[TLDR: I paid $95 for a 10 minute video consultation with a doctor, told them I was depressed and wanted fluvoxamine, and got my prescription immediately.]

I’m not a doctor, and this isn’t medical advice. If you want information on the status of fluvoxamine as a Covid treatment, you can see the evidence base in the appendix, but interpreting those results isn’t my business.

I’m just here to tell you that if you want fluvoxamine, you can get it.

Years ago, some of my friends were into downloading apps that would get you a 10 minute consultation with a doctor in order to quickly acquire a prescription for medical marajuana. Today, similar apps exist for a wide range of medications, and with a bit of Googling, you can find one that will prescribe you fluvoxamine.

What’s required on your end? In my case, $95, 10 minutes of my time, and some white lies about my mental health. Fluvoxamine is only prescribed right now for depression and anxiety, so if you want it, my advice is to say that:

• You have an ongoing history of moderate depression and anxiety
• You have taken Fluvoxamine in the past, and it’s helped

And that’s basically it. Because there are many other treatments for depression, you do specifically have to ask for Fluvoxamine by name. If they try to give you something else, say that you’ve tried it before and didn’t like the side effects (weight gain, insomnia, headaches, whatever).

One more note, and this is critical: unless you are actually suicidal, do not tell your doctor that you have plans to commit suicide, to hurt yourself or others, or do anything that sounds like an immediate threat. This puts you at risk of being put involuntarily in an inpatient program, and you don’t want that.

Finally, you might ask: isn’t this super unethical? Aren’t you not supposed to lie to doctors to get drugs? Maybe, I don’t know, this isn’t medical advice, and it’s not really ethical advice either. I think the only real potential harms here are we consume so much fluvoxamine that there isn’t enough for depressed people, or that doctors start taking actual depressed patients who want fluvoxamine less seriously. As far as I can tell, there isn’t currently a shortage, as to the latter concern, I couldn’t really say.

Appendix

Again, this isn’t medical advice. You shouldn’t take any of these results or pieces of news coverage as evidence that fluvoxamine works and that the benefits outweigh the costs. I’m literally only adding this to cover my own ass and make the point that fluvoxamine is a normal mainstream thing and not some weird conspiracy drug.

Here’s the Lancet article, and the JAMA article.

Here’s Kelsey Piper at Vox:

One medication the TOGETHER trial found strong results for, fluvoxamine, is generally used as an antidepressant and to treat obsessive-compulsive disorder. But it appears to reduce the risk of needing hospitalization or medical observation for Covid-19 by about 30 percent, and by considerably more among those patients who stick with the 10-day course of medication. Unlike monoclonal antibodies, fluvoxamine can be taken as a pill at home — which has been an important priority for scientists researching treatments, because it means that patients can take their medication without needing to leave the home and without straining a hospital system that is expected to be overwhelmed.

“We would not expect it to be affected by which variants” a person is sick with, Angela Reiersen, a psychiatrist at Washington University in St. Louis whose research turned up fluvoxamine as a promising anti-Covid candidate, told me.

And here’s a Wall Street Journal article headlined “Is Fluvoxamine the Covid Drug We’ve Been Waiting For?” with subheading “A 10-day treatment costs only $4 and appears to greatly reduce symptoms, hospitalization and death.”:

A small randomized control trial last year by psychiatrists at the Washington University School of Medicine in St. Louis was a spectacular success: None of the 80 participants who started fluvoxamine within seven days of developing symptoms deteriorated. In the placebo group, six of the 72 patients got worse, and four were hospitalized. The results were published in November 2020 in the Journal of the American Medical Association and inspired a real-world experiment.

…The three fluvoxamine trials were conducted while different variants were circulating, so there’s no reason to think the drug wouldn’t work as well against Omicron

Here’s Scott Alexander:

It decreased COVID hospitalizations by about 30%… I and many others take Luvox pretty seriously. At this point I’d give it 60-40 it works.

Here’s Derek Lowe.

Here’s the Johns Hopkins guidlines which recommend fluvoxamine for “Ambulatory Patients Early in Disease at Risk of Developing Severe COVID-19”. It also notes that this might be a bad idea if you’re pregnant.

And that’s it. Again, not medical advice.

Since quitting my job to blog full time, I didn’t make a lot of money until recently. As of last month, some readers are paying me to advise/edit their new blog, and the Center for Effective Altruism is paying me to write the EA Newsletter.

So far, I’ve made $1890, with another $1200 due soon. Of the $3090 total, I’m donating $2800 to Slime Mold Time Mold to support their research agenda on the environmental contaminant theory of obesity.

I plan to continue donating 90% of my income to this research until either:
A) The authors are funded by a billionaire patron
B) The authors are funded by a grant endowed by a billionaire patron
C) The authors tell me they don’t need any more money

If you would like to join me, you can get in contact with me at applieddivinitystudies@gmail.com, with the authors directly at slimemoldtimemold@gmail.com, make a recurring donation on Patreon, or make a one time donation through Paypal.

Some of you might ask “why are you giving money to obesity research? Shouldn’t you be spending it on bednets or AI safety, or at least on Give Directly?”

First of all, I’m not giving my money to obesity research in the abstract, which I agree is quite low impact. I’m giving it to specific people (Slime Mold Time Mold) to pursue a specific research agenda (the contamination theory of obesity).

Second, though I’ve previously expressed some doubts about the impact of donations to EA causes already funded by large foundations, I agree that Give Directly is a pretty safe bet to achieve fairly massive impact at a very low cost. There are many very poor people, and transfering wealth to them (either through health interventions or direct giving) is still incredibly low hanging ethical fruit.

Having said all that, at this particular margin, I genuinely think that donating to Slime Mold Time Mold is more important. It’s not just the obesity research, it’s the opportunity to see a genuine scientific revolution play out in real time, and I would pay just about anything to get a front row seat.

[EDIT 01/18/2022] In an earlier version, I included my estimates that the SMTM theory is actually correct. I ommited them for brevity, but it has been recommended that I include them here. So okay:

In 2021, The NIH spent around $1.2 billion on obesity research, with another $280 million on childhood obesity research. By one esimates, the US spends $190 billion on obesity-related health care expenses. And that’s just direct financial costs! That’s not even indirect costs from lost life, or lost happiness or anything else.

So extrememy back of the napkin, the SMTM research is probably worth funding, compared to an NIH baseline, if it has something like a 0.1% chance of resulting in a breakthrough at a cost of under $10 million. Where “breakthrough” basically means that it becomes the dominant paradigm and enables future NIH spending to be much more effective.

Having said that, we should be cautious of pascalian arguments, and I would not fund SMTM if I thought they only had a 0.1% chance of success. My actual view is that the odds of their theory (or something close to it) being correct are around 10%. That’s not exceptionally high, but it’s 100x higher than it needs to be.

What about using Give Directly as a baseline and looking at QALYs instead of financial costs? This depends a lot on how much you think your donation counterfactually enables more research from SMTM. But okay, say 3 million people “die from obesity” each year, such that ending the obesity epidemic a year earlier is worth 3 million QALYs. It’s probably more because you don’t just buy an extra year, but let’s be conservative.

Off the top of my head, the minimal cost per life saved is ~$5000, which is supposed to be equivalent to 35 QALYs, so that’s $143/QALY. But I have some concerns about crowding out large donors, so say I donate to GiveDirectly instead, which is more like $1000/QALY.

So the opportunity cost of $100k is 100 QALYs. Which means to justify a donation of that size to SMTM, we would have to believe that they’ll accelerate the end of the obesity epidemic by… about 15 minutes.

Seriously, that’s how the math works out. It’s 3M QALYs per year, which is 8,200 QALYs per day, or 340 per hour, so 100 QALYs is about 15 minutes. Alternatively, you have to believe that there’s a 0.1% chance that the donation will accelerate the end by about two weeks.

Obviously this is all absurdly abstracted, and you should’t wake QALY estimates too literally and so on. I’m just saying, we should at least try to make up numbers, and when we do so, we get that my decision is not obviously wrong.

Last century, since the end of the Cold War, economic criteria have come to rule our day-to-day lives, and humanity, ruled by these criteria, has reached great heights. Now we have ended wars and poverty, and we have restored our planet’s ecology. The Earth has truly become a paradise. This has led us to put ever more trust in the efficiency of the economic principle. It has become paramount, permeating our very DNA. In every aspect and element, human society has become an economic society. Nothing that yields less than what is invested in it will ever even be considered. Developing the Moon makes no economic sense, and large-scale manned exploration of space would be considered an economic crime. And as for interstellar flight, that would be seen as outright psychotic. Now humanity knows only investment, production and reaping the fruits!

– Liu Cixin, Sun of China

The macro-history of Silicon Valley is that it used to be run by the military, then by hackers (nerds), then briefly by MBAs (or nerds who had read books by MBAs). And now it’s run not quite by financiers, but by these weird hybrid Finance Techies who both write code and read Matt Levine on weekends, then go into their day jobs as angel investors and crypto founders.

It’s easier to explain the shift through a Chapman-esque chart:

It’s easy to feel repulsed by this shift, but more important to understand it as a reflection of broader trends.[1] As Byrne Hobart’s one sentence horror story once put it: “your life is more financialized than you think”.

Financialization refers to a bunch of related, but essentially different phenomena:

1. A broad multi-century shift towards wealth as an indicator of success and driver of happiness, rather than God, or virtue or other forgotten values.

2. The sense of longing caused by the elimination of the gold standard, resulting simultaneously in A) Yearning for grounding, truth and reason (it’s not a coincidence that “post-modernism” really only took off after 1970) and B) The sense of limitless opportunity unhampered by physical reality.

3. Your weird cousin buying peak GME.

4. The many decade old American and now Chinese norm of coupling your choice of shelter to the largest financial decision you’ll ever make. (Byrne Hobart once wrote "Most consumers don’t think to themselves ‘I expect rates vol to rise in the future, so I’d better be long gamma right now.’ " He was right at the time, but he won’t be in 20 years.)

5. Growing inequality resulting in A) Wealth feeling more fake (“What does $200 billion even mean?”), B) Many Americans increasingly forced to think about money as a matter of survival, and C) The disconnect between the two mediated somewhat successfully by leftist politics, but still resulting in angst vacillating between “the economy is made up so it doesn’t matter” and “the economy is made up, so maybe I can meme myself into wealth” and subsequent rise of “scam culture” (see f.e.x. calling out Belle Delphine for selling bathwater while also celebrating her for securing the bag)

6. Crypto gains occurring nearly overnight, alienating the nouveau riche from their own wealth, while simultaneously generating FOMO of unprecedented scale.

7. All of this happening on the backdrop of several non-financial crises (climate change, covid, poverty) forcing A) The question of why financial growth feels decoupled from important measures of progress and wellbeing, B) Why we can’t just print our way out of these crises if money is fake anyway, and C) The perverse dynamic in which the perceived illegitimacy of finance-as-practice serves to draw more attention to finance-as-concept, bolstering it’s memetic strength (i.e. in an ironic twist, shouting “money is only real because everyone believes it’s real” feels less like the Wizard of Oz ending where the curtain is drawn back, and more like the end of Elf where Will Ferell explains that we need to believe in Santa’s magic in order to bootstrap the self-fulfilling prophecy of making him magic.)

It’s easy to feel repulsed by all of this. Meanwhile, the scant havens of non-financialized life are now seen as the glorious low hanging fruit of the “last unoptimized asset class”, with an increasingly fine line between democratizing something and financializing it (see Lambda School for education, Substack for writing, NFTs for art). [2]

But the optimistic version is that the financialization has been there for centuries, it just hasn’t been evident. And if so, “financialization” refers not to the actual encroachment of finance onto everyday lives, but only to our growing awareness of it. Is that good?

In other domains, Alvaro laments publicizing the replication crisis, and Eigenrobot claims “popular knowledge of quantitative argumentation was a mistake.”

But I say screw it: let the masses know what’s happening to them. Let them see the inner machinations of this strange and beautiful world. And if they choose to abuse their newfound knowledge then that’s fine too. We are no worse nor less powerful than Gods.

[1] If anything, tech has resisted financialization due to the nature of the industry:

• There are no calls or puts, no leverage, no complex financial instruments: all you can do is invest or not invest, you’re either in or out.
• Portfolio returns come almost entirely from one or two assets, diversification is an absurd anachronism.
• Outcomes are highly binary, it’s useless to talk about a particular year’s growth rate.
• There’s basically no debt, which some see as the foundation or at least origin of all trade.

[2] Ultimately, none of this is coincidental. It’s that democracy and finance really are intimately linked. Although it’s sometimes important to distinguish between the three meanings of “democratization” (1. Everyone has governance abilities over X, 2. Everyone can produce X, 3. Everyone can consume X) we have to recognize that in this case it doesn’t really matter. As mediated by markets, the ability to consume is identical to both governance and production. “You vote with your dollar”, and so too do you build.