Speaker 1: Bloomberg Audio Studios, Podcasts, Radio News.
Speaker 2: Hello and welcome to another episode of The Odd Lots podcast.
Speaker 3: I'm Jolle Wisenthal and I'm Tracy Alloway.
Speaker 2: Tracy, I was gonna ask you a question, but I
Speaker 2: already know the answer to it. I was going to say, like, oh,
Speaker 2: have you ever tried adderall? But I already know you're not,
Speaker 2: so I don't want to like fake the intro whatever,
Speaker 2: but I'm just curious, like, what percentage of our colleagues
Speaker 2: do you think use some sort of stimulant adderall something,
Speaker 2: some sort of performance enhancing workplace.
Speaker 3: Drug like coffee, No, something a little stronger than college. Okay,
Speaker 3: We've had this conversation before, and I think it's such
Speaker 3: an interesting one because, as you know, I have never
Speaker 3: tried adderall. It is a complete cultural blind spot for me.
Speaker 3: But I am one hundred percent sure that you and I,
Speaker 3: in the context of this podcast and our day to
Speaker 3: day lives, have absolutely spoken to people who have been
Speaker 3: on adderall. In fact, a very famous one springs to
Speaker 3: mind right now. I don't know who you're talking about,
Speaker 3: SBF Sam been Free, There you go, there you go,
Speaker 3: but it is an interesting thought experiment. To think about
Speaker 3: the proportion of people around you, you know, sometimes highly
Speaker 3: productive people who may or may not be on adderall
Speaker 3: or something similar.
Speaker 2: So here's my thought, which is that, like, my big
Speaker 2: fear with adderall is like, I'm not maybe against trying
Speaker 2: it because I don't think I have the most focused
Speaker 2: brain in the world. In fact, I know I don't,
Speaker 2: and I get scartered. I'm worried that I would be
Speaker 2: really productive on it and then for the rest of
Speaker 2: my life be faced with this choice of do you
Speaker 2: want to stay on this drug forever or do you
Speaker 2: just want to go back to your old self knowing
Speaker 2: that you have this other potential state in you. Yes,
Speaker 2: that's my big fear.
Speaker 3: I feel the same way. I am deeply concerned that
Speaker 3: I would start writing a book and be successful at it. No,
Speaker 3: that's a joke, but I think, like to me, it
Speaker 3: opens up kind of interesting questions about fairness and access
Speaker 3: and if someone next to you is getting an edge
Speaker 3: because they either have a prescription that maybe they don't
Speaker 3: need or maybe they do need it, and we can
Speaker 3: get into the degree to which adderall actually is needed
Speaker 3: by the population, or they're accessing it illegally. In one
Speaker 3: way or another. It just opens up like interesting questions.
Speaker 3: But then again, I mean, the person next to you
Speaker 3: can drink ten cups of coffee and that's allowed, right,
Speaker 3: Like you're allowed to do that.
Speaker 2: Yeah, I mean, this is not the Olympics. We're trying
Speaker 2: to all maximize our performance here in the corporate world.
Speaker 2: So I first heard about adderall when I was in
Speaker 2: high school. I graduated in ninety eight, and I wasn't
Speaker 2: like a great student. I got bored a lot in class.
Speaker 2: I've just been scattered. I couldn't focus and such, And
Speaker 2: I feel like I was probably in a slightly different environment.
Speaker 2: Maybe if I had been born a couple of years younger,
Speaker 2: I might have been prescribed it. I think maybe not
Speaker 2: because my parents were hippies and so they didn't really
Speaker 2: believe probably and prescribing drugs for that sort of thing.
Speaker 2: But then you know, sort of this cultural thing. It's like, oh,
Speaker 2: they're giving all these boys.
Speaker 3: Yeah, predominantly boys. I think this is a big issue
Speaker 3: that a lot of women weren't diagnosed when they were young,
Speaker 3: and there are a lot of people right now in
Speaker 3: their thirties and forties who are getting late diagnoses because
Speaker 3: all the symptoms that people were looking out for, were,
Speaker 3: you know, hyperactive boys basically.
Speaker 2: Totally, and so it went from a hyperactive boys in
Speaker 2: high school thing, and then I sort of forgot about
Speaker 2: it for a while. Then I went to college and
Speaker 2: I found that to be a little easier, and then
Speaker 2: like I forgot all about adderall. And then over the
Speaker 2: last several years, what we've seen is prescriptions for adderall
Speaker 2: absolutely explode much more adult use, as you say, people
Speaker 2: finding out later in life that they're diagnosed with ADHD,
Speaker 2: which of course has also led to shortages, which have
Speaker 2: a variety of reasons, some relating to the DEA and manufacturing,
Speaker 2: some just related to the absolute booming in demand. And
Speaker 2: so adderall is just sort of an omnipresent topic of
Speaker 2: conversation and an angst in its owne right.
Speaker 3: Yes, And I am just going to emphasize this again
Speaker 3: cultural blind spot for me. So I'm very interested to
Speaker 3: hear how you know, how it works, what the impact
Speaker 3: might be, and what's driving the boom in usage as
Speaker 3: you mentioned.
Speaker 2: Well, I'm really excited to say we do, in fact
Speaker 2: have the perfect guest, someone I've wanted to talk to
Speaker 2: for a long time on the show. And you know
Speaker 2: someone who recently wrote about it, And so there was
Speaker 2: this great set of essays collected by pioneer works talking
Speaker 2: about the adderall phenomenon from various phenomenons.
Speaker 3: I read all of these in one sitting without the
Speaker 3: use of adderall. They're very, very good.
Speaker 2: They're very good. Everyone should read all of them. But
Speaker 2: I'm really excited. We're going to be talking to one
Speaker 2: of the contributors, Danielle Carr. She's an assistant professor at
Speaker 2: the Institute for Society and Genetics at UCLA, and she's
Speaker 2: a history storian of science and psychology. So hopefully we're
Speaker 2: going to understand how did we get to this point
Speaker 2: and what is widespread adderall consumption? How is it rewiring
Speaker 2: our brains or if not, society. So, Danielle, thank you
Speaker 2: so much for coming on odd lots.
Speaker 4: Thank you so much. It's wonderful to be here.
Speaker 2: Describe your work in general. You had a great New
Speaker 2: York Magazine cover story last year, But talk about like
Speaker 2: sort of your from an academic perspective, like what is
Speaker 2: your focus? How does adderall fit into your broader research
Speaker 2: and work over time?
Speaker 4: So I guess I should say that adderall and tension
Speaker 4: deficit diagnoses are not my specific realm of expertise. My
Speaker 4: dissertation work and now my first book is looking at
Speaker 4: the rise of neural implants a la Elon Musk's neuralink
Speaker 4: to treat psychiatric disorders such as anxiety depression PTSD and
Speaker 4: so on. But I guess more generally my line of
Speaker 4: work is looking at the political, economy and historical emergence
Speaker 4: of different types of experimental psychiatric treatments from the twentieth
Speaker 4: to the twenty four century.
Speaker 3: I have a really basic question to start out with,
Speaker 3: what happened to Riddlin? So no, but honestly, so if
Speaker 3: we had been having this discussion in like the nineteen
Speaker 3: nineties or the early two thousands, I don't think we'd
Speaker 3: be talking about adderall. We'd be talking about Riddlin.
Speaker 4: Yeah, I think that that's absolutely right. I mean, one
Speaker 4: of the interesting things to note about the sort of
Speaker 4: cluster of names for this behavioral disorder that is, you know,
Speaker 4: currently called ADD or ADHD, is that there have been
Speaker 4: since nineteen oh two about twenty different names for this
Speaker 4: kind of cluster of syndromes. And so Riddlin emerged as
Speaker 4: it's methyl fenidate rather than an amphetamine, so it's slightly
Speaker 4: different pharmacologically, And it was formulated in the mid nineteen
Speaker 4: fifties as what was hypothesized to be a less addictive
Speaker 4: alternative to amphetamines, which were at that time being used
Speaker 4: to treat children with what was being called hyperkinesis Concerta,
Speaker 4: by the way, is just methyal fenatic x are. But
Speaker 4: there was a period basically in the nineteen seventies when
Speaker 4: and I'm sure we'll get into this, there was a
Speaker 4: sort of widespread panic over the enormous prevalence of infitamines,
Speaker 4: especially to treat children, and riddlin was sort of preferred
Speaker 4: as an alternative that had fewer side effects allegedly and
Speaker 4: was less addictive allegedly, which accounts for the prevalence of
Speaker 4: Riddlin through the sort of mid nineties, at which point
Speaker 4: there's a switch when Shire Pharmaceuticals acquires Obatral, which is
Speaker 4: rebranded as Adderall, and that's really when the Adderall craze hits.
Speaker 5: Tracy.
Speaker 2: I'm glad you asked that, because I had forgotten all
Speaker 2: about Ridlin. But now that you say it, that's what
Speaker 2: people were talking. They weren't talking about adderall yet when
Speaker 2: I was in high school, but I was aware that
Speaker 2: this was the thing, and like CNN and stuff would
Speaker 2: talk about all these boys being described Ridlin. So I
Speaker 2: mentioned Danielle, I was in high school in the mid nineties.
Speaker 2: What was going on then that suddenly there seemed to
Speaker 2: be this, you know, the first wave, or maybe the
Speaker 2: way you describe it, the second wave of this phenomenon
Speaker 2: of let's get all the boys on Ridlin.
Speaker 5: Yeah.
Speaker 4: So I guess we can start the story in media
Speaker 4: res as it were in the mid nineties. But really
Speaker 4: the work of a historian named Nicholas Rusmussen has I
Speaker 4: think done a very magisterial job in showing that the
Speaker 4: twentieth century was defined in many ways by recurrent waves
Speaker 4: of infatimine use. The first wave really began with the
Speaker 4: rise of infetamine use during the Second World War, and
Speaker 4: we can talk about that if you guys would like.
Speaker 4: But by the mid nineties, one of the major things
Speaker 4: that had happened was a panic in the nineteen seventies,
Speaker 4: a sort of moral panic over the extraordinary prevalence of amphetamines,
Speaker 4: mostly dexidron and benzydrin, that were being prescribed without any
Speaker 4: sort of federal control. It was extraordinarily prevalent across the
Speaker 4: US population, and there really were not very many controls
Speaker 4: at all in terms of how doctors needed to report
Speaker 4: these prescriptions to any sort of federal data collection. And
Speaker 4: so in nineteen seventy one you had Congress tasked deda
Speaker 4: with reclassifying amphetamines as being a schedule to substance, that is,
Speaker 4: prescriptions needed to be reported to a central government administration,
Speaker 4: and there were limits and quotas placed on the quantities
Speaker 4: of mphetamines that could be manufactured and then distributed to
Speaker 4: pharmaceutical companies, and so used to have this sort of
Speaker 4: moral panic around that that actually led to a congressional
Speaker 4: investigation in nineteen seventy and there was this sort of
Speaker 4: broader crackdown both legally in the nineteen seventies and also
Speaker 4: culturally where you had like the sort of countercultural figures
Speaker 4: decrying speed freaks, which had also you know, there was
Speaker 4: this discourse in this narrative that for instance, like the
Speaker 4: heighth Atsbury sort of summer of love had been that
Speaker 4: had been destroyed by speed freaks and so on and
Speaker 4: so forth, and so in the nineteen seventies you have
Speaker 4: a movement away from amphetamines proper, which a creates the
Speaker 4: conditions for the rise of things like ritilin, which is
Speaker 4: a methyl feenadate, which is you know, it's pharmacologically quite similar,
Speaker 4: but it was not subject to exactly the same controls
Speaker 4: as emphetamines. And secondly, I think the thing, the very
Speaker 4: important thing that happens is that one of the few
Speaker 4: medical uses for which amphetamines are going into the late
Speaker 4: nineteen seventy is still allowed to be prescribed are child
Speaker 4: behavioral disorders. Now, prior to nineteen seventy and fetamines had
Speaker 4: been used off label for everything from weight loss to
Speaker 4: mood to just like a variety of off label prescriptions.
Speaker 4: But you have this sort of concentration after this crackdown
Speaker 4: by the DEA to focus amphetamine use medically specifically on
Speaker 4: this you know, small cluster of childhood behavioral disorders. This
Speaker 4: sets us up for, by the time we get to
Speaker 4: the nineteen nineties, the sort of growing market for childhood
Speaker 4: applications for m ffetamines. And I guess like the third
Speaker 4: intervening factor here would be that in nineteen teen eighty
Speaker 4: there was the third publication of the Diagnostic and statistical Manual,
Speaker 4: which is the DSM, which is widely described as psychiatry's
Speaker 4: diagnostic bible. This is essentially the list of diagnoses held
Speaker 4: to be medically viable that insurers will agree to cover,
Speaker 4: that clinical trials will investigate, and so on and so forth.
Speaker 4: And add attention deficit disorder is installed in that version
Speaker 4: of the DSM, and so I think this really sets
Speaker 4: the stage for the rise of ADD as a clinical
Speaker 4: diagnostic entity that receives a lot of research funding in
Speaker 4: the nineteen eighties, such that by the nineteen nineties, once
Speaker 4: adderall comes onto the market, the stage is set for
Speaker 4: a very wide sudden uptick in adderall prescriptions for children.
Speaker 3: So talk to us about what adderall actually does. And
Speaker 3: here I have to confess. In preparation for this conversation,
Speaker 3: I walked around Union Square in New York and ask
Speaker 3: people why they take adderall.
Speaker 4: No.
Speaker 3: I asked some people that I know about adderall, and
Speaker 3: someone explained it to me as this idea that if
Speaker 3: you do have ADHD, then you don't have the normal
Speaker 3: level of dopamine in your brain, or your brain handles
Speaker 3: it slightly differently, and so adderall basically helps to normalize
Speaker 3: dopamine and bring it closer to what a neurotypical person
Speaker 3: might have without medication. Could you maybe explain exactly what
Speaker 3: adderall is doing on someone's brain and the differences between
Speaker 3: someone who's maybe taking it to boost their productivity versus
Speaker 3: someone who's taking it because they have been diagnosed with
Speaker 3: ADHD or something else and they have an actual prescription
Speaker 3: from a doctor.
Speaker 5: Yeah.
Speaker 4: So I think the question of what adderall is and
Speaker 4: what it does neurologically is very connected to the very
Speaker 4: contested and open question of what ADD and ADHD are neurologically.
Speaker 4: So maybe I'll start with what is ADD what is ADHD. Now,
Speaker 4: what you have to understand is that with the emergence
Speaker 4: of the DSM three in nineteen eighty, this was a
Speaker 4: document that was created essentially to bring together a bunch
Speaker 4: of different stakeholders under a very large tent. These stakeholders
Speaker 4: included insurers, clinical researchers, formalcological companies of course, and of
Speaker 4: course patients and doctors. And the DSM describes clusters of symptoms,
Speaker 4: that is, syndromes that tend to occur together. So, for instance,
Speaker 4: here's a list of ten to twelve behavioral manifestations that
Speaker 4: tend to cluster together and we're going to call that depression,
Speaker 4: so on and so forth. But particularly in nineteen eighty,
Speaker 4: there was not a robust sense of what the neurological
Speaker 4: underpinning of each of these diagnoses were. These were descriptions
Speaker 4: behaviorally of how these syndromes manifest that were presumed to
Speaker 4: be disease entities. But I mean, if you ask anyone
Speaker 4: working at the cutting edge of sort of neurology psychiatry
Speaker 4: right now, they will tell you quite frankly, that there
Speaker 4: is no guarantee that any one case of let's say,
Speaker 4: depression or anxiety neurologically looks like any other case of
Speaker 4: depression or anxiety. That's because there are many different ways
Speaker 4: to have depressions. Some people might be crying a lot
Speaker 4: and not eating very much. Someone else might not be
Speaker 4: crying very much and eating a lot, for instance, right,
Speaker 4: and so there's no guarantee that each instance of the
Speaker 4: disease entity is going to have the same sort of
Speaker 4: biological underpinning behind it. Now, this works fine for things
Speaker 4: like insurance markets or billing insurers, or sort of getting
Speaker 4: medicine done in a sort of day to day sense,
Speaker 4: But once it comes to sort of extrapolating and understanding
Speaker 4: the neurological basis of diseases, the system does sort of
Speaker 4: fall apart. This is why increasingly clinical research is moving
Speaker 4: towards the ICD system rather than the DSM system. So
Speaker 4: this is neither here nor there, perhaps generally, but specifically
Speaker 4: when it comes to add and ADHD, I think it's
Speaker 4: very important to keep in mind that there is no
Speaker 4: widely accepted, beyond contestation understanding of what these disease entities
Speaker 4: actually are on a neurobiological basis. So there are theories
Speaker 4: that there's some sort of deficit in dopamine production or
Speaker 4: the rear partake of nopernepherin and dopamine. But I think
Speaker 4: it's important to keep in mind that these explanations they
Speaker 4: might be having prevalence now. But if you think about
Speaker 4: the rise of, for instance, the serotonin hypothesis when it
Speaker 4: comes to depression, the serotonin hypothesis dominated theories of depression
Speaker 4: for quite some time and then has been pretty roundly disproven.
Speaker 4: There is not a robust link between depression and serotonin deficits,
Speaker 4: and so I think that's one important thing to keep
Speaker 4: in mind, is that we don't necessarily have a robust
Speaker 4: and agreed upon understanding of what this disease entity quote
Speaker 4: unquote actually is. Now when it comes to what it
Speaker 4: is that stimulants actually do in the brain, the brain
Speaker 4: releases neurotransmitters that then sort of hang out in the
Speaker 4: space in the sort of synaptic space between the axon
Speaker 4: and the dendrite and then are reabsorbed. So neurotransmitters are
Speaker 4: things like, for instance, nopernethyrine, dopamine. Right there's these are
Speaker 4: things that your listeners probably have already heard of. Something
Speaker 4: like an amphetamine decreases the amount of those neurotransmitters that
Speaker 4: are re uptaken, meaning that the sort of synapse is
Speaker 4: bathed for a longer period of time by those chemicals.
Speaker 4: So that's how an amphetamine works, is that it really
Speaker 4: bathes the brain. In dopamine no reprodefron. Dopamine is sort
Speaker 4: of widely theorized or described as being a chemical that
Speaker 4: codes for expectation of reward. So one way that I
Speaker 4: like to explain this is that if you go to
Speaker 4: a gumball and you're expecting to get one gumball, but
Speaker 4: the machine gives you two for one quarter, you're going
Speaker 4: to have a huge dopamine spike because that reward is
Speaker 4: double what you were expecting. And when you think about
Speaker 4: the way that, for instance, addictive technologies like video gambling
Speaker 4: or social media work, they work by introducing variable rewards
Speaker 4: that hook into this very very motivating dopaminergic system in
Speaker 4: the brain. No Ropernaffron similarly controls the body's sort of
Speaker 4: readiness for fight or flight, and so it sort of
Speaker 4: generally increases a feeling of alertness and readiness. But this
Speaker 4: is why you know, it feels really really good to
Speaker 4: be on amphetamines, and it sort of increases this general
Speaker 4: sense of well being and alertness. And indeed, this is
Speaker 4: why you know in the early nineteen thirties, am fetamine
Speaker 4: was widely prescribed for antedonia or a lack of pleasure.
Speaker 4: In fact, historian Nicholas Rismusin has made the case convincingly.
Speaker 4: I think that empetamine was in fact the first antidepressant.
Speaker 4: But at a neurological level, that is essentially what amphetamines
Speaker 4: are doing. They also, because of their dopaminergic action, they
Speaker 4: increase the rewardingness of a task. It is a common
Speaker 4: talking point for sort of ADHD advocates that amphetamines only
Speaker 4: work if you indeed have add or ADHD, and unfortunately
Speaker 4: this is simply not true. Anyone who takes amphetamines has
Speaker 4: this burst in heart rate, burst in feelings of well being,
Speaker 4: burst in ability to concentrate. This has been documented clinically
Speaker 4: over and over again that there's not really a perceptible
Speaker 4: difference between people who have been diagnosed with add or
Speaker 4: ADHD and people who have not when they take these drugs.
Speaker 2: So someone like myself who sometimes worries that maybe I
Speaker 2: have another level of productivity above me, even I've never
Speaker 2: been diagnosed with anything, like, maybe that's true. So you know,
Speaker 2: I get like, as you say, okay, it makes internet
Speaker 2: gambling you could see or tweeting, tweeting, et cetera. But like,
Speaker 2: what is the theory by which like a bunch of
Speaker 2: people who have jobs where they have to make powerpoints
Speaker 2: about some m and a deal and they're all many
Speaker 2: of them apparently on adderall. Like for that person they
Speaker 2: have a job, they're in the office until eleven pm,
Speaker 2: they get one TYPEO wrong, they have to start it
Speaker 2: all over. What does ederall do for them in the
Speaker 2: sort of corporate context or the work context.
Speaker 4: So one of the things that I discussed in my
Speaker 4: essay was clinical literature around what psychiatrists call punding, which
Speaker 4: is repetitive behavioral loops that are often observed in patients
Speaker 4: that are taking drugs that bathe the brain in dopinergic chemicals.
Speaker 4: So punding was first described in the nineteen seventies by
Speaker 4: a psychiatrist who was observing the sort of repetitive behavioral
Speaker 4: loops like tweezing your eyebrows, or sorting and handling objects,
Speaker 4: or hunting for things or collecting things, so on and
Speaker 4: so forth in patients who are taking levadopa, which is
Speaker 4: a dopamine replacement that is used in patients with Parkinson's.
Speaker 4: And I think that this gives us a pretty interesting
Speaker 4: angle into what it is exactly that amphetamines do, which
Speaker 4: is to make these repetitive tasks much much more rewarding
Speaker 4: than they would otherwise be. And so, when you think
Speaker 4: about the forms of work that predominate in the so
Speaker 4: called knowledge economy, right where you're on a computer looking
Speaker 4: for things, searching for information, organizing information, so on and so forth.
Speaker 4: First of all, and amfetamine makes any task that you're
Speaker 4: engaged in much more rewarding because it's massively ramping up
Speaker 4: the dopamine signals in your brain that are telling you
Speaker 4: keep doing this. This thing that you're doing is better
Speaker 4: and better and better than you expected. But I think
Speaker 4: that what's interesting about the role of emphetamine specifically in
Speaker 4: sort of knowledge work is that it makes these repetitive
Speaker 4: tasks feel more like hunting and gathering. Right, It's more
Speaker 4: or it's a more exciting task to do these repetitive tasks.
Speaker 4: And this is not something that is specific to the
Speaker 4: nineteen nineties. When psychiatrist Abraham Myerson, who is one of
Speaker 4: the first psychiatrists to widely use benzydream for a depressed
Speaker 4: and antidonic patients in the nineteen twenties, his clinical area
Speaker 4: of expertise was the sort of neurosis of what he
Speaker 4: called the brain workers of the upper class. So I
Speaker 4: think that there is, you know, a robust through line
Speaker 4: of amphetamines being used for these emergent forms of work
Speaker 4: in the US. That was great.
Speaker 2: By the way, I never heard punding before you wrote
Speaker 2: about it, but if you go to the Wikipedia page
Speaker 2: for punding, there is a very cute photo of someone
Speaker 2: who has lined up all of their rubber duckies. I
Speaker 2: was just looking in sequence, so I guess that person,
Speaker 2: you know, there you go, must have been very satisfying
Speaker 2: for that person to arrange all of their toys.
Speaker 4: If you think about the sort of phenomenological experience of
Speaker 4: what it is like to be online on adderall or
Speaker 4: to do research on at there is a sort of
Speaker 4: punding like quality to always another real watch, always another
Speaker 4: link to open right, and the sort of punding phenomenon
Speaker 4: I think is definitely one way to describe the addictive
Speaker 4: behavioral loops that are built into this sort of giant
Speaker 4: casino called the Internet that we all live in now.
Speaker 3: So this is one of the reasons we wanted to
Speaker 3: talk to you specifically, because you do write about this
Speaker 3: in your essay. This idea that, Okay, the medication is
Speaker 3: now available and more people can access it, but at
Speaker 3: the same time, there might be things actually going on
Speaker 3: with our society, with our economy that make this medication
Speaker 3: more desirable or more useful to people. This idea that
Speaker 3: we're doing more repetitive tasks, that the amount of content
Speaker 3: available to us is basically endless, and so if we
Speaker 3: have a drug that makes it more even more enjoyable
Speaker 3: to sift through all of it. It's sort of like
Speaker 3: two self reinforcing things here.
Speaker 4: Yeah, absolutely, And I mean I think I want to
Speaker 4: duck out of coming down on the side of chicken
Speaker 4: or egg here. Right, these things are co constitutive. But
Speaker 4: the reason that I wrote the piece was that I
Speaker 4: think that there has been a prevalence of a certain
Speaker 4: kind of narrative about the relation between the so called
Speaker 4: attention crisis, the Internet and aderall. And I think in
Speaker 4: most of the commentary that I've read, even commentary that
Speaker 4: has been very critical of the proliferation of telehealth startups
Speaker 4: such as Cerebral or Done, and I'm sure we'll talk
Speaker 4: about those in a little bit. Even in these critiques
Speaker 4: of the overreaches of telepsychiatry and the sudden boom, the
Speaker 4: latest boom in prescription for ADHD and add stimulant medication,
Speaker 4: there's this idea that we are medicating an attention crisis
Speaker 4: that is in fact caused by the prevalence of smartphones
Speaker 4: in the Internet. So then the causal chain there would
Speaker 4: be first you have the Internet, then you have the
Speaker 4: attention crisis, and then we're medicating that attention crisis through adderall.
Speaker 4: And I think that that's only one half of the story.
Speaker 4: One of the arguments that I make in the piece
Speaker 4: is that, in fact, if you look at the emergence
Speaker 4: of let's say, millennial Internet culture, which is to say,
Speaker 4: sort of smartphone CUSP internet culture, first of all, the
Speaker 4: technical architecture of the Internet is overwhelmingly created by people
Speaker 4: who are on stimulants. If you think about the extraordinary
Speaker 4: prevalence of ADHD medication among coders, you could hardly imagine
Speaker 4: a job that lends itself better to the sort of
Speaker 4: jacking up of reward systems that amfetines produced than the
Speaker 4: extremely boring task of coding. Right. So there's that. And
Speaker 4: then also if you kind of think about that moment
Speaker 4: from let's say two thousand and five to twenty fifteen,
Speaker 4: where you had the proliferation of things like alt lit,
Speaker 4: tau l in, Ben Lerner, Jonathan Saffaran Foyer, Vice Pitchfork, right,
Speaker 4: if you think about that sort of milange that was
Speaker 4: that moment in the culture, I think that one of
Speaker 4: the defining features of that zeitgeist was the prevalence of
Speaker 4: adderall and the prevalence of millennials who had either been
Speaker 4: put on adderall as children, overwhelming the upper middle class
Speaker 4: ensured children who then go on to sort of set
Speaker 4: the BPM of the culture in the zeitgeist, right or
Speaker 4: the dissemination of adderall through elite college networks.
Speaker 2: I want to get to the rise of telehealth and
Speaker 2: the pandemic and how that sort of opened up the
Speaker 2: door to many more people. But before we even get
Speaker 2: to the sort of broader question, is it a phenomenon
Speaker 2: when you looking at history, and it certainly sounds like
Speaker 2: it where whether it's the government or regulators or the
Speaker 2: medical profession, it sounds like these things go in waves,
Speaker 2: and it's like there's a drug gets prescribed popularly. Then
Speaker 2: there's a backlash and everyone gets concerned. Maybe we're part
Speaker 2: of the backlash right now to adderall. Then everyone gets concerned.
Speaker 2: Then it sort of attenuates for a while, and then
Speaker 2: suddenly there's a new reason and then it picks back up.
Speaker 2: Is that a general phenomenon in psychology?
Speaker 4: Yeah, Well, you know, I think that I'm prone to
Speaker 4: describe things as a dialectic in that sense, I would
Speaker 4: say yes, But you can see this type of pattern
Speaker 4: and a variety of psychiatric medications. For instance, if you
Speaker 4: think about the emergence of antidepressants SSRIs, SNRIs like prozac, likexepro,
Speaker 4: well beutrid and so on and so forth in the nineties,
Speaker 4: there is a huge amount of optimism about the serotonin hypothesis,
Speaker 4: that is that serious mood disorders like depression are caused
Speaker 4: by a deficiency of serotonin in the brain. And this
Speaker 4: is coterminous with very serious marketing campaigns by pharmaceutical companies
Speaker 4: that include things like funding patients advocacy groups to sort
Speaker 4: of demand recognition and access to these drugs. And then
Speaker 4: you have this sort of decline in optimism around these
Speaker 4: drugs that I would say dates roughly to twenty ten,
Speaker 4: and the sort of fall in optimism because in fact,
Speaker 4: most SSRIs and sent arized do not perform very much
Speaker 4: better than placebos when looked at in aggregate, that is,
Speaker 4: through meta analyzes, and so I do think that there
Speaker 4: is a kind of push and pull here that is
Speaker 4: maybe not so dissimilar to this general dynamic in psychiatric
Speaker 4: medications more broadly. But what's interesting about amphetamines in particular
Speaker 4: is that sort of the first wave of amphetamine use
Speaker 4: really gets going during World War Two, when both Allied
Speaker 4: and Axis powers are using amphetamines or in the case
Speaker 4: of the Germans, just meth straight up to fuel wartime
Speaker 4: activities and to quote unquote boost morale. But I mean,
Speaker 4: there's a historian named Norman Ohler has laid out very capably.
Speaker 4: I think the argument that, like for instance, Blitzkraig, cannot
Speaker 4: be understood apart from the widespread use of by German troops.
Speaker 4: So you have the sort of large, large spike in
Speaker 4: population levels of usage around World War Two, that sort
Speaker 4: of rises and rises and rises and rises. And then
Speaker 4: with the sort of panic around overprescription among children in
Speaker 4: the early nineteen seventies, I think that that backlash against
Speaker 4: the sort of psychiatric medication being used on children has
Speaker 4: to be understood in tandem with, for instance, youth counterculture,
Speaker 4: with youth suspicion of the way that older generations were,
Speaker 4: you know, doing things like suppressing student organizing. Right, the
Speaker 4: youth culture comes to be this sort of anti establishment
Speaker 4: suspicion of a variety of different systems, including electoral systems,
Speaker 4: but also specifically the psychiatric system as an agent of control. Right,
Speaker 4: So if you think about, for instance, Michelle Fucou, Thomas Zazz,
Speaker 4: the wide spectrum of thinkers in the nineteen seventies who
Speaker 4: were explicitly making the case that psychiatry was an agent
Speaker 4: of social control. The backlash against emphetamines, particularly emphatamines, being
Speaker 4: used to treat child behavioral disorders becomes a bit more legible,
Speaker 4: and so then, of course, you know, in the nineteen eighties,
Speaker 4: with the crackdown on emphetamines, this is one of the
Speaker 4: conditions for the rise of cocaine usage, for instance. But
Speaker 4: I think that there is this kind of push and pull,
Speaker 4: a sort of dialectic, if you will, between the cultural
Speaker 4: meanings of em fetamine, and we're now at a moment
Speaker 4: where I think there's real tension between a narrative that says, oh, well,
Speaker 4: when you look at the increase in prescriptions that have
Speaker 4: been enabled by, for instance, the rise of telepsychiatry, most
Speaker 4: of those prescriptions are going to women in their twenties
Speaker 4: and thirties who may have been, you know, left out
Speaker 4: of a sort of sexist division of prescribing, whereby their
Speaker 4: ADHD was not recognized for gendered reasons. So on the
Speaker 4: one hand, that would be good presumably right. And then
Speaker 4: you know another line of critique that says that the
Speaker 4: shocking and enormous rise in stimulant prescription, especially during the pandemic,
Speaker 4: is maybe more profit driven and not so salutary. And
Speaker 4: I think like that's the space in which this conversation
Speaker 4: is unfolding today.
Speaker 3: What actually drives the availability of adderall currently? Is it regulation?
Speaker 3: And one thing I didn't realize before I started asking
Speaker 3: around about this, but Adderall isn't licensed in the UK,
Speaker 3: so I don't think you can get a prescription for
Speaker 3: adderall over there. Is it the rise of prescriptions, the
Speaker 3: increased use of telehealth which makes it maybe easier to
Speaker 3: access this drug, or is it the companies themselves? I
Speaker 3: mean this has been a talking point with the opioid epidemic,
Speaker 3: this idea that there is a built in incentive for
Speaker 3: a pharma company to want to demand for its own supply.
Speaker 3: So what exactly is driving the availability here?
Speaker 4: Yeah? Okay, So I think this is where maybe we
Speaker 4: talk about what is specific about pandemic telepsychiatry to the
Speaker 4: recent adderall boom. I think the first thing to be noted,
Speaker 4: as you mentioned, is that this is a specifically US phenomenon.
Speaker 4: And I think that, like for all of the activism,
Speaker 4: and I'm sure, like you know, I'm going to get
Speaker 4: a lot of angry emails after this podcast you always
Speaker 4: get about I mean, honestly, don't email me, but you
Speaker 4: know what I mean. I think that for all that
Speaker 4: people want to really double down on the validity of
Speaker 4: the ADD or ADHD diagnosis, there is, you know, significant
Speaker 4: evidence that this is a culturally bound phenomenon just by
Speaker 4: virtue of the fact that it is essentially a US
Speaker 4: bounded phenomenon. I think that people should take that pretty
Speaker 4: seriously when we think about what is driving the current
Speaker 4: adderall shortage, which was announced by the FDA in October
Speaker 4: of two. In twenty two, because of the classification of
Speaker 4: m fatamines as a schedule to substance in the nineteen
Speaker 4: seventy one order from Congress to the DEA. This means
Speaker 4: that there are quotas that are established for how many
Speaker 4: emphatamine salts can be produced and how those are distributed. Now,
Speaker 4: there's been a lot of back and forth between pharmaceutical
Speaker 4: companies and the DA sort of pointing fingers, and the
Speaker 4: DEA says that in fact, what's going on is that
Speaker 4: pharmaceutical manufacturers are not actually hitting their production quotas. Pharmaceutical
Speaker 4: companies are striking back and saying no, in fact, the
Speaker 4: production quotas on the amphetamine salts themselves are too low.
Speaker 4: I don't actually know which one is true. It seems
Speaker 4: pretty hard to figure out which one is true. But
Speaker 4: when we look at the enormous recent spike, even between
Speaker 4: twenty nineteen and twenty twenty two. In twenty nineteen, for instance,
Speaker 4: there were sixty six point six million prescriptions for all
Speaker 4: ADHD medications that includes things like vibance, concerta riddle and
Speaker 4: so on, in forty five million for adderall alone, And
Speaker 4: in the first two years of the pandemic there was
Speaker 4: six million new prescriptions. So one of the narratives that
Speaker 4: you'll hear a lot about this extraordinary rise in stimulant
Speaker 4: prescriptions is that this is owing to the proliferation of
Speaker 4: telepsychiatry companies like Cerebral Done and so on. And I
Speaker 4: think this only gets a part of the story. During COVID,
Speaker 4: the rule that mandated that Schedule two substances could not
Speaker 4: be prescribed over telepsychiatry was lifted, which meant, especially that
Speaker 4: people who had never had an ADHD medication prescription before
Speaker 4: could suddenly get one. There's been a lot of fighting
Speaker 4: over whether or not that rule will be extended, but
Speaker 4: that's certainly a huge part of the proliferation of these
Speaker 4: telepsychiatry prescription rates. But what's interesting is that a recent
Speaker 4: study using CDC data know that the rise through tele
Speaker 4: psychiatry of these prescriptions are specific to VC backed startups.
Speaker 4: That is, if you were getting telepsychiatry through a sort
Speaker 4: of established provider like let's say Kaiser or something who
Speaker 4: had been doing tele psychiatry before, there was not a
Speaker 4: huge increase in adderall prescriptions for those types of companies.
Speaker 4: It was specifically the emergence of these new types of
Speaker 4: companies like Cerebral and Done that were pushing this enormous
Speaker 4: increase in diagnosis. And I think that part of this
Speaker 4: is just a pretty open and shutcase of like a
Speaker 4: company basing its profit model on slinging addictive medications into
Speaker 4: this loophole that was created by the pandemic. The Wall
Speaker 4: Street Journal has done a pretty magisterial and heroic reporting
Speaker 4: job I think of documenting that. But one of the
Speaker 4: interesting thing that comes out of that type of reporting
Speaker 4: is that it's very difficult to get national data about
Speaker 4: levels of prescribing because there is no rule MANDATEA that
Speaker 4: the number of prescriptions for these stimulants be made publicly
Speaker 4: available in any way. The CDC has to collect this
Speaker 4: data by doing reviews of private insurance records, but those
Speaker 4: tend to lag by about a year to two years.
Speaker 4: And so when we all started seeing these advertisements for
Speaker 4: cerebral which were all over TikTok, all over Instagram, that
Speaker 4: were basically like do you want some adderall you can
Speaker 4: basically have some, it was very hard for reporters to
Speaker 4: sort of track the increase that was actually represented by
Speaker 4: those prescribing numbers because they simply aren't federally available. I mean,
Speaker 4: I think among the many arguments for a national health
Speaker 4: insurance or Medicare for All as it's called in the
Speaker 4: United States, is that it's very difficult to track the
Speaker 4: number of controlled substance prescriptions in a way that sort
Speaker 4: of stays ocurrant. You know, this is also relevant I
Speaker 4: think too, for instance, the opiate crisis. But yes, I
Speaker 4: think that when you look at this enormous increase in
Speaker 4: telepsychiatry prescription, there's both this sort of que bono line
Speaker 4: that you can take of, just like there was an
Speaker 4: enormous amount of money to be made through these telepsychiatry
Speaker 4: loopholes that allowed slinging these addictive substances into a pandemic.
Speaker 4: And then simultaneously, I think there is the reality that
Speaker 4: it was enormously difficult to pay attention to anything during
Speaker 4: the pandemic, which contributed I think to many people feeling
Speaker 4: that because it was difficult for them to pay attention
Speaker 4: in zooms for ten hours or you know, or however
Speaker 4: long it was, that they must have some sort of
Speaker 4: attention deficit diagnosis.
Speaker 2: I find that really fascinating this idea, especially that point
Speaker 2: about the gap and the increase in prescriptions from the
Speaker 2: sort of vcback startups which we know need growth, growth, growth,
Speaker 2: versus the sort of legacy healthcare providers that had been
Speaker 2: doing telemedicine for some time that didn't pick up. I
Speaker 2: guess I should have just like done a test, But like,
Speaker 2: what do you have to demonstrate to get at all?
Speaker 2: Presumably you can't just click a button.
Speaker 3: But how simple you can?
Speaker 4: Is it? Like?
Speaker 2: What is there some sort of basic test? And like
Speaker 2: do different doctors, like do the ones who worked through
Speaker 2: the legacy providers have a more perhaps stringent test or expectations,
Speaker 2: like what do the various types of medical professionals want
Speaker 2: to see before they'll write data prescription.
Speaker 4: I mean, I think the most succinct answer to this
Speaker 4: question is that it has been and remains essentially vibes based,
Speaker 4: and the quality of that vibees based assessment basically depends
Speaker 4: on the quality of the medical care that you're receiving.
Speaker 4: I mean, I remember that when I was prescribed adderall
Speaker 4: as an eight year old, I went to like a
Speaker 4: child psychiatrist who played a board game with me called Stop,
Speaker 4: Relax and Think loosely based off of shoots and ladders,
Speaker 4: and at the end of that, I walked out with
Speaker 4: an adderall prescription, Right, And so, like, the thing is,
Speaker 4: there's not any sort of blood test or genetic test
Speaker 4: or brain scan that you could take that would stitch
Speaker 4: some sort of by physiological substrate to this disease entity,
Speaker 4: and to say there's no one to one correspondence between
Speaker 4: the disease entity and some sort of test that you
Speaker 4: could take, because it's not actually clear out neurological level
Speaker 4: what this disease entity quote unquote is and so in
Speaker 4: that sense, assessment is bound to be essentially vibespace. Now,
Speaker 4: you know, if you have a clinician who is behaving responsibly,
Speaker 4: they will do a variety of tests and sort of
Speaker 4: ask either the child or the parent, or in the
Speaker 4: case of adult ADHD diagnosis, the patient themselves about their
Speaker 4: functioning across a variety of domains, including focus on work organization,
Speaker 4: ability to sit still for long periods of time, and
Speaker 4: so on and so forth. But in reality, there is
Speaker 4: not really a robust test that differentiates people who do
Speaker 4: have add from people who don't, even in the best
Speaker 4: of cases, even in the case of very high quality
Speaker 4: in person pediatric or adult psychiatric care. Now, when it
Speaker 4: comes to something like telepsychiatry startups like done in Cerebral,
Speaker 4: I think that there's been a lot of reporting and
Speaker 4: documentation now on the way that providers who were essentially
Speaker 4: working in this sort of gig economy Uber for psychiatric
Speaker 4: professionals type of platform were punished if they refused to
Speaker 4: prescribe stimulants at Cerebral for a while, if you refuse
Speaker 4: to prescribe a stimulant, you had to write up a
Speaker 4: justification for why you were not doing that, you would
Speaker 4: think that responsible medical practice would be the opposite. Cerebral
Speaker 4: has since after this series of investigations that prompted a
Speaker 4: DJ investigation, stopped prescribing schedule to substances through their platform.
Speaker 4: But I think that regardless of whether or not they're
Speaker 4: still slinging like adderall or concerto on there, I think
Speaker 4: that it bears on, for instance, what kinds of assessments
Speaker 4: are being used to prescribe for it antidepressants, which are
Speaker 4: also serious, psychoactive medifications that can be very very difficult
Speaker 4: to wean off of. But in short, answers to your question, no,
Speaker 4: there's no specific diagnostic test that guarantees the appropriateness of
Speaker 4: amphetamines for any given patient.
Speaker 3: This is a very wide ranging question. But what are
Speaker 3: the implications for society of this increased adderall use? And
Speaker 3: obviously there's a physical impact of having a higher proportion
Speaker 3: of the population dependent in varying degrees on a particular substance.
Speaker 3: But also I kind of joked in the intro about
Speaker 3: unfairness and competitive edges here and then Joe said that
Speaker 3: it's not the Olympics, but of course life is competitive,
Speaker 3: and it is in some degree a competition, and you
Speaker 3: could make a serious argument that, like, some people have
Speaker 3: access to a drug that increases their productivity and has
Speaker 3: positive outcomes on their economic lives at the very least,
Speaker 3: So you have people who have boosted their careers by
Speaker 3: being on this particular drug. And maybe they got the
Speaker 3: prescription when they were younger because their parents had money
Speaker 3: and health insurance and were able to get it, or
Speaker 3: maybe they had a network of friends who are on
Speaker 3: the drug or have access to it. In another slightly
Speaker 3: more dubious way, it does feel like there might be
Speaker 3: some fairness questions tied to this.
Speaker 4: Yeah, I think one of the first things to be
Speaker 4: said about this is, like so many other things in
Speaker 4: psychiatric treatment, there are a series of strange paradoxes that
Speaker 4: define how amphetamine treatment have been used over the twentieth century. So,
Speaker 4: for instance, one of the big pushes against the use
Speaker 4: of Riddlin for children in the nineteen seventies came from
Speaker 4: the Black Panthers, who saw that amphetamines and Riddlin were
Speaker 4: being tested on children in residential care facilities, many of
Speaker 4: whom were black, right, And so there was a sort
Speaker 4: of lower class iffication of amphetamines in the nineteen seventies
Speaker 4: because they were being tested on populations in juvenile detention centers,
Speaker 4: residential care homes, so on and so forth. There's a
Speaker 4: real switch in the nineties, right when suddenly attention deficit
Speaker 4: disorders become kind of the explanation for why white, well ensured,
Speaker 4: upper middle class children are not doing as well as
Speaker 4: would be expected in class. And so I think I
Speaker 4: say that to just sort of problematize some of the
Speaker 4: narratives that like emfetamine usage, it has always been considered
Speaker 4: an upper middle class competitive edge thing, and I think
Speaker 4: in line with this, for instance, I don't think necessarily
Speaker 4: that empfetamine use always gives someone a sort of performance
Speaker 4: enhancing edge. One of the arguments that I make in
Speaker 4: the Adderall essay that I wrote is that in fact
Speaker 4: adderall makes you more susceptible to different types of digital
Speaker 4: behavioral loops, these addictive digital behavioral loops like scrolling Twitter
Speaker 4: infinitely or scrolling TikTok infinitely that sort of directly impact
Speaker 4: one's ability to lead like a thoughtful, well informed life.
Speaker 3: One of the.
Speaker 4: Interesting responses to the club Med Adderall essay collection I
Speaker 4: thought was that there was a lot of anger and
Speaker 4: accusations that some of the arguments that the authors made
Speaker 4: were prohibitionist in impulse, And I can see why that
Speaker 4: would be a concern, but I think that it's misplaced, because,
Speaker 4: in fact, if you think about the clinically documented fact
Speaker 4: that there is really not that much of a difference
Speaker 4: in effectivity for emphetamines between people who have been diagnosed
Speaker 4: with attention deficit disorders and people who have not, then
Speaker 4: in fact, the real prohibitionist impulse is to say that
Speaker 4: because we have this real diagnostic clinical entity, which is
Speaker 4: you know, in fact, like quite contested and not a
Speaker 4: robust disease entity, all, because we have this robust disease entity,
Speaker 4: we are the only ones who should have adderall. And
Speaker 4: I think that there's this very serious conversation to be
Speaker 4: had about equity and distribution and what prohibitionism actually means
Speaker 4: in terms of the implications, however, for widespread amphetamine use.
Speaker 4: I think that when we look at emerging forms and
Speaker 4: organizations of work, which many theorists have described as sort
Speaker 4: of just in time production flexible production, when you think
Speaker 4: about the sort of increased stretching of the worker, the
Speaker 4: need for different types of flexibility across time and space
Speaker 4: and so on and so forth, and the sort of
Speaker 4: ever increasing demands for a sort of infinitely flexible worker.
Speaker 4: I think that it makes a lot of sense why
Speaker 4: adderall or different types of amphetamines would be the drug
Speaker 4: that facilitates that.
Speaker 5: But I think that the.
Speaker 4: Conversation that I hope to see emerged in the coming
Speaker 4: years is one that's less focused on sort of who
Speaker 4: legitimately has ADHD and who does, because in fact, these
Speaker 4: and fetimins have remarkable advocacy for both groups that have
Speaker 4: been diagnosed in groups that haven't, and more of a
Speaker 4: turn towards thinking about what it is that adderall does
Speaker 4: in terms of setting a sort of pace of freneticism
Speaker 4: and susceptibility to different forms of behavioral addiction, particularly Internet
Speaker 4: based behavioral addiction. And I guess my closing point here
Speaker 4: would be that adderall cannot fix the sort of internetified
Speaker 4: attention crisis because adderall hooks us deeper than ever into
Speaker 4: the sort of structures of addiction that are the sand
Speaker 4: Quanon of the Internet as a sort of giant casino
Speaker 4: that we all live in.
Speaker 2: Danielle, this was fascinating. We can probably talk for hours
Speaker 2: on this subject. I just want to say I'm addicted
Speaker 2: to Twitter and Instagram totally naturally, totally clean. But thank
Speaker 2: you so much for coming on odd Lauds. There's a
Speaker 2: great conversation and glad we finally got a chance.
Speaker 4: To talk to Thank you so much.
Speaker 5: This was really fun, Tracy.
Speaker 2: I really enjoyed that conversation, and there were a number
Speaker 2: of things that really are going to stick with me.
Speaker 2: But you know, one thing that sort of I had
Speaker 2: never really thought about before is the idea that sure
Speaker 2: being on one of these drugs can sort of change
Speaker 2: the way you consume information or perform tasks online, whether
Speaker 2: productive or unproductive, but also the idea that the entire
Speaker 2: online world was also built by the people on these drugs.
Speaker 3: Yeah, it's sort of intertwined. Yeah, right. The other thing
Speaker 3: that I thought was really interesting was Danielle's point about
Speaker 3: the knowledge economy. And part of this is because I've
Speaker 3: been reading Oh I'm going to have to Censor myself
Speaker 3: BS Jobs by David Graber, and it's sort of like
Speaker 3: a dystopian Studs tircle in the sense that it just
Speaker 3: details how much dissatisfaction people seem to have with a
Speaker 3: lot of modern day jobs where you feel like you're
Speaker 3: not really doing anything. There's a lot of bureaucracy involved,
Speaker 3: and yet you have to pay attention, per Danielle's points,
Speaker 3: So I think there's an aspect of that in there.
Speaker 3: The other thing that was very I guess attention grabbing
Speaker 3: was the idea of no pun intended was the idea
Speaker 3: of some of the venture capital backed health services writing
Speaker 3: more prescriptions than perhaps some of the more traditional health
Speaker 3: care providers.
Speaker 2: That was totally eye opening for me, and I was,
Speaker 2: you know, I'm aware of the proliferation of these telehealth companies.
Speaker 2: As a mail in my mid forties, I constantly get
Speaker 2: ads for you know, various pills that I can just
Speaker 2: go on for like hair loss and things like that,
Speaker 2: and so I see them targeted to me all the time.
Speaker 2: But I hadn't realized the degree to which that specific
Speaker 2: combination that Danielle described, which was the relaxation of prescription
Speaker 2: drug obligations due to the pandemic and then the simultaneous
Speaker 2: explosion of these news services, which it sounds like the
Speaker 2: drugs are kind of being given out like candy.
Speaker 4: Well.
Speaker 3: The other thing that I think is something of a
Speaker 3: tell is the fact that adderall is not licensed in
Speaker 3: places like the UK. This seems in many respects to
Speaker 3: be a sort of peculiarly or especially American phenomenon.
Speaker 4: Which Tracy, Yes.
Speaker 2: What do they do in the UK if they don't
Speaker 2: get if they can't get ederall.
Speaker 3: They get their energy. If you work in finance, you
Speaker 3: get your energy the old fashioned way. I'm not gonna
Speaker 3: say what that. I mean coffee of oh yes, uh no,
Speaker 3: it's powdered coffee. Yeah, there we go. But I think
Speaker 3: like it is suggestive as to what's going on here,
Speaker 3: the fact that there might be something structural or specific
Speaker 3: about the US economy or the healthcare system that seems
Speaker 3: to be driving some of this.
Speaker 2: Get two things on that. So Daniel made this point,
Speaker 2: and I had realized this six months ago. I remember,
Speaker 2: out of interest, trying to find some number about like
Speaker 2: finding how much of a drug has been described, how
Speaker 2: many doses prescribed? And you can't find it. And if
Speaker 2: you look, the only entities that offer that data are
Speaker 2: these like private for profit collectors, and you have to
Speaker 2: pay like ten thousand dollars or whatever just for a
Speaker 2: data set who try to aggregate, you know, how many
Speaker 2: prescriptions of each and it's sort of this idea for
Speaker 2: better or worse, and listeners can make up their mind.
Speaker 2: But like, if you do have a sort of more
Speaker 2: national healthcare system and there's only essentially one monopoly prescription writer,
Speaker 2: whether it's the NHS or whatever it is they have
Speaker 2: in Canada, then you know those numbers in real time
Speaker 2: and you can say, oh my god, like these prescriptions
Speaker 2: are totally exploding.
Speaker 3: Yeah, that point by Danielle, the idea that maybe there
Speaker 3: are data benefits to have a national healthcare service, that
Speaker 3: was one I hadn't heard before. But it makes some
Speaker 3: sense to have a sort of centralized body that is
Speaker 3: actually writing these things, perhaps has a better outlook anyway,
Speaker 3: fascinating conversation. You know it's going to be good when
Speaker 3: you ask someone for context on this and they start
Speaker 3: out with, you know, meth addiction in World War Two.
Speaker 3: So I really enjoyed that conversation. I feel like I
Speaker 3: have a better handle on a sort of cultural site
Speaker 3: geist of the American economy. But wow, there are a
Speaker 3: lot of questions that come out of this conversation.
Speaker 4: You know.
Speaker 2: One other thing too about this sort of maybe the
Speaker 2: pathologies of the US healthcare system is I don't think
Speaker 2: that any of these drugs are as bad as like
Speaker 2: addictive painkillers. But it is striking to me that we
Speaker 2: did just have this like huge, sort of multi year
Speaker 2: realization that the opioid sellers that it was riven with abuse,
Speaker 2: a lot of the same things about like so called
Speaker 2: like nonprofit patient advocacy groups trying to make these drugs
Speaker 2: more available and ease the regulations, and then we had
Speaker 2: this big sort of national reckoning with it various books
Speaker 2: and documentaries. Is such a disaster, and then we just
Speaker 2: like move on to the next drug. And again I'm
Speaker 2: not saying it's necessarily comparable, but the speed with which
Speaker 2: we just sort of here's the new drug that we're
Speaker 2: going to commercialize and promote aggressively, it's like, didn't we
Speaker 2: just do this?
Speaker 5: Well?
Speaker 3: Danielle made that point to the idea that like it
Speaker 3: kind of goes in cycles, all right, And it does
Speaker 3: feel like these things kind of come and go in
Speaker 3: terms of popularity, in terms of commercialization, as you mentioned
Speaker 3: it is. Yeah, you're right, it's nuts, but it seems
Speaker 3: like it is getting a little bit more attention nowadays.
Speaker 3: We'll see what happens. We'll see shall we leave it there?
Speaker 2: Let's leave it there.
Speaker 3: This has been another episode of the All Blots podcast.
Speaker 3: I'm Tracy Alloway. You can follow me at Tracy Alloway.
Speaker 2: And I'm Joe Wisenthal. You can follow me at the Stalwart.
Speaker 2: Follow our guest Danielle Carr, She's at Underscore Danielle Underscore Car.
Speaker 2: Follow our producers Carmen Rodriguez at Carmen Arman, dash Ol
Speaker 2: Bennett at Dashbot and Kilbrooks at Kilbrooks. Thank you to
Speaker 2: our producer Moses Ondam. For more Oddlots content, go to
Speaker 2: Bloomberg dot com slash odd Lots, where we have transcripts,
Speaker 2: a blog and the newsletter and you can chat about
Speaker 2: all of these topics twenty four to seven in the
Speaker 2: discord with fellow listeners Discord dodgg slash Oddlines.
Speaker 3: And if you enjoy All Blots, if you like it
Speaker 3: when we do healthcare or pharma themed episodes, then please
Speaker 3: leave us a positive review on your favorite podcast platform.
Speaker 3: And remember, if you're a Bloomberg subscriber, you can listen
Speaker 3: to all of our episodes absolutely ad free. All you
Speaker 3: need to do is connect your Bloomberg account with Apple Podcasts.
Speaker 3: Thanks for listening.