behavioral manifestations that

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Speaker 4: tend to cluster together and we're going to call that depression,

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Speaker 4: so on and so forth. But particularly in nineteen eighty,

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Speaker 4: there was not a robust sense of what the neurological

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Speaker 4: underpinning of each of these diagnoses were. These were descriptions

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Speaker 4: behaviorally of how these syndromes manifest that were presumed to

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Speaker 4: be disease entities. But I mean, if you ask anyone

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Speaker 4: working at the cutting edge of sort of neurology psychiatry

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Speaker 4: right now, they will tell you quite frankly, that there

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Speaker 4: is no guarantee that any one case of let's say,

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Speaker 4: depression or anxiety neurologically looks like any other case of

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Speaker 4: depression or anxiety. That's because there are many different ways

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Speaker 4: to have depressions. Some people might be crying a lot

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Speaker 4: and not eating very much. Someone else might not be

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Speaker 4: crying very much and eating a lot, for instance, right,

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Speaker 4: and so there's no guarantee that each instance of the

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Speaker 4: disease entity is going to have the same sort of

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Speaker 4: biological underpinning behind it. Now, this works fine for things

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Speaker 4: like insurance markets or billing insurers, or sort of getting

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Speaker 4: medicine done in a sort of day to day sense,

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Speaker 4: But once it comes to sort of extrapolating and understanding

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Speaker 4: the neurological basis of diseases, the system does sort of

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Speaker 4: fall apart. This is why increasingly clinical research is moving

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Speaker 4: towards the ICD system rather than the DSM system. So

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Speaker 4: this is neither here nor there, perhaps generally, but specifically

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Speaker 4: when it comes to add and ADHD, I think it's

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Speaker 4: very important to keep in mind that there is no

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Speaker 4: widely accepted, beyond contestation understanding of what these disease entities

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Speaker 4: actually are on a neurobiological basis. So there are theories

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Speaker 4: that there's some sort of deficit in dopamine production or

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Speaker 4: the rear partake of nopernepherin and dopamine. But I think

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Speaker 4: it's important to keep in mind that these explanations they

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Speaker 4: might be having prevalence now. But if you think about

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Speaker 4: the rise of, for instance, the serotonin hypothesis when it

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Speaker 4: comes to depression, the serotonin hypothesis dominated theories of depression

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Speaker 4: for quite some time and then has been pretty roundly disproven.

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Speaker 4: There is not a robust link between depression and serotonin deficits,

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Speaker 4: and so I think that's one important thing to keep

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Speaker 4: in mind, is that we don't necessarily have a robust

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Speaker 4: and agreed upon understanding of what this disease entity quote

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Speaker 4: unquote actually is. Now when it comes to what it

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Speaker 4: is that stimulants actually do in the brain, the brain

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Speaker 4: releases neurotransmitters that then sort of hang out in the

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Speaker 4: space in the sort of synaptic space between the axon

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Speaker 4: and the dendrite and then are reabsorbed. So neurotransmitters are

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Speaker 4: things like, for instance, nopernethyrine, dopamine. Right there's these are

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Speaker 4: things that your listeners probably have already heard of. Something

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Speaker 4: like an amphetamine decreases the amount of those neurotransmitters that

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Speaker 4: are re uptaken, meaning that the sort of synapse is

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Speaker 4: bathed for a longer period of time by those chemicals.

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Speaker 4: So that's how an amphetamine works, is that it really

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Speaker 4: bathes the brain. In dopamine no reprodefron. Dopamine is sort

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Speaker 4: of widely theorized or described as being a chemical that

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Speaker 4: codes for expectation of reward. So one way that I

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Speaker 4: like to explain this is that if you go to

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Speaker 4: a gumball and you're expecting to get one gumball, but

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Speaker 4: the machine gives you two for one quarter, you're going

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Speaker 4: to have a huge dopamine spike because that reward is

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Speaker 4: double what you were expecting. And when you think about

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Speaker 4: the way that, for instance, addictive technologies like video gambling

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Speaker 4: or social media work, they work by introducing variable rewards

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Speaker 4: that hook into this very very motivating dopaminergic system in

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Speaker 4: the brain. No Ropernaffron similarly controls the body's sort of

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Speaker 4: readiness for fight or flight, and so it sort of

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Speaker 4: generally increases a feeling of alertness and readiness. But this

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Speaker 4: is why you know, it feels really really good to

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Speaker 4: be on amphetamines, and it sort of increases this general

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Speaker 4: sense of well being and alertness. And indeed, this is

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Speaker 4: why you know in the early nineteen thirties, am fetamine

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Speaker 4: was widely prescribed for antedonia or a lack of pleasure.

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Speaker 4: In fact, historian Nicholas Rismusin has made the case convincingly.

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Speaker 4: I think that empetamine was in fact the first antidepressant.

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Speaker 4: But at a neurological level, that is essentially what amphetamines

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Speaker 4: are doing. They also, because of their dopaminergic action, they

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Speaker 4: increase the rewardingness of a task. It is a common

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Speaker 4: talking point for sort of ADHD advocates that amphetamines only

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Speaker 4: work if you indeed have add or ADHD, and unfortunately

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Speaker 4: this is simply not true. Anyone who takes amphetamines has

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Speaker 4: this burst in heart rate, burst in feelings of well being,

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Speaker 4: burst in ability to concentrate. This has been documented clinically

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Speaker 4: over and over again that there's not really a perceptible

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Speaker 4: difference between people who have been diagnosed with add or

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Speaker 4: ADHD and people who have not when they take these drugs.

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Speaker 2: So someone like myself who sometimes worries that maybe I

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Speaker 2: have another level of productivity above me, even I've never

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Speaker 2: been diagnosed with anything, like, maybe that's true. So you know,

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Speaker 2: I get like, as you say, okay, it makes internet

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Speaker 2: gambling you could see or tweeting, tweeting, et cetera. But like,

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Speaker 2: what is the theory by which like a bunch of

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Speaker 2: people who have jobs where they have to make powerpoints

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Speaker 2: about some m and a deal and they're all many

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Speaker 2: of them apparently on adderall. Like for that person they

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Speaker 2: have a job, they're in the office until eleven pm,

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Speaker 2: they get one TYPEO wrong, they have to start it

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Speaker 2: all over. What does ederall do for them in the

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Speaker 2: sort of corporate context or the work context.

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Speaker 4: So one of the things that I discussed in my

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Speaker 4: essay was clinical literature around what psychiatrists call punding, which

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Speaker 4: is repetitive behavioral loops that are often observed in patients

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Speaker 4: that are taking drugs that bathe the brain in dopinergic chemicals.

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Speaker 4: So punding was first described in the nineteen seventies by

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Speaker 4: a psychiatrist who was observing the sort of repetitive behavioral

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Speaker 4: loops like tweezing your eyebrows, or sorting and handling objects,

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Speaker 4: or hunting for things or collecting things, so on and

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Speaker 4: so forth in patients who are taking levadopa, which is

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Speaker 4: a dopamine replacement that is used in patients with Parkinson's.

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Speaker 4: And I think that this gives us a pretty interesting

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Speaker 4: angle into what it is exactly that amphetamines do, which

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Speaker 4: is to make these repetitive tasks much much more rewarding

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Speaker 4: than they would otherwise be. And so, when you think

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Speaker 4: about the forms of work that predominate in the so

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Speaker 4: called knowledge economy, right where you're on a computer looking

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Speaker 4: for things, searching for information, organizing information, so on and so forth.

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Speaker 4: First of all, and amfetamine makes any task that you're

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Speaker 4: engaged in much more rewarding because it's massively ramping up

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Speaker 4: the dopamine signals in your brain that are telling you

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Speaker 4: keep doing this. This thing that you're doing is better

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Speaker 4: and better and better than you expected. But I think

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Speaker 4: that what's interesting about the role of emphetamine specifically in

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Speaker 4: sort of knowledge work is that it makes these repetitive

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Speaker 4: tasks feel more like hunting and gathering. Right, It's more

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Speaker 4: or it's a more exciting task to do these repetitive tasks.

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Speaker 4: And this is not something that is specific to the

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Speaker 4: nineteen nineties. When psychiatrist Abraham Myerson, who is one of

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Speaker 4: the first psychiatrists to widely use benzydream for a depressed

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Speaker 4: and antidonic patients in the nineteen twenties, his clinical area

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Speaker 4: of expertise was the sort of neurosis of what he

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Speaker 4: called the brain workers of the upper class. So I

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Speaker 4: think that there is, you know, a robust through line

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Speaker 4: of amphetamines being used for these emergent forms of work

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Speaker 4: in the US. That was great.

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Speaker 2: By the way, I never heard punding before you wrote

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Speaker 2: about it, but if you go to the Wikipedia page

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Speaker 2: for punding, there is a very cute photo of someone

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Speaker 2: who has lined up all of their rubber duckies. I

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Speaker 2: was just looking in sequence, so I guess that person,

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Speaker 2: you know, there you go, must have been very satisfying

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Speaker 2: for that person to arrange all of their toys.

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Speaker 4: If you think about the sort of phenomenological experience of

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Speaker 4: what it is like to be online on adderall or

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Speaker 4: to do research on at there is a sort of

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Speaker 4: punding like quality to always another real watch, always another

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Speaker 4: link to open right, and the sort of punding phenomenon

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Speaker 4: I think is definitely one way to describe the addictive

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Speaker 4: behavioral loops that are built into this sort of giant

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Speaker 4: casino called the Internet that we all live in now.

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Speaker 3: So this is one of the reasons we wanted to

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Speaker 3: talk to you specifically, because you do write about this

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Speaker 3: in your essay. This idea that, Okay, the medication is

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Speaker 3: now available and more people can access it, but at

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Speaker 3: the same time, there might be things actually going on

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Speaker 3: with our society, with our economy that make this medication

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Speaker 3: more desirable or more useful to people. This idea that

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Speaker 3: we're doing more repetitive tasks, that the amount of content

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Speaker 3: available to us is basically endless, and so if we

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Speaker 3: have a drug that makes it more even more enjoyable

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Speaker 3: to sift through all of it. It's sort of like

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Speaker 3: two self reinforcing things here.

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Speaker 4: Yeah, absolutely, And I mean I think I want to

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Speaker 4: duck out of coming down on the side of chicken

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Speaker 4: or egg here. Right, these things are co constitutive. But

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Speaker 4: the reason that I wrote the piece was that I

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Speaker 4: think that there has been a prevalence of a certain

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Speaker 4: kind of narrative about the relation between the so called

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Speaker 4: attention crisis, the Internet and aderall. And I think in

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Speaker 4: most of the commentary that I've read, even commentary that

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Speaker 4: has been very critical of the proliferation of telehealth startups

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Speaker 4: such as Cerebral or Done, and I'm sure we'll talk

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Speaker 4: about those in a little bit. Even in these critiques

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Speaker 4: of the overreaches of telepsychiatry and the sudden boom, the

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Speaker 4: latest boom in prescription for ADHD and add stimulant medication,

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Speaker 4: there's this idea that we are medicating an attention crisis

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Speaker 4: that is in fact caused by the prevalence of smartphones

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Speaker 4: in the Internet. So then the causal chain there would

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Speaker 4: be first you have the Internet, then you have the

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Speaker 4: attention crisis, and then we're medicating that attention crisis through adderall.

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Speaker 4: And I think that that's only one half of the story.

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Speaker 4: One of the arguments that I make in the piece

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Speaker 4: is that, in fact, if you look at the emergence

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Speaker 4: of let's say, millennial Internet culture, which is to say,

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Speaker 4: sort of smartphone CUSP internet culture, first of all, the

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Speaker 4: technical architecture of the Internet is overwhelmingly created by people

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Speaker 4: who are on stimulants. If you think about the extraordinary

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Speaker 4: prevalence of ADHD medication among coders, you could hardly imagine

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Speaker 4: a job that lends itself better to the sort of

432
00:24:36,400 --> 00:24:39,720
Speaker 4: jacking up of reward systems that amfetines produced than the

433
00:24:39,760 --> 00:24:43,359
Speaker 4: extremely boring task of coding. Right. So there's that. And

434
00:24:43,400 --> 00:24:46,159
Speaker 4: then also if you kind of think about that moment

435
00:24:46,240 --> 00:24:49,200
Speaker 4: from let's say two thousand and five to twenty fifteen,

436
00:24:49,760 --> 00:24:53,080
Speaker 4: where you had the proliferation of things like alt lit,

437
00:24:53,280 --> 00:24:58,600
Speaker 4: tau l in, Ben Lerner, Jonathan Saffaran Foyer, Vice Pitchfork, right,

438
00:24:58,640 --> 00:25:01,600
Speaker 4: if you think about that sort of milange that was

439
00:25:01,920 --> 00:25:05,480
Speaker 4: that moment in the culture, I think that one of

440
00:25:05,520 --> 00:25:10,960
Speaker 4: the defining features of that zeitgeist was the prevalence of

441
00:25:11,000 --> 00:25:13,640
Speaker 4: adderall and the prevalence of millennials who had either been

442
00:25:13,640 --> 00:25:17,080
Speaker 4: put on adderall as children, overwhelming the upper middle class

443
00:25:17,160 --> 00:25:19,720
Speaker 4: ensured children who then go on to sort of set

444
00:25:19,800 --> 00:25:23,240
Speaker 4: the BPM of the culture in the zeitgeist, right or

445
00:25:23,400 --> 00:25:26,640
Speaker 4: the dissemination of adderall through elite college networks.

446
00:25:27,560 --> 00:25:30,280
Speaker 2: I want to get to the rise of telehealth and

447
00:25:30,320 --> 00:25:32,639
Speaker 2: the pandemic and how that sort of opened up the

448
00:25:32,640 --> 00:25:34,440
Speaker 2: door to many more people. But before we even get

449
00:25:34,440 --> 00:25:37,640
Speaker 2: to the sort of broader question, is it a phenomenon

450
00:25:37,720 --> 00:25:40,119
Speaker 2: when you looking at history, and it certainly sounds like

451
00:25:40,119 --> 00:25:44,280
Speaker 2: it where whether it's the government or regulators or the

452
00:25:44,320 --> 00:25:47,360
Speaker 2: medical profession, it sounds like these things go in waves,

453
00:25:47,440 --> 00:25:51,239
Speaker 2: and it's like there's a drug gets prescribed popularly. Then

454
00:25:51,280 --> 00:25:53,840
Speaker 2: there's a backlash and everyone gets concerned. Maybe we're part

455
00:25:53,840 --> 00:25:56,440
Speaker 2: of the backlash right now to adderall. Then everyone gets concerned.

456
00:25:56,600 --> 00:25:59,560
Speaker 2: Then it sort of attenuates for a while, and then

457
00:25:59,680 --> 00:26:01,919
Speaker 2: suddenly there's a new reason and then it picks back up.

458
00:26:02,200 --> 00:26:06,160
Speaker 2: Is that a general phenomenon in psychology?

459
00:26:07,359 --> 00:26:10,520
Speaker 4: Yeah, Well, you know, I think that I'm prone to

460
00:26:10,560 --> 00:26:13,760
Speaker 4: describe things as a dialectic in that sense, I would

461
00:26:13,800 --> 00:26:16,280
Speaker 4: say yes, But you can see this type of pattern

462
00:26:16,359 --> 00:26:20,439
Speaker 4: and a variety of psychiatric medications. For instance, if you

463
00:26:20,520 --> 00:26:27,639
Speaker 4: think about the emergence of antidepressants SSRIs, SNRIs like prozac, likexepro,

464
00:26:27,920 --> 00:26:30,960
Speaker 4: well beutrid and so on and so forth in the nineties,

465
00:26:31,040 --> 00:26:35,720
Speaker 4: there is a huge amount of optimism about the serotonin hypothesis,

466
00:26:35,760 --> 00:26:39,200
Speaker 4: that is that serious mood disorders like depression are caused

467
00:26:39,240 --> 00:26:42,199
Speaker 4: by a deficiency of serotonin in the brain. And this

468
00:26:42,400 --> 00:26:48,119
Speaker 4: is coterminous with very serious marketing campaigns by pharmaceutical companies

469
00:26:48,480 --> 00:26:52,960
Speaker 4: that include things like funding patients advocacy groups to sort

470
00:26:52,960 --> 00:26:56,840
Speaker 4: of demand recognition and access to these drugs. And then

471
00:26:56,880 --> 00:27:00,520
Speaker 4: you have this sort of decline in optimism around these

472
00:27:00,600 --> 00:27:03,960
Speaker 4: drugs that I would say dates roughly to twenty ten,

473
00:27:04,359 --> 00:27:08,240
Speaker 4: and the sort of fall in optimism because in fact,

474
00:27:08,600 --> 00:27:11,920
Speaker 4: most SSRIs and sent arized do not perform very much

475
00:27:11,960 --> 00:27:15,439
Speaker 4: better than placebos when looked at in aggregate, that is,

476
00:27:15,520 --> 00:27:17,800
Speaker 4: through meta analyzes, and so I do think that there

477
00:27:17,880 --> 00:27:20,720
Speaker 4: is a kind of push and pull here that is

478
00:27:20,800 --> 00:27:25,840
Speaker 4: maybe not so dissimilar to this general dynamic in psychiatric

479
00:27:25,880 --> 00:27:30,240
Speaker 4: medications more broadly. But what's interesting about amphetamines in particular

480
00:27:30,760 --> 00:27:33,480
Speaker 4: is that sort of the first wave of amphetamine use

481
00:27:34,040 --> 00:27:38,120
Speaker 4: really gets going during World War Two, when both Allied

482
00:27:38,200 --> 00:27:42,760
Speaker 4: and Axis powers are using amphetamines or in the case

483
00:27:42,800 --> 00:27:46,960
Speaker 4: of the Germans, just meth straight up to fuel wartime

484
00:27:47,359 --> 00:27:50,399
Speaker 4: activities and to quote unquote boost morale. But I mean,

485
00:27:50,480 --> 00:27:54,120
Speaker 4: there's a historian named Norman Ohler has laid out very capably.

486
00:27:54,160 --> 00:27:57,399
Speaker 4: I think the argument that, like for instance, Blitzkraig, cannot

487
00:27:57,440 --> 00:28:01,520
Speaker 4: be understood apart from the widespread use of by German troops.

488
00:28:01,640 --> 00:28:04,800
Speaker 4: So you have the sort of large, large spike in

489
00:28:04,920 --> 00:28:08,800
Speaker 4: population levels of usage around World War Two, that sort

490
00:28:08,800 --> 00:28:11,320
Speaker 4: of rises and rises and rises and rises. And then

491
00:28:11,760 --> 00:28:15,719
Speaker 4: with the sort of panic around overprescription among children in

492
00:28:15,760 --> 00:28:19,760
Speaker 4: the early nineteen seventies, I think that that backlash against

493
00:28:19,800 --> 00:28:23,120
Speaker 4: the sort of psychiatric medication being used on children has

494
00:28:23,160 --> 00:28:27,120
Speaker 4: to be understood in tandem with, for instance, youth counterculture,

495
00:28:27,560 --> 00:28:31,480
Speaker 4: with youth suspicion of the way that older generations were,

496
00:28:31,560 --> 00:28:34,639
Speaker 4: you know, doing things like suppressing student organizing. Right, the

497
00:28:35,080 --> 00:28:38,240
Speaker 4: youth culture comes to be this sort of anti establishment

498
00:28:38,760 --> 00:28:43,320
Speaker 4: suspicion of a variety of different systems, including electoral systems,

499
00:28:43,320 --> 00:28:47,160
Speaker 4: but also specifically the psychiatric system as an agent of control. Right,

500
00:28:47,200 --> 00:28:50,680
Speaker 4: So if you think about, for instance, Michelle Fucou, Thomas Zazz,

501
00:28:51,080 --> 00:28:53,680
Speaker 4: the wide spectrum of thinkers in the nineteen seventies who

502
00:28:53,720 --> 00:28:56,600
Speaker 4: were explicitly making the case that psychiatry was an agent

503
00:28:56,640 --> 00:29:02,480
Speaker 4: of social control. The backlash against emphetamines, particularly emphatamines, being

504
00:29:02,600 --> 00:29:06,680
Speaker 4: used to treat child behavioral disorders becomes a bit more legible,

505
00:29:07,120 --> 00:29:09,520
Speaker 4: and so then, of course, you know, in the nineteen eighties,

506
00:29:09,680 --> 00:29:13,000
Speaker 4: with the crackdown on emphetamines, this is one of the

507
00:29:13,000 --> 00:29:16,800
Speaker 4: conditions for the rise of cocaine usage, for instance. But

508
00:29:16,840 --> 00:29:19,000
Speaker 4: I think that there is this kind of push and pull,

509
00:29:19,360 --> 00:29:22,800
Speaker 4: a sort of dialectic, if you will, between the cultural

510
00:29:22,880 --> 00:29:25,800
Speaker 4: meanings of em fetamine, and we're now at a moment

511
00:29:25,880 --> 00:29:30,360
Speaker 4: where I think there's real tension between a narrative that says, oh, well,

512
00:29:30,480 --> 00:29:33,280
Speaker 4: when you look at the increase in prescriptions that have

513
00:29:33,400 --> 00:29:36,880
Speaker 4: been enabled by, for instance, the rise of telepsychiatry, most

514
00:29:36,880 --> 00:29:39,760
Speaker 4: of those prescriptions are going to women in their twenties

515
00:29:39,760 --> 00:29:42,840
Speaker 4: and thirties who may have been, you know, left out

516
00:29:42,920 --> 00:29:46,920
Speaker 4: of a sort of sexist division of prescribing, whereby their

517
00:29:46,960 --> 00:29:51,560
Speaker 4: ADHD was not recognized for gendered reasons. So on the

518
00:29:51,600 --> 00:29:54,800
Speaker 4: one hand, that would be good presumably right. And then

519
00:29:54,960 --> 00:29:57,920
Speaker 4: you know another line of critique that says that the

520
00:29:57,960 --> 00:30:03,360
Speaker 4: shocking and enormous rise in stimulant prescription, especially during the pandemic,

521
00:30:03,520 --> 00:30:06,520
Speaker 4: is maybe more profit driven and not so salutary. And

522
00:30:06,600 --> 00:30:09,080
Speaker 4: I think like that's the space in which this conversation

523
00:30:09,160 --> 00:30:23,920
Speaker 4: is unfolding today.

524
00:30:25,680 --> 00:30:31,960
Speaker 3: What actually drives the availability of adderall currently? Is it regulation?

525
00:30:32,240 --> 00:30:35,240
Speaker 3: And one thing I didn't realize before I started asking

526
00:30:35,280 --> 00:30:38,560
Speaker 3: around about this, but Adderall isn't licensed in the UK,

527
00:30:38,960 --> 00:30:41,080
Speaker 3: so I don't think you can get a prescription for

528
00:30:41,080 --> 00:30:44,360
Speaker 3: adderall over there. Is it the rise of prescriptions, the

529
00:30:44,440 --> 00:30:47,920
Speaker 3: increased use of telehealth which makes it maybe easier to

530
00:30:48,080 --> 00:30:51,800
Speaker 3: access this drug, or is it the companies themselves? I

531
00:30:51,840 --> 00:30:55,160
Speaker 3: mean this has been a talking point with the opioid epidemic,

532
00:30:55,240 --> 00:30:58,040
Speaker 3: this idea that there is a built in incentive for

533
00:30:58,200 --> 00:31:02,720
Speaker 3: a pharma company to want to demand for its own supply.

534
00:31:02,920 --> 00:31:06,360
Speaker 3: So what exactly is driving the availability here?

535
00:31:07,120 --> 00:31:09,240
Speaker 4: Yeah? Okay, So I think this is where maybe we

536
00:31:09,280 --> 00:31:14,320
Speaker 4: talk about what is specific about pandemic telepsychiatry to the

537
00:31:14,360 --> 00:31:17,440
Speaker 4: recent adderall boom. I think the first thing to be noted,

538
00:31:17,520 --> 00:31:20,920
Speaker 4: as you mentioned, is that this is a specifically US phenomenon.

539
00:31:21,000 --> 00:31:24,080
Speaker 4: And I think that, like for all of the activism,

540
00:31:24,080 --> 00:31:25,959
Speaker 4: and I'm sure, like you know, I'm going to get

541
00:31:26,000 --> 00:31:28,480
Speaker 4: a lot of angry emails after this podcast you always

542
00:31:28,520 --> 00:31:33,480
Speaker 4: get about I mean, honestly, don't email me, but you

543
00:31:33,520 --> 00:31:35,680
Speaker 4: know what I mean. I think that for all that

544
00:31:35,680 --> 00:31:38,960
Speaker 4: people want to really double down on the validity of

545
00:31:39,000 --> 00:31:43,240
Speaker 4: the ADD or ADHD diagnosis, there is, you know, significant

546
00:31:43,280 --> 00:31:46,479
Speaker 4: evidence that this is a culturally bound phenomenon just by

547
00:31:46,600 --> 00:31:50,400
Speaker 4: virtue of the fact that it is essentially a US

548
00:31:50,480 --> 00:31:52,840
Speaker 4: bounded phenomenon. I think that people should take that pretty

549
00:31:52,840 --> 00:31:56,160
Speaker 4: seriously when we think about what is driving the current

550
00:31:56,240 --> 00:31:59,680
Speaker 4: adderall shortage, which was announced by the FDA in October

551
00:31:59,680 --> 00:32:03,480
Speaker 4: of two. In twenty two, because of the classification of

552
00:32:03,600 --> 00:32:06,560
Speaker 4: m fatamines as a schedule to substance in the nineteen

553
00:32:06,600 --> 00:32:10,600
Speaker 4: seventy one order from Congress to the DEA. This means

554
00:32:10,600 --> 00:32:14,480
Speaker 4: that there are quotas that are established for how many

555
00:32:14,520 --> 00:32:17,959
Speaker 4: emphatamine salts can be produced and how those are distributed. Now,

556
00:32:18,000 --> 00:32:20,880
Speaker 4: there's been a lot of back and forth between pharmaceutical

557
00:32:20,920 --> 00:32:23,960
Speaker 4: companies and the DA sort of pointing fingers, and the

558
00:32:24,000 --> 00:32:26,800
Speaker 4: DEA says that in fact, what's going on is that

559
00:32:27,120 --> 00:32:32,600
Speaker 4: pharmaceutical manufacturers are not actually hitting their production quotas. Pharmaceutical

560
00:32:32,640 --> 00:32:35,760
Speaker 4: companies are striking back and saying no, in fact, the

561
00:32:35,800 --> 00:32:39,600
Speaker 4: production quotas on the amphetamine salts themselves are too low.

562
00:32:39,800 --> 00:32:42,240
Speaker 4: I don't actually know which one is true. It seems

563
00:32:42,280 --> 00:32:44,720
Speaker 4: pretty hard to figure out which one is true. But

564
00:32:44,800 --> 00:32:49,080
Speaker 4: when we look at the enormous recent spike, even between

565
00:32:49,320 --> 00:32:53,800
Speaker 4: twenty nineteen and twenty twenty two. In twenty nineteen, for instance,

566
00:32:53,880 --> 00:32:57,560
Speaker 4: there were sixty six point six million prescriptions for all

567
00:32:57,840 --> 00:33:02,480
Speaker 4: ADHD medications that includes things like vibance, concerta riddle and

568
00:33:02,520 --> 00:33:06,000
Speaker 4: so on, in forty five million for adderall alone, And

569
00:33:06,120 --> 00:33:09,000
Speaker 4: in the first two years of the pandemic there was

570
00:33:09,040 --> 00:33:12,920
Speaker 4: six million new prescriptions. So one of the narratives that

571
00:33:13,040 --> 00:33:18,080
Speaker 4: you'll hear a lot about this extraordinary rise in stimulant

572
00:33:18,160 --> 00:33:20,960
Speaker 4: prescriptions is that this is owing to the proliferation of

573
00:33:21,000 --> 00:33:25,600
Speaker 4: telepsychiatry companies like Cerebral Done and so on. And I

574
00:33:25,600 --> 00:33:29,160
Speaker 4: think this only gets a part of the story. During COVID,

575
00:33:29,360 --> 00:33:33,640
Speaker 4: the rule that mandated that Schedule two substances could not

576
00:33:33,800 --> 00:33:39,520
Speaker 4: be prescribed over telepsychiatry was lifted, which meant, especially that

577
00:33:39,560 --> 00:33:44,080
Speaker 4: people who had never had an ADHD medication prescription before

578
00:33:44,320 --> 00:33:47,800
Speaker 4: could suddenly get one. There's been a lot of fighting

579
00:33:47,880 --> 00:33:50,520
Speaker 4: over whether or not that rule will be extended, but

580
00:33:50,560 --> 00:33:53,760
Speaker 4: that's certainly a huge part of the proliferation of these

581
00:33:53,760 --> 00:33:57,640
Speaker 4: telepsychiatry prescription rates. But what's interesting is that a recent

582
00:33:57,680 --> 00:34:02,400
Speaker 4: study using CDC data know that the rise through tele

583
00:34:02,440 --> 00:34:08,520
Speaker 4: psychiatry of these prescriptions are specific to VC backed startups.

584
00:34:08,560 --> 00:34:12,080
Speaker 4: That is, if you were getting telepsychiatry through a sort

585
00:34:12,120 --> 00:34:16,080
Speaker 4: of established provider like let's say Kaiser or something who

586
00:34:16,160 --> 00:34:18,719
Speaker 4: had been doing tele psychiatry before, there was not a

587
00:34:18,800 --> 00:34:22,680
Speaker 4: huge increase in adderall prescriptions for those types of companies.

588
00:34:22,880 --> 00:34:25,640
Speaker 4: It was specifically the emergence of these new types of

589
00:34:25,640 --> 00:34:30,400
Speaker 4: companies like Cerebral and Done that were pushing this enormous

590
00:34:30,400 --> 00:34:32,880
Speaker 4: increase in diagnosis. And I think that part of this

591
00:34:33,000 --> 00:34:35,279
Speaker 4: is just a pretty open and shutcase of like a

592
00:34:35,360 --> 00:34:40,280
Speaker 4: company basing its profit model on slinging addictive medications into

593
00:34:40,280 --> 00:34:42,920
Speaker 4: this loophole that was created by the pandemic. The Wall

594
00:34:42,920 --> 00:34:47,000
Speaker 4: Street Journal has done a pretty magisterial and heroic reporting

595
00:34:47,080 --> 00:34:49,600
Speaker 4: job I think of documenting that. But one of the

596
00:34:49,640 --> 00:34:52,160
Speaker 4: interesting thing that comes out of that type of reporting

597
00:34:52,680 --> 00:34:56,239
Speaker 4: is that it's very difficult to get national data about

598
00:34:56,320 --> 00:35:00,799
Speaker 4: levels of prescribing because there is no rule MANDATEA that

599
00:35:01,080 --> 00:35:05,040
Speaker 4: the number of prescriptions for these stimulants be made publicly

600
00:35:05,080 --> 00:35:07,520
Speaker 4: available in any way. The CDC has to collect this

601
00:35:07,600 --> 00:35:10,959
Speaker 4: data by doing reviews of private insurance records, but those

602
00:35:11,040 --> 00:35:13,400
Speaker 4: tend to lag by about a year to two years.

603
00:35:13,400 --> 00:35:16,719
Speaker 4: And so when we all started seeing these advertisements for

604
00:35:16,800 --> 00:35:20,239
Speaker 4: cerebral which were all over TikTok, all over Instagram, that

605
00:35:20,280 --> 00:35:23,239
Speaker 4: were basically like do you want some adderall you can

606
00:35:23,280 --> 00:35:26,840
Speaker 4: basically have some, it was very hard for reporters to

607
00:35:26,880 --> 00:35:31,120
Speaker 4: sort of track the increase that was actually represented by

608
00:35:31,160 --> 00:35:34,279
Speaker 4: those prescribing numbers because they simply aren't federally available. I mean,

609
00:35:34,320 --> 00:35:37,439
Speaker 4: I think among the many arguments for a national health

610
00:35:37,480 --> 00:35:39,640
Speaker 4: insurance or Medicare for All as it's called in the

611
00:35:39,760 --> 00:35:43,279
Speaker 4: United States, is that it's very difficult to track the

612
00:35:43,440 --> 00:35:47,560
Speaker 4: number of controlled substance prescriptions in a way that sort

613
00:35:47,560 --> 00:35:50,400
Speaker 4: of stays ocurrant. You know, this is also relevant I

614
00:35:50,440 --> 00:35:53,239
Speaker 4: think too, for instance, the opiate crisis. But yes, I

615
00:35:53,280 --> 00:35:56,680
Speaker 4: think that when you look at this enormous increase in

616
00:35:56,840 --> 00:36:01,680
Speaker 4: telepsychiatry prescription, there's both this sort of que bono line

617
00:36:01,719 --> 00:36:03,520
Speaker 4: that you can take of, just like there was an

618
00:36:03,640 --> 00:36:06,240
Speaker 4: enormous amount of money to be made through these telepsychiatry

619
00:36:06,560 --> 00:36:11,600
Speaker 4: loopholes that allowed slinging these addictive substances into a pandemic.

620
00:36:12,000 --> 00:36:15,480
Speaker 4: And then simultaneously, I think there is the reality that

621
00:36:15,640 --> 00:36:19,719
Speaker 4: it was enormously difficult to pay attention to anything during

622
00:36:19,760 --> 00:36:22,520
Speaker 4: the pandemic, which contributed I think to many people feeling

623
00:36:22,600 --> 00:36:25,040
Speaker 4: that because it was difficult for them to pay attention

624
00:36:25,120 --> 00:36:27,640
Speaker 4: in zooms for ten hours or you know, or however

625
00:36:27,680 --> 00:36:29,640
Speaker 4: long it was, that they must have some sort of

626
00:36:29,640 --> 00:36:31,439
Speaker 4: attention deficit diagnosis.

627
00:36:31,719 --> 00:36:35,920
Speaker 2: I find that really fascinating this idea, especially that point

628
00:36:35,960 --> 00:36:39,960
Speaker 2: about the gap and the increase in prescriptions from the

629
00:36:40,000 --> 00:36:43,240
Speaker 2: sort of vcback startups which we know need growth, growth, growth,

630
00:36:43,600 --> 00:36:46,879
Speaker 2: versus the sort of legacy healthcare providers that had been

631
00:36:46,920 --> 00:36:51,000
Speaker 2: doing telemedicine for some time that didn't pick up. I

632
00:36:51,000 --> 00:36:53,560
Speaker 2: guess I should have just like done a test, But like,

633
00:36:53,600 --> 00:36:55,239
Speaker 2: what do you have to demonstrate to get at all?

634
00:36:55,280 --> 00:36:58,640
Speaker 2: Presumably you can't just click a button.

635
00:36:58,320 --> 00:36:59,520
Speaker 3: But how simple you can?

636
00:36:59,680 --> 00:37:00,400
Speaker 4: Is it? Like?

637
00:37:00,440 --> 00:37:02,960
Speaker 2: What is there some sort of basic test? And like

638
00:37:03,000 --> 00:37:06,160
Speaker 2: do different doctors, like do the ones who worked through

639
00:37:06,200 --> 00:37:13,360
Speaker 2: the legacy providers have a more perhaps stringent test or expectations,

640
00:37:13,440 --> 00:37:16,080
Speaker 2: like what do the various types of medical professionals want

641
00:37:16,080 --> 00:37:17,800
Speaker 2: to see before they'll write data prescription.

642
00:37:18,400 --> 00:37:20,960
Speaker 4: I mean, I think the most succinct answer to this

643
00:37:21,080 --> 00:37:25,840
Speaker 4: question is that it has been and remains essentially vibes based,

644
00:37:26,040 --> 00:37:30,160
Speaker 4: and the quality of that vibees based assessment basically depends

645
00:37:30,280 --> 00:37:33,640
Speaker 4: on the quality of the medical care that you're receiving.

646
00:37:34,120 --> 00:37:36,920
Speaker 4: I mean, I remember that when I was prescribed adderall

647
00:37:37,000 --> 00:37:39,239
Speaker 4: as an eight year old, I went to like a

648
00:37:39,320 --> 00:37:43,320
Speaker 4: child psychiatrist who played a board game with me called Stop,

649
00:37:43,400 --> 00:37:46,640
Speaker 4: Relax and Think loosely based off of shoots and ladders,

650
00:37:46,880 --> 00:37:48,319
Speaker 4: and at the end of that, I walked out with

651
00:37:48,320 --> 00:37:51,080
Speaker 4: an adderall prescription, Right, And so, like, the thing is,

652
00:37:51,320 --> 00:37:54,720
Speaker 4: there's not any sort of blood test or genetic test

653
00:37:55,239 --> 00:37:58,880
Speaker 4: or brain scan that you could take that would stitch

654
00:37:59,239 --> 00:38:04,280
Speaker 4: some sort of by physiological substrate to this disease entity,

655
00:38:04,280 --> 00:38:07,960
Speaker 4: and to say there's no one to one correspondence between

656
00:38:08,160 --> 00:38:10,480
Speaker 4: the disease entity and some sort of test that you

657
00:38:10,520 --> 00:38:13,359
Speaker 4: could take, because it's not actually clear out neurological level

658
00:38:13,800 --> 00:38:17,839
Speaker 4: what this disease entity quote unquote is and so in

659
00:38:17,840 --> 00:38:22,399
Speaker 4: that sense, assessment is bound to be essentially vibespace. Now,

660
00:38:22,680 --> 00:38:26,000
Speaker 4: you know, if you have a clinician who is behaving responsibly,

661
00:38:26,480 --> 00:38:29,480
Speaker 4: they will do a variety of tests and sort of

662
00:38:29,560 --> 00:38:32,480
Speaker 4: ask either the child or the parent, or in the

663
00:38:32,480 --> 00:38:36,640
Speaker 4: case of adult ADHD diagnosis, the patient themselves about their

664
00:38:36,640 --> 00:38:41,080
Speaker 4: functioning across a variety of domains, including focus on work organization,

665
00:38:41,719 --> 00:38:43,920
Speaker 4: ability to sit still for long periods of time, and

666
00:38:43,920 --> 00:38:46,560
Speaker 4: so on and so forth. But in reality, there is

667
00:38:46,680 --> 00:38:53,480
Speaker 4: not really a robust test that differentiates people who do

668
00:38:53,600 --> 00:38:56,680
Speaker 4: have add from people who don't, even in the best

669
00:38:56,840 --> 00:39:00,840
Speaker 4: of cases, even in the case of very high quality

670
00:39:00,880 --> 00:39:04,440
Speaker 4: in person pediatric or adult psychiatric care. Now, when it

671
00:39:04,480 --> 00:39:08,360
Speaker 4: comes to something like telepsychiatry startups like done in Cerebral,

672
00:39:08,480 --> 00:39:10,880
Speaker 4: I think that there's been a lot of reporting and

673
00:39:10,960 --> 00:39:15,320
Speaker 4: documentation now on the way that providers who were essentially

674
00:39:15,360 --> 00:39:19,799
Speaker 4: working in this sort of gig economy Uber for psychiatric

675
00:39:19,800 --> 00:39:24,880
Speaker 4: professionals type of platform were punished if they refused to

676
00:39:24,920 --> 00:39:29,160
Speaker 4: prescribe stimulants at Cerebral for a while, if you refuse

677
00:39:29,280 --> 00:39:31,920
Speaker 4: to prescribe a stimulant, you had to write up a

678
00:39:32,040 --> 00:39:35,520
Speaker 4: justification for why you were not doing that, you would

679
00:39:35,520 --> 00:39:39,680
Speaker 4: think that responsible medical practice would be the opposite. Cerebral

680
00:39:39,719 --> 00:39:43,480
Speaker 4: has since after this series of investigations that prompted a

681
00:39:43,560 --> 00:39:48,840
Speaker 4: DJ investigation, stopped prescribing schedule to substances through their platform.

682
00:39:49,200 --> 00:39:51,359
Speaker 4: But I think that regardless of whether or not they're

683
00:39:51,360 --> 00:39:54,359
Speaker 4: still slinging like adderall or concerto on there, I think

684
00:39:54,360 --> 00:39:57,880
Speaker 4: that it bears on, for instance, what kinds of assessments

685
00:39:57,920 --> 00:40:01,440
Speaker 4: are being used to prescribe for it antidepressants, which are

686
00:40:01,480 --> 00:40:05,080
Speaker 4: also serious, psychoactive medifications that can be very very difficult

687
00:40:05,480 --> 00:40:08,600
Speaker 4: to wean off of. But in short, answers to your question, no,

688
00:40:08,840 --> 00:40:15,239
Speaker 4: there's no specific diagnostic test that guarantees the appropriateness of

689
00:40:15,440 --> 00:40:17,240
Speaker 4: amphetamines for any given patient.

690
00:40:17,960 --> 00:40:20,040
Speaker 3: This is a very wide ranging question. But what are

691
00:40:20,080 --> 00:40:25,040
Speaker 3: the implications for society of this increased adderall use? And

692
00:40:25,160 --> 00:40:30,120
Speaker 3: obviously there's a physical impact of having a higher proportion

693
00:40:30,280 --> 00:40:35,680
Speaker 3: of the population dependent in varying degrees on a particular substance.

694
00:40:36,000 --> 00:40:39,040
Speaker 3: But also I kind of joked in the intro about

695
00:40:39,239 --> 00:40:43,000
Speaker 3: unfairness and competitive edges here and then Joe said that

696
00:40:43,040 --> 00:40:45,520
Speaker 3: it's not the Olympics, but of course life is competitive,

697
00:40:45,560 --> 00:40:49,040
Speaker 3: and it is in some degree a competition, and you

698
00:40:49,080 --> 00:40:52,520
Speaker 3: could make a serious argument that, like, some people have

699
00:40:52,719 --> 00:40:57,320
Speaker 3: access to a drug that increases their productivity and has

700
00:40:57,600 --> 00:41:02,080
Speaker 3: positive outcomes on their economic lives at the very least,

701
00:41:02,080 --> 00:41:06,040
Speaker 3: So you have people who have boosted their careers by

702
00:41:06,080 --> 00:41:08,279
Speaker 3: being on this particular drug. And maybe they got the

703
00:41:08,280 --> 00:41:11,800
Speaker 3: prescription when they were younger because their parents had money

704
00:41:11,880 --> 00:41:14,400
Speaker 3: and health insurance and were able to get it, or

705
00:41:14,480 --> 00:41:17,719
Speaker 3: maybe they had a network of friends who are on

706
00:41:17,880 --> 00:41:20,960
Speaker 3: the drug or have access to it. In another slightly

707
00:41:21,000 --> 00:41:23,640
Speaker 3: more dubious way, it does feel like there might be

708
00:41:23,680 --> 00:41:26,399
Speaker 3: some fairness questions tied to this.

709
00:41:27,360 --> 00:41:29,279
Speaker 4: Yeah, I think one of the first things to be

710
00:41:29,320 --> 00:41:32,279
Speaker 4: said about this is, like so many other things in

711
00:41:32,320 --> 00:41:36,160
Speaker 4: psychiatric treatment, there are a series of strange paradoxes that

712
00:41:36,640 --> 00:41:41,719
Speaker 4: define how amphetamine treatment have been used over the twentieth century. So,

713
00:41:41,880 --> 00:41:45,480
Speaker 4: for instance, one of the big pushes against the use

714
00:41:45,520 --> 00:41:48,440
Speaker 4: of Riddlin for children in the nineteen seventies came from

715
00:41:48,520 --> 00:41:52,839
Speaker 4: the Black Panthers, who saw that amphetamines and Riddlin were

716
00:41:52,880 --> 00:41:56,960
Speaker 4: being tested on children in residential care facilities, many of

717
00:41:57,000 --> 00:42:00,719
Speaker 4: whom were black, right, And so there was a sort

718
00:42:00,760 --> 00:42:06,719
Speaker 4: of lower class iffication of amphetamines in the nineteen seventies

719
00:42:06,840 --> 00:42:11,960
Speaker 4: because they were being tested on populations in juvenile detention centers,

720
00:42:12,200 --> 00:42:15,239
Speaker 4: residential care homes, so on and so forth. There's a

721
00:42:15,280 --> 00:42:18,960
Speaker 4: real switch in the nineties, right when suddenly attention deficit

722
00:42:19,000 --> 00:42:24,560
Speaker 4: disorders become kind of the explanation for why white, well ensured,

723
00:42:24,640 --> 00:42:26,879
Speaker 4: upper middle class children are not doing as well as

724
00:42:26,880 --> 00:42:29,080
Speaker 4: would be expected in class. And so I think I

725
00:42:29,160 --> 00:42:31,920
Speaker 4: say that to just sort of problematize some of the

726
00:42:32,000 --> 00:42:35,960
Speaker 4: narratives that like emfetamine usage, it has always been considered

727
00:42:36,000 --> 00:42:40,479
Speaker 4: an upper middle class competitive edge thing, and I think

728
00:42:40,680 --> 00:42:45,080
Speaker 4: in line with this, for instance, I don't think necessarily

729
00:42:45,160 --> 00:42:49,000
Speaker 4: that empfetamine use always gives someone a sort of performance

730
00:42:49,440 --> 00:42:52,480
Speaker 4: enhancing edge. One of the arguments that I make in

731
00:42:52,520 --> 00:42:55,440
Speaker 4: the Adderall essay that I wrote is that in fact

732
00:42:55,520 --> 00:42:59,960
Speaker 4: adderall makes you more susceptible to different types of digital

733
00:43:00,040 --> 00:43:04,960
Speaker 4: behavioral loops, these addictive digital behavioral loops like scrolling Twitter

734
00:43:05,080 --> 00:43:09,880
Speaker 4: infinitely or scrolling TikTok infinitely that sort of directly impact

735
00:43:09,960 --> 00:43:13,920
Speaker 4: one's ability to lead like a thoughtful, well informed life.

736
00:43:14,640 --> 00:43:15,160
Speaker 3: One of the.

737
00:43:15,719 --> 00:43:21,000
Speaker 4: Interesting responses to the club Med Adderall essay collection I

738
00:43:21,040 --> 00:43:22,880
Speaker 4: thought was that there was a lot of anger and

739
00:43:23,000 --> 00:43:27,040
Speaker 4: accusations that some of the arguments that the authors made

740
00:43:27,239 --> 00:43:31,960
Speaker 4: were prohibitionist in impulse, And I can see why that

741
00:43:32,000 --> 00:43:35,479
Speaker 4: would be a concern, but I think that it's misplaced, because,

742
00:43:35,520 --> 00:43:39,479
Speaker 4: in fact, if you think about the clinically documented fact

743
00:43:39,520 --> 00:43:41,880
Speaker 4: that there is really not that much of a difference

744
00:43:42,320 --> 00:43:46,120
Speaker 4: in effectivity for emphetamines between people who have been diagnosed

745
00:43:46,160 --> 00:43:49,319
Speaker 4: with attention deficit disorders and people who have not, then

746
00:43:49,360 --> 00:43:51,799
Speaker 4: in fact, the real prohibitionist impulse is to say that

747
00:43:51,880 --> 00:43:56,120
Speaker 4: because we have this real diagnostic clinical entity, which is

748
00:43:56,160 --> 00:43:58,759
Speaker 4: you know, in fact, like quite contested and not a

749
00:43:58,840 --> 00:44:02,520
Speaker 4: robust disease entity, all, because we have this robust disease entity,

750
00:44:02,800 --> 00:44:05,640
Speaker 4: we are the only ones who should have adderall. And

751
00:44:05,719 --> 00:44:08,080
Speaker 4: I think that there's this very serious conversation to be

752
00:44:08,120 --> 00:44:13,480
Speaker 4: had about equity and distribution and what prohibitionism actually means

753
00:44:14,040 --> 00:44:18,239
Speaker 4: in terms of the implications, however, for widespread amphetamine use.

754
00:44:18,800 --> 00:44:21,920
Speaker 4: I think that when we look at emerging forms and

755
00:44:22,040 --> 00:44:25,680
Speaker 4: organizations of work, which many theorists have described as sort

756
00:44:25,680 --> 00:44:29,200
Speaker 4: of just in time production flexible production, when you think

757
00:44:29,200 --> 00:44:33,239
Speaker 4: about the sort of increased stretching of the worker, the

758
00:44:33,320 --> 00:44:36,280
Speaker 4: need for different types of flexibility across time and space

759
00:44:36,360 --> 00:44:37,920
Speaker 4: and so on and so forth, and the sort of

760
00:44:38,280 --> 00:44:41,600
Speaker 4: ever increasing demands for a sort of infinitely flexible worker.

761
00:44:42,000 --> 00:44:43,759
Speaker 4: I think that it makes a lot of sense why

762
00:44:43,840 --> 00:44:47,760
Speaker 4: adderall or different types of amphetamines would be the drug

763
00:44:47,880 --> 00:44:49,239
Speaker 4: that facilitates that.

764
00:44:50,040 --> 00:44:51,200
Speaker 5: But I think that the.

765
00:44:51,200 --> 00:44:53,960
Speaker 4: Conversation that I hope to see emerged in the coming

766
00:44:54,080 --> 00:44:57,399
Speaker 4: years is one that's less focused on sort of who

767
00:44:57,480 --> 00:45:01,680
Speaker 4: legitimately has ADHD and who does, because in fact, these

768
00:45:01,680 --> 00:45:05,680
Speaker 4: and fetimins have remarkable advocacy for both groups that have

769
00:45:05,760 --> 00:45:08,520
Speaker 4: been diagnosed in groups that haven't, and more of a

770
00:45:08,560 --> 00:45:11,880
Speaker 4: turn towards thinking about what it is that adderall does

771
00:45:11,960 --> 00:45:14,879
Speaker 4: in terms of setting a sort of pace of freneticism

772
00:45:15,400 --> 00:45:20,880
Speaker 4: and susceptibility to different forms of behavioral addiction, particularly Internet

773
00:45:20,880 --> 00:45:24,000
Speaker 4: based behavioral addiction. And I guess my closing point here

774
00:45:24,000 --> 00:45:27,080
Speaker 4: would be that adderall cannot fix the sort of internetified

775
00:45:27,160 --> 00:45:31,240
Speaker 4: attention crisis because adderall hooks us deeper than ever into

776
00:45:31,440 --> 00:45:34,480
Speaker 4: the sort of structures of addiction that are the sand

777
00:45:34,520 --> 00:45:38,160
Speaker 4: Quanon of the Internet as a sort of giant casino

778
00:45:38,200 --> 00:45:38,920
Speaker 4: that we all live in.

779
00:45:39,480 --> 00:45:42,880
Speaker 2: Danielle, this was fascinating. We can probably talk for hours

780
00:45:43,040 --> 00:45:45,320
Speaker 2: on this subject. I just want to say I'm addicted

781
00:45:45,400 --> 00:45:49,399
Speaker 2: to Twitter and Instagram totally naturally, totally clean. But thank

782
00:45:49,480 --> 00:45:51,799
Speaker 2: you so much for coming on odd Lauds. There's a

783
00:45:51,800 --> 00:45:54,400
Speaker 2: great conversation and glad we finally got a chance.

784
00:45:54,239 --> 00:45:55,640
Speaker 4: To talk to Thank you so much.

785
00:45:55,680 --> 00:46:10,080
Speaker 5: This was really fun, Tracy.

786
00:46:10,239 --> 00:46:13,239
Speaker 2: I really enjoyed that conversation, and there were a number

787
00:46:13,239 --> 00:46:14,920
Speaker 2: of things that really are going to stick with me.

788
00:46:15,239 --> 00:46:17,839
Speaker 2: But you know, one thing that sort of I had

789
00:46:17,960 --> 00:46:21,320
Speaker 2: never really thought about before is the idea that sure

790
00:46:21,640 --> 00:46:24,200
Speaker 2: being on one of these drugs can sort of change

791
00:46:24,239 --> 00:46:27,359
Speaker 2: the way you consume information or perform tasks online, whether

792
00:46:27,400 --> 00:46:31,040
Speaker 2: productive or unproductive, but also the idea that the entire

793
00:46:31,120 --> 00:46:34,080
Speaker 2: online world was also built by the people on these drugs.

794
00:46:34,280 --> 00:46:37,319
Speaker 3: Yeah, it's sort of intertwined. Yeah, right. The other thing

795
00:46:37,320 --> 00:46:40,120
Speaker 3: that I thought was really interesting was Danielle's point about

796
00:46:40,120 --> 00:46:42,759
Speaker 3: the knowledge economy. And part of this is because I've

797
00:46:42,760 --> 00:46:46,000
Speaker 3: been reading Oh I'm going to have to Censor myself

798
00:46:46,160 --> 00:46:50,360
Speaker 3: BS Jobs by David Graber, and it's sort of like

799
00:46:50,400 --> 00:46:54,239
Speaker 3: a dystopian Studs tircle in the sense that it just

800
00:46:54,360 --> 00:46:58,200
Speaker 3: details how much dissatisfaction people seem to have with a

801
00:46:58,239 --> 00:47:01,120
Speaker 3: lot of modern day jobs where you feel like you're

802
00:47:01,160 --> 00:47:03,920
Speaker 3: not really doing anything. There's a lot of bureaucracy involved,

803
00:47:03,960 --> 00:47:07,360
Speaker 3: and yet you have to pay attention, per Danielle's points,

804
00:47:07,400 --> 00:47:09,440
Speaker 3: So I think there's an aspect of that in there.

805
00:47:09,760 --> 00:47:14,280
Speaker 3: The other thing that was very I guess attention grabbing

806
00:47:14,760 --> 00:47:18,400
Speaker 3: was the idea of no pun intended was the idea

807
00:47:18,480 --> 00:47:22,440
Speaker 3: of some of the venture capital backed health services writing

808
00:47:22,480 --> 00:47:25,799
Speaker 3: more prescriptions than perhaps some of the more traditional health

809
00:47:25,840 --> 00:47:26,640
Speaker 3: care providers.

810
00:47:27,000 --> 00:47:29,319
Speaker 2: That was totally eye opening for me, and I was,

811
00:47:29,520 --> 00:47:33,480
Speaker 2: you know, I'm aware of the proliferation of these telehealth companies.

812
00:47:33,920 --> 00:47:36,839
Speaker 2: As a mail in my mid forties, I constantly get

813
00:47:36,880 --> 00:47:39,040
Speaker 2: ads for you know, various pills that I can just

814
00:47:39,080 --> 00:47:41,200
Speaker 2: go on for like hair loss and things like that,

815
00:47:41,320 --> 00:47:44,360
Speaker 2: and so I see them targeted to me all the time.

816
00:47:44,719 --> 00:47:48,759
Speaker 2: But I hadn't realized the degree to which that specific

817
00:47:48,840 --> 00:47:54,160
Speaker 2: combination that Danielle described, which was the relaxation of prescription

818
00:47:54,400 --> 00:47:58,600
Speaker 2: drug obligations due to the pandemic and then the simultaneous

819
00:47:58,680 --> 00:48:03,320
Speaker 2: explosion of these news services, which it sounds like the

820
00:48:03,400 --> 00:48:05,320
Speaker 2: drugs are kind of being given out like candy.

821
00:48:05,600 --> 00:48:05,799
Speaker 4: Well.

822
00:48:05,880 --> 00:48:08,480
Speaker 3: The other thing that I think is something of a

823
00:48:08,600 --> 00:48:12,080
Speaker 3: tell is the fact that adderall is not licensed in

824
00:48:12,280 --> 00:48:15,480
Speaker 3: places like the UK. This seems in many respects to

825
00:48:15,560 --> 00:48:21,319
Speaker 3: be a sort of peculiarly or especially American phenomenon.

826
00:48:20,880 --> 00:48:22,560
Speaker 4: Which Tracy, Yes.

827
00:48:22,360 --> 00:48:23,879
Speaker 2: What do they do in the UK if they don't

828
00:48:23,920 --> 00:48:25,840
Speaker 2: get if they can't get ederall.

829
00:48:25,960 --> 00:48:28,279
Speaker 3: They get their energy. If you work in finance, you

830
00:48:28,320 --> 00:48:30,759
Speaker 3: get your energy the old fashioned way. I'm not gonna

831
00:48:30,800 --> 00:48:34,399
Speaker 3: say what that. I mean coffee of oh yes, uh no,

832
00:48:34,520 --> 00:48:37,440
Speaker 3: it's powdered coffee. Yeah, there we go. But I think

833
00:48:37,560 --> 00:48:40,799
Speaker 3: like it is suggestive as to what's going on here,

834
00:48:40,920 --> 00:48:44,160
Speaker 3: the fact that there might be something structural or specific

835
00:48:44,280 --> 00:48:46,920
Speaker 3: about the US economy or the healthcare system that seems

836
00:48:46,960 --> 00:48:48,200
Speaker 3: to be driving some of this.

837
00:48:48,600 --> 00:48:51,759
Speaker 2: Get two things on that. So Daniel made this point,

838
00:48:51,800 --> 00:48:55,080
Speaker 2: and I had realized this six months ago. I remember,

839
00:48:55,200 --> 00:48:58,080
Speaker 2: out of interest, trying to find some number about like

840
00:48:58,280 --> 00:49:00,840
Speaker 2: finding how much of a drug has been described, how

841
00:49:00,880 --> 00:49:03,960
Speaker 2: many doses prescribed? And you can't find it. And if

842
00:49:03,960 --> 00:49:07,200
Speaker 2: you look, the only entities that offer that data are

843
00:49:07,239 --> 00:49:09,520
Speaker 2: these like private for profit collectors, and you have to

844
00:49:09,520 --> 00:49:11,640
Speaker 2: pay like ten thousand dollars or whatever just for a

845
00:49:11,719 --> 00:49:14,520
Speaker 2: data set who try to aggregate, you know, how many

846
00:49:14,560 --> 00:49:18,239
Speaker 2: prescriptions of each and it's sort of this idea for

847
00:49:18,360 --> 00:49:21,160
Speaker 2: better or worse, and listeners can make up their mind.

848
00:49:21,440 --> 00:49:23,160
Speaker 2: But like, if you do have a sort of more

849
00:49:23,600 --> 00:49:29,120
Speaker 2: national healthcare system and there's only essentially one monopoly prescription writer,

850
00:49:29,239 --> 00:49:31,400
Speaker 2: whether it's the NHS or whatever it is they have

851
00:49:31,440 --> 00:49:33,879
Speaker 2: in Canada, then you know those numbers in real time

852
00:49:33,880 --> 00:49:35,680
Speaker 2: and you can say, oh my god, like these prescriptions

853
00:49:35,680 --> 00:49:36,560
Speaker 2: are totally exploding.

854
00:49:36,760 --> 00:49:39,200
Speaker 3: Yeah, that point by Danielle, the idea that maybe there

855
00:49:39,200 --> 00:49:42,840
Speaker 3: are data benefits to have a national healthcare service, that

856
00:49:42,960 --> 00:49:45,719
Speaker 3: was one I hadn't heard before. But it makes some

857
00:49:46,000 --> 00:49:48,200
Speaker 3: sense to have a sort of centralized body that is

858
00:49:48,239 --> 00:49:51,680
Speaker 3: actually writing these things, perhaps has a better outlook anyway,

859
00:49:51,800 --> 00:49:54,680
Speaker 3: fascinating conversation. You know it's going to be good when

860
00:49:54,760 --> 00:49:57,320
Speaker 3: you ask someone for context on this and they start

861
00:49:57,360 --> 00:49:59,799
Speaker 3: out with, you know, meth addiction in World War Two.

862
00:50:00,239 --> 00:50:03,080
Speaker 3: So I really enjoyed that conversation. I feel like I

863
00:50:03,160 --> 00:50:06,960
Speaker 3: have a better handle on a sort of cultural site

864
00:50:07,080 --> 00:50:09,800
Speaker 3: geist of the American economy. But wow, there are a

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00:50:09,840 --> 00:50:12,320
Speaker 3: lot of questions that come out of this conversation.

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Speaker 4: You know.

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Speaker 2: One other thing too about this sort of maybe the

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00:50:15,840 --> 00:50:19,520
Speaker 2: pathologies of the US healthcare system is I don't think

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00:50:19,600 --> 00:50:22,200
Speaker 2: that any of these drugs are as bad as like

870
00:50:22,520 --> 00:50:25,520
Speaker 2: addictive painkillers. But it is striking to me that we

871
00:50:25,880 --> 00:50:28,799
Speaker 2: did just have this like huge, sort of multi year

872
00:50:29,000 --> 00:50:34,240
Speaker 2: realization that the opioid sellers that it was riven with abuse,

873
00:50:34,400 --> 00:50:36,560
Speaker 2: a lot of the same things about like so called

874
00:50:36,680 --> 00:50:40,760
Speaker 2: like nonprofit patient advocacy groups trying to make these drugs

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00:50:40,800 --> 00:50:43,400
Speaker 2: more available and ease the regulations, and then we had

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00:50:43,400 --> 00:50:47,000
Speaker 2: this big sort of national reckoning with it various books

877
00:50:47,040 --> 00:50:50,480
Speaker 2: and documentaries. Is such a disaster, and then we just

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00:50:50,480 --> 00:50:52,560
Speaker 2: like move on to the next drug. And again I'm

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00:50:52,560 --> 00:50:55,600
Speaker 2: not saying it's necessarily comparable, but the speed with which

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00:50:55,640 --> 00:50:57,560
Speaker 2: we just sort of here's the new drug that we're

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00:50:57,560 --> 00:51:01,239
Speaker 2: going to commercialize and promote aggressively, it's like, didn't we

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00:51:01,360 --> 00:51:01,879
Speaker 2: just do this?

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00:51:02,280 --> 00:51:02,520
Speaker 5: Well?

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Speaker 3: Danielle made that point to the idea that like it

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00:51:05,200 --> 00:51:07,439
Speaker 3: kind of goes in cycles, all right, And it does

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00:51:07,520 --> 00:51:09,880
Speaker 3: feel like these things kind of come and go in

887
00:51:09,960 --> 00:51:13,760
Speaker 3: terms of popularity, in terms of commercialization, as you mentioned

888
00:51:14,000 --> 00:51:17,040
Speaker 3: it is. Yeah, you're right, it's nuts, but it seems

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00:51:17,080 --> 00:51:20,680
Speaker 3: like it is getting a little bit more attention nowadays.

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Speaker 3: We'll see what happens. We'll see shall we leave it there?

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Speaker 2: Let's leave it there.

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00:51:23,920 --> 00:51:26,640
Speaker 3: This has been another episode of the All Blots podcast.

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00:51:26,719 --> 00:51:29,680
Speaker 3: I'm Tracy Alloway. You can follow me at Tracy Alloway.

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00:51:29,800 --> 00:51:32,600
Speaker 2: And I'm Joe Wisenthal. You can follow me at the Stalwart.

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00:51:32,800 --> 00:51:37,480
Speaker 2: Follow our guest Danielle Carr, She's at Underscore Danielle Underscore Car.

896
00:51:37,719 --> 00:51:41,000
Speaker 2: Follow our producers Carmen Rodriguez at Carmen Arman, dash Ol

897
00:51:41,000 --> 00:51:44,440
Speaker 2: Bennett at Dashbot and Kilbrooks at Kilbrooks. Thank you to

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00:51:44,480 --> 00:51:47,600
Speaker 2: our producer Moses Ondam. For more Oddlots content, go to

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00:51:47,600 --> 00:51:50,200
Speaker 2: Bloomberg dot com slash odd Lots, where we have transcripts,

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00:51:50,239 --> 00:51:52,799
Speaker 2: a blog and the newsletter and you can chat about

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Speaker 2: all of these topics twenty four to seven in the

902
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Speaker 2: discord with fellow listeners Discord dodgg slash Oddlines.

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Speaker 3: And if you enjoy All Blots, if you like it

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Speaker 3: when we do healthcare or pharma themed episodes, then please

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Speaker 3: leave us a positive review on your favorite podcast platform.

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Speaker 3: Thanks for listening.