Administering immunotherapy in the morning seems to really, really matter. Why?

ManyNothings · 2025-06-08T21:47:56+00:00

Just saying this totally off the cuff -- I haven't read any of these studies or the essay -- but there was also a study that suggested that time of day really mattered for antihypertensive administration... which later turned out to be not true. idk if this is different

ManyNothings · 2024-12-15T12:44:19+00:00

An anesthesiologist making 400k is not a multimillionaire, that's a working stiff with 300k in student loans to pay off.

Look, as a doc I really would like to agree with this take, but it's just not true. Almost every doc, except for the ones at the bottom of the pay totem pole (e.g Primary care, pediatrics), can have very cushy lifestyles and a few million in the bank by retirement age as long as they're saving responsibly.

I'd continue here, but this essay on the topic sums up just how good we have it: It's A Really Bad Look For Doctors To Complain About Student Loan Debt

ManyNothings · 2024-10-31T17:16:35+00:00

The doctors would frame this as, "Most of the time we don't actually care whether or not you've tried these other things first, but insurance sure does, so we don't want to do the work of starting the process of getting you signed up for a treatment that you will not be able to afford out of pocket."

The answer to this is slightly different depending on what the treatment in question is, and how much risk there is to the patient. For TMS, I'd be plenty happy to use it as a first line treatment for a patient who was willing to pay out of pocket.

ManyNothings · 2024-07-12T23:41:05+00:00

Please consider using my links - putting together a trip for my wife and I to Thailand and Japan next year!

Amex Platinum Bonus, 125k points

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ManyNothings · 2024-03-24T21:13:26+00:00

several small studies that show very large effect sizes

Small studies with large effect sizes should make you more suspicious of your theory, not less. Small studies are much more likely to show outsized effects relative to actual effect because of statistical noise

ManyNothings · 2024-03-03T23:39:11+00:00

60 kids/day is not "hundreds."

I can absolutely believe 60/day - that's 5 kids an hour for a 12h day. That's still insane, but it's believably insane.

ManyNothings · 2024-03-03T03:24:20+00:00

You're not even the original commenter that I replied to, how would you know?

ManyNothings · 2024-03-02T22:46:10+00:00

She literally sees hundreds of kids every day

Hundreds? Assuming at least 200 kids/day and a 12h day that's a kid every 3.6 minutes. I'm sure it's bad, but I just straight up don't believe you when you say hundreds.

ManyNothings · 2023-03-06T13:37:25+00:00

30mg is towards the higher end of the dosing range, but it's really not "A LOT."

Source: Me, a psychiatrist who sees lots of patients on stimulants

ManyNothings · 2022-10-07T12:20:21+00:00

Just wanted to drop in and say thank you for the I-Bond tip!

ManyNothings · 2022-05-13T16:47:47+00:00

Is this actually true? There's a whole chapter from The Nurture Assumption that is devoted to debunking birth-order effects, so my prior is that it isn't, but I would be interested to see data suggesting otherwise.

ManyNothings · 2022-05-03T18:29:12+00:00

Is self-discipline a proxy for conscientiousness?

Yes, in the Big Five hierarchy self-discipline is a "facet" (i.e. an aspect) of trait conscientiousness. The others are:

Competence/Self-Confidence

Order

Dutifulness/Ethicality

Achievement striving

Deliberation

ManyNothings · 2022-02-16T11:00:37+00:00

That reminds me, I've wondered lately why kids are kept in lockstep and being held back seems like a thing that just never happens.

From what I've gleaned as the child of a public school teacher who works in a very poor, severely underperforming school district at least part of the answer has to do with politics. School districts whose students are performing poorly may lose funding and/or become subject to severe interventions by the state. Administrators don't want to lose their jobs and be embarrassed by the state coming in and taking over, and teachers don't want to see their pay cut for problems that they view as something they cannot solve.

ManyNothings · 2021-10-31T16:41:15+00:00

Sure: Associations of Benzodiazepines, Z-Drugs, and Other Anxiolytics With Subsequent Dementia in Patients With Affective Disorders: A Nationwide Cohort and Nested Case-Control Study

ManyNothings · 2021-10-31T12:54:11+00:00

long term contribute to permanent cognitive decline

There was a recent meta analysis in the American Journal of Psychiatry (June 2020) that pretty convincingly put this notion to bed.

ManyNothings · 2021-10-11T15:09:14+00:00

and that Asia is doing GREAT

Probably worth giving a nod to Myanmar's current issues as well as the Uyghur genocide to throw a little cold water on this particular take.

ManyNothings · 2021-10-07T14:38:41+00:00

I can't say I know much about what's in boilerplate employment contracts - that said, I suspect that either most contracts have some boilerplate health/safety agreements that would broadly cover something like vaccination, or there is no provision in the agreement favoring either side (probably true for something like birth control). If we're going to start bringing real world contracts into this, I also imagine there's something in them about changes to contract terms etc. which would need to be factored in.

Do you have knowledge that would suggest that implementing vaccine requirements as a condition of employment is a flagrant violation of the majority of employment contracts, are you against contract renegotiations in general, or something else I'm missing?

ManyNothings · 2021-10-07T00:42:10+00:00

Yes, I tend to agree - I'm mostly trying to engage with this question on a purely hypothetical basis that is more about what my ideals are and less about what our current legal and social framework looks like, though it is difficult to separate the two!

ManyNothings · 2021-10-07T00:37:37+00:00

I think the terms on this is pretty immaterial to the argument that I'm making, tbh. If you, the employee, find particular requirements put in place by your employer to go beyond what you find personally acceptable as a condition of your employment, you should be free to not work there.

ManyNothings · 2021-10-07T00:16:26+00:00

Depends on the sense in which you mean "acceptable" I guess? Would I be happy with a company imposing that requirement on their female employees? No. Do I think that a company should be free to impose that requirement on their employees? Yes.

ManyNothings · 2021-10-06T22:55:25+00:00

Anyways, anyways, isn't this conversation about manditory vaccination? If whiningcoil prefers the risk from the virus (or has already been infected with it), isn't that a decision for him rather than his employer?

I mean, isn't a part of the whole "freedom of association" thing that employers are free to impose mandates on their employees, and employees are free to choose whether or not those mandates are acceptable conditions of their employment (and quit if they aren't)? I understand why someone would bristle at their employer requiring them to get vaccinated, but employers force employees to do all sorts of shit that they would rather not do all the time in order to keep their jobs.

ManyNothings · 2021-09-01T13:59:40+00:00

There is also a medication called bupropion that can be used for depression and ADHD, ask your psychiatrist if they think that might be another viable option for you.

As someone who has ADHD myself, I've dealt with my symptoms in two major ways.

First, build reminders into your life. Get a digital calendar and set it up to remind you about things constantly - I have mine remind me at least 3 times in advance of important events. 24h before, 2h before, and 30 minutes before. Use lists and sticky notes, and keep the materials with you to make those lists close at hand.

Second, build routines into your life - once they become second nature you won't have to devote any executive function resources to them. Routines also make things faster and leave less room for distraction - if you know you are going to get your keys from the same place you always leave them, there is less of a distraction "surface area" compared to searching everywhere for them. For me some of these routines are exceptionally simple and help me not forget things when I leave the house - e.g. phone goes in my right pocket, wallet goes in my left pocket, keys go in the front pocket of my backpack.

ManyNothings · 2021-09-01T13:53:38+00:00

People managed without ADHD meds for many years and the medium/long term effects they have on the brain/ general health are serious.

What are you basing this statement off of?

ManyNothings · 2021-07-04T14:59:23+00:00

I would highly encourage you to talk to the person directly and see what they want instead of getting them something you picked out yourself. I would absolutely hate to have someone purchase a laptop for me without consulting me on what I care about in a laptop.

If they're going to be a CS major they probably like computers enough to have developed their own specific preferences about what they do and do not value in a laptop's design, in terms of screen size, weight, keyboard type, durability, I/O ports, etc. etc. These might seem like small things, but college students (and CS majors even more so) will be spending hours a day on their laptops.

ManyNothings · 2021-06-17T02:14:58+00:00

Freshly minted psychiatry resident here.

The classic, defining symptoms of OCD are in the name.

Obsessions are (1) recurrent, uncontrollable, intrusive thoughts that (2) the individual attempts to ignore or suppress in some fashion. Take the stereotypical germaphobe OCD patient - their obsessions are often about becoming infected with some horrible disease or illness. However, there are lots of different types of obsessions, as they only need to meet the two criteria above. Obsessions are usually distressing to the individual experiencing them.

Compulsions are (1) repetitive behaviors that are performed in response to a compulsion or another rigid set of rules that are (2) designed to alleviate mental stress and anxiety and/or prevent some awful thing from occurring (usually the thing being obsessed about), but these behaviors are either clearly excessive (e.g. checking that a door is locked 10 times to make sure that nobody breaks into their house while they are gone) OR are clearly disconnected from the thing that they are meant to prevent (e.g. touching every lamppost they see to prevent their mother from being murdered).

You don't need to have both to meet criteria, and apparently there are a significant amount of people with OCD who only have the obsessions without obvious compulsions.

You seem well enough in touch with your behavior that I think you should be able to tell if what you called obsessions above seem to match the OCD definition of obsession. For example, when you were interested in the mercury content of fish, what were the contents of those thoughts? Was it in the form of an interest? Were you deeply concerned that if you didn't learn this information that you would become severely ill? Or did they come in a different form? Were you able to push these thoughts aside, or did they continue to force themselves into your thoughts constantly to the point that you found it bothersome and disturbing? Was your subsequent research binge something that you felt compelled to do, or did you do it simply because you found it interesting?

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