Slate Star Codex is very nearly an anagram of the pseudonym chosen by its author, Scott Alexander, who is completing his training in psychiatric medicine somewhere in the United States — currently the Bay Area, I think. The medicine explains the pseudonym. If you are a doctor, you do not want to be caught writing about your patients anywhere except a learned journal. Alexander often writes directly about his work, taking care that individual patients cannot be identified; ideas drawn from medicine and psychology inform almost all of his posts.
With this as his hinterland, Scott Alexander writes brilliantly about everything, but especially, thanks to his combination of intelligence and professional experience, about pharmacology. Here are a few lines from an assessment of doctors’ habits when prescribing anti-depressants:
The average person who dies of Seroquel never knows they died of Seroquel, but the average person who dies from nefazodone is easily identified as a nefazodone-related death. The end result is this: When treatment with an SSRI fails, nefazodone and Seroquel naively seem to be equally good alternatives. Except nefazodone has a death rate of 1/300,000 patient years, and Seroquel 1/20,000 patient years. And yet everyone stays the hell away from the nefazodone because it’s known to be unsafe, and chooses the Seroquel. I conclude either doctors are terrible at thinking about risk, or else maybe a little too good at thinking about risk.
Other Less Wrong bloggers can seem to dismiss human fallibilities as arbitrary and therefore worthless. Alexander looks with curiosity on his own, and with sympathy on those of others — his disposition to theory is tempered by frequent contact with reality. Here he describes the process of beginning to understand a patient:
If someone said “I hate my husband so much,†my natural instinct might be to ask “Why?†But maybe why isn’t the question the patient cares about. Maybe what she really wants to talk about is how guilty she feels about hating their husband, and if I asked her why then we’d get on a tangent about what the husband is doing that never addresses her real problem. Maybe she’s agonizing every moment about whether or not to divorce him, and losing sleep over it, and coming to me for a sleeping pill. Maybe she’s just hatched a plan to kill him and wants to check it over with me to see if I can find any flaws. In any case I should probably figure out why they hate him eventually, but if their real issue is whether or not I approve of their murder plot then we should probably get to that first.
It is clear from this alone that Scott Alexander has the essential virtue that one seeks in any blogger: He is a gifted conversationalist.
Robert Cottrell is editor of The Browser, which recommends five or six pieces of exceptional writing available online each day. He was previously a staff writer for The Economist and the Financial Times.
