edit: of course, maybe that means we need a meta-suite, that uses a different LLM to tell you which tests you should write yourself and which tests you can safely leave to LLM review.

The defendants rights were violated, but there is no doubt about the legitimacy of the data, and what it implies. Police now know they cannot use this method in the future, so suppressing the evidence in this particular case does not disincentivize anything, as long as its made clear that it cannot be done in the future.

I don't like the mechanism he chose to implement them, or the sharpness with which they were imposed, but I do think implementing actual proper reciprocal tariffs phased in over a reasonable period of time was a good idea. And I agree with you re: the service/goods issue. Them excluding services in their trade deficit calculation is by far the dumbest part of this plan.

I think it is true that most people don't understand the economic principles of tariffs, including most economists. But I do think the plan he's implemented largely comports with what he's consistently said he would do.

Even though his first pass crude approximation is stupid, it's really how other countries react, and how he reacts to them that will determine whether they behave like reciprocal tariffs or not.

There is a baked-in plan to test if they're going to work: they are formulaic, based on the trade deficit. Supposing that deficit falls, they will automaticlaly readjust downwards. I don't think the trade deficit (particularly restricted to goods, as they did it) is a good proxy for that, but it's also not completely untethered from reality.

Fwiw I'd prefer the republicans win again, so my optimism is actual (not that I don't have substantial criticisms of the current admin's policies). However, it is refreshing to have a content-focused exchange on the internet about politics, so h/t to you :)

I do think a lot of the details are bad. But Trump is not exactly a details guy. And while I think they could have been better (by a lot, fairly easily), I do think they are an accurate, if crude, representation of the policy vision Trump has been consistently articulating for decades (he's been talking about tariffs and trade deficits like this since the 90s).

However, as a political tactic, the sharp implementation gives them breathing room to re-calibrate before the midterms. That comes at a real GDP cost, though.

However, because they are doing it so early, they will have time to recalibrate and bake in exemptions until the market / inflation is happy. Up to and including backing off of the policy entirely, if that ends up being necessary. As a political strategy, it is perfectly timed to allow Trump to "save the economy" from his own policies. This is true imo independently of what you may think about the policy as policy.

When it comes to the policy as such, recipirocal tariffs, conceptually, are designed to incentivize the overall global reduction in tariffs. So, as a headline, implementing "reciprocal tariffs" is actually favorable to free trade. However, there are some important details that they have fucked up, such as identifying tariffs with trade deficits in general, and in particular identifying them with trade deficits in goods only. That is really the component of the policy that doesn't make sense, and it is important.

Most likely, they will recalibrate and/or provide a lot of exemptions, particularly as the midterms approach. As a political tactic, I think it will work out fairly well, if they respond to the feedback appropriately - that's the big question though, and that uncertainty is the most significant reason for the market drop.

Loans involve the calculation of parameters. You can either choose those implicitly through personal knowledge, or explicitly through a scalar metric (credit score). There is no viable third option, and the first option is just a bad version of the second, in the end.

This has changed over time. At first it was the pharmaceutical route, largely due to the shift in medical norms to prescribe opioids for chronic, not just acute, pain. Prescribing them for chronic pain is a near guaranteed recipe for addiction. However, I think things have changed in the past decade or so, with people largely moving straight to fentanyl and/or other illicit opioids. I don't think the pipeline is largely pharmaceutical in nature anymore.

Portugal is not the ringing endorsement that it is sometimes touted as. Some indicators have improved, some have worsened substantially:

https://en.wikipedia.org/wiki/Drug_policy_of_Portugal#Observ...

Causality is hard to tease out here, but more importantly, all they're doing is decriminalizing it and offering methadone/buprenorphine maintenance treatments. And the effect on number of addicts has not been good:

https://www.washingtonpost.com/world/2023/07/07/portugal-dru...

> Coca in Bolivia (I am on thin ice, I know too little, but they elected a coca grower as president)

Coca is really not anything. If you've ever chewed coca leaves, they're mildly stimulating. They're nothing like cocaine.

> I think there is plenty of evidence that a considered thoughtful approach to drugs is better

Considered, thoughtful approaches are always better! The question is, what are you considering and being thoughtful about. And the fact of the matter is that the most drug-liberal cities in the US have the worst drug problems, and so do the most drug liberal countries (like Portugal).

The countries that have the fewest problems with addiction are the harshest: Singapore, China, Japan. These things are not an accident. I'm not necessarily advocating adopting policies that harsh, just pointing out that they do actually work, whereas the liberal policies fail disastrously everywhere they're implemented. I'm in favor of criminalization, but only as a tool to force people into deferral/treatment programs. I don't want to see anyone actually put in jail for using drugs, unless they fail to complete their deferral program.

I'll quibble on two points. "used as a wedge issue by foreigners", while perhaps true in some moral sense, it does not really make much sense, on closer scrutiny. To reduce things down to being some foreign imposition is to suggest that it could have been any product. But it couldn't - only opium has the special properties necessary to become this kind of product. Nobody fought a war over tobacco, or even cocaine.

It is also true that Arabia, and even the ancient Greeks ('land of the lotus eaters') were aware of and could obtain Opium. However, I'd inquire as to how it is that the primary opium growing regions of Arabia are doing lately, or say, ever.

It is true that Opium has been available to varying degrees, at various times, in various places without a total social breakdown. However, widespread, sustained, cheap availability of pure Opium without total social breakdown is, as far as I know, unheard of. The over the counter stuff in Europe and the early US were mixed with other things, as in Laudanum. Almost all of high society at the time was addicted anyway, and this was the mild form.

The Chinese discovered that they could smoke it, and changing ROA from oral to smoking is a radical step change in addictiveness. I'm not entirely sure why this didn't catch on elsewhere at the time, but the fact of the matter is it didn't, and the difference between these things is a difference in kind, not degree.

> It is not a choice between continued sadism or free reign herion and cocaine dealing

I hope you're right! But I don't observe anything in the world that would support it, unfortunately. I quit because I was arrested, for instance. I want to be careful about causal meaning here, I didn't stay off because I was arrested, but it was the excipient that proximately caused and also facilitated it. It was a structural break that allowed other things to change around it.

That's not to say that the judicial system is a good way to deal with things - it's not. But the credible threat of the judicial system cannot really be done away with here without courting disaster. When dealing with highly physically addictive substances, shaping short term behavior by force is often a necessary ingredient in having any hope of shaping medium or long term behavior via therapy, life circumstance changes, or anything else.

Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.

> There is a large delta between the average response curve and an individual's response curve!

True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.

There are a lot of sources of variability, but variation does not actually make it very difficult to detect improper opioid prescribing behavior. Just like the variation in people's weights would not tell you much about the strength of asphalt roads. These things are not measured in the same scale.

The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.

This is mostly not a thing. I have known hundreds of current and former opioid addicts. I don't think I know a single one that was "on-ramped" from Vicodin or Percocet in any truly meaningful sense. It is the case that people almost always use these first. But it is relatively rare to become an opioid addict as the result of a one-off, acute vicodin prescription, per se.

> is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open.

I hope that is true! It doesn't seem like that to me, but I admit to not having carefully studied the data. Casually, there are 1.6 million opioid addictions currently in the US [1]. There were ~50,000 overdose deaths in 2019. That is, 1/1600 opioid addicts died in 2019 alone. To a first approximation, 0 people overdose annually from vicodin/percocet and other short term acute pain treatments.

It would be fairly surprising to me if (much) more than 1/1000 strong opioid users (per year) dies from an overdose. If the numbers were substantially higher than this, the epidemic would burn itself out in the population rather quickly. We can infer from this that most active opioid addicts are users of strong opioids, which are basically never prescribed for acute use. Hence, the overwhelming majority of current addicts are users of strong, non-acute opioids.

This doesn't mean there can't be some gateway effect (I do in fact think there is), but it does mean that "the problem" is mostly the presence of the strong opioids, not the Vicodin prescription for your wisdom teeth.

I'd be open to contrary data on the matter, though.

> The fact that medical boards allow these doctors to retain their licenses is the core of the issue

It is an issue, and we should absolutely try to improve it. It's just unlikely to materially dent the larger issue.

> I am only aware of a handful of the most obvious, blatant, and egregious pill mill operators being prosecuted. Regular doctors who simply cannot be fucked to care for their patients, and prescribe them pills so they leave their office, have yet to be held accountable.

I can personally attest to this being false. It was really quite annoying - I had to find new doctors on a number of occasions as a result, and that was ~15 years ago. Things have gotten much, much tighter on the pharmaceutical side since then. Every doctor who wrote me something was in prison or dead (from suicide, in prison) within 2-3 years of the last time I saw them, and I didn't even turn them in.

It is true that at any given time the Oxycontin prescriptions are power-law distributed, with most of the scripts being written by a small number of doctors. But this is a little bit like looking at the profits in the high frequency trading industry, or the cartels in Mexico (not to morally equate these things). Yes, there are a small number of them and they seem to make a lot of excess profits, but that does not mean you can knock them off and change anything. Nature abhors a vacuum, as they say.

1. https://www.hhs.gov/opioids/statistics/index.html

> Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely?

The simple answer is "less and with better monitoring". The first half of that was the equilibrium that Purdue intentionally shifted in the medical establishment. The cascading effects of that are what caused the modern day opioid crisis. Unfortunately, the modern-day opioid crisis as I understand it is mostly no longer related to pharmaceutical availability. So, while we should improve and lock down that supply chain route, unfortunately I don't expect it to make a large dent in the overall problem.

> Are there certain formulations that have been or should be removed from the market?

Take-home fentanyl is probably unnecessary, but again, I wouldn't really expect this to be a silver bullet. The DEA/FDA has gotten much tighter on their prescribing rules for powerful opioids, but their doing so has largely coincided with the expansion of the illegal heroin, and then fentanyl markets. It is now too late to fix by choking off supply, because the market has mostly moved outside of the regulatory regime (though we should still do that, to the extent we can).

> How do we reinstate the taboo on prescribing them?

These answers keep getting worse but we largely already have. We could probably do more, but if you are an MD and you are not "opioids are dangerous actually"-pilled, I think you need to go back to medical school. There was a short period in the mid 2000s where doctors were convinced otherwise by Purdue among others. Doctors who "think otherwise" today are almost without exception just outright criminals.

> For EG: I got a vasectomy recently and was told to expect a day or two of pain. I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. My understanding is that this is how people get introduced to opioids; the pathway goes "legal scrip -> addiction -> illegal supply -> fentanyl -> death" and that's the engine of the epidemic.

Overprescription like that (which that definitely is) is bad and unfortunately common. It's hard to say exactly how much addiction is caused by that variety, though. Most serious opioid addictions that I am aware of didn't get that way from a one time moderate overprescription of things like Vicodin or Percocet. It is possible to get "mildly" addicted from a month's supply of that and when you run out you might have a slightly unpleasant day or two, but not worse than that. If the illicit market wasn't there, that 30 day supply would be the end of any binge, and that would be "mostly fine", as such. That is not an endorsement or to say that it is at all a safe thing to do, but the risk comes primarily from not wanting to quit when you run out, and having other options available.

Two things changed with the introduction of Oxycontin:

1. It started being prescribed for chronic, not acute pain. This meant that people had permanent, ongoing prescriptions for them. Which meant that people built up a very large tolerance, which led to..

2. Oxycontin is pure oxycodone, it is not formulated with an NSAID (like Percocet is). The presence of an NSAID limits the amount you can take before you get sick, and prevents you from (straightforwardly) consuming it via non-oral routes of administration, which is exponentially more addictive.

> Should it be legal for the doctor to prescribe pain meds like this? (Or, should it be legal but discouraged? Is there a well-understood way to do this?) If it should be legal, should we expect the epidemic to continue? And if so, is post-bankruptcy Purdue a good thing or a bad thing?

Legal but discouraged, definitely. They are an important tool in the treatment of acute pain. They can, more rarely, be an important tool in the treatment of chronic pain (cancer / chemotherapy being a good example of a sufficiently serious condition). And finally, they are absolutely worthwhile for palliative care. For these reasons and what is now the magnitude of the illicit market, I don't think there is a lot of value in a total restriction.