[yayana]

> 4) I suspect depression is seriously underdiagnosed in med students and MORE students should be taking antidepressants than those currently on them.

I find that seriously messed up. Maybe it's not 75%, but let's assume an extra margin should be taking antidepressants to exist in the highly competitive med school environment. Further, let's assume that antidepressants progress and competitive programs keep raising the bar based on entrants and dropout rate..

Our public health goal seems to be to develop a society so stressful that psychiatric drugs are not for unbalance in the patient compared to a healthy control but to make unhealthy people that can survive hyper-competition and are maximally profitable for institutions.

[kendallpark]

I'm confused as to why blanket "antidepressants" are being treated as performance enhancing drugs in the same line as stimulants (as u/ravenstine has posited in a sibling comment). Med school is psychologically taxing which can cause or exacerbate depression. People that have clinical depression should get some sort of treatment for their depression.

Yes, I agree with you that the environment needs to be changed so that it is more hospitable from a mental health standpoint. But this doesn't change the fact that you have medical students right now that are not being treated for the clinical depression from which they are suffering.

One of the absolute issues with the statement "75% of med students are on antidepressants or stimulants" is that it conflates appropriate medication for diagnosed disorders with illegal misuse of Schedule II stimulants for competition. Your typical first-line antidepressants (eg, sertraline, escitalopram) aren't scheduled and are pretty easy to obtain via a PCP visit. They don't offer a "competitive advantage" unless people consider stuff like "being happy" or "not wanting to kill oneself" as an unfair competitive advantage in medical school.

> keep raising the bar based on entrants and dropout rate..

Dropout rates in med school are actually extremely low, at least in the US. Burnout rates as physicians, however...

[erikpukinskis]

You have to think about what's the system that will lead to the most economic growth.

If you have constant problems and no social support network, you need to spend your way out of all of those problems. That leads to people maxing out their credit, working as hard as possible for their employer, and being afraid to leave their jobs. Which equals mondo economic growth.

We used to have a society where people generally took care of each other and made a little money for specialty items as part of their career. Money was used to change your position, not to maintain it. The economy was much smaller then.

[ravenstine]

If med students ought to take antidepressants, then athletes ought to take anabolic steroids.

[derefr]

Doctors and athletes aren't quite comparable.

For doctors, brain drugs → knowledge → saving lives.

For athletes, body drugs → strength → showing off.

"Showing off" isn't really something we require much of in society, or see as a moral good (however entertaining we happen to find it when it is done well.) "Saving lives" is something we want to happen as much as possible, to the point that we might be willing to ask the people doing so to harm themselves a bit to get it done.

A better comparison to doctors might be, say, firefighters: body drugs → strength → saving lives.

Would it make sense for a firefighter to take anabolic steroids if it increased the maximum weight they could lift-and-carry out of a burning building? I don't know. I don't think there's an automatic answer to that.

[yayana]

Showing that you can maintain a stress state for school years doesn't really tell us whether you will retain any information after you are done or be a safe doctor by retirement age. I would guess today's doctors will have a much higher chance of dementia than equally educated but never sleep deprived peers.

Similarly, a firefighter who does steroids might be better until he dies of a heart attack at an inopportune time causing additional deaths. But the real risk as far as I am concerned is that if the steroids are allowed and the tests are standard, then his eventual choice is to take steroids or not be a firefighter. Play that out enough and you have a doped out society that is quantitatively better on what you choose to measure, but highly toxic, needing bail outs for long term side effects, and making short term labor discounts until you figure out where the no free lunch thereom has stashed the harm.

[mythas]

“Until you figure out where the no free lunch theorem has stashed the harm” is a saying I will be using for the rest of my days.

[FiveSquared25]

Or ham ;) “Until you figure out where the no free lunch theorem has stashed the ham.”

[wonderwonder]

Playing devil's advocate, if you believe that we are a capitalist society (not advocating for or against capitalism) and operating under an efficient market then society does in fact value professional athletes on an individual basis more than doctors as they are paid far more.

Also I would argue that professional athletes playing their chosen sport for the entertainment of those watching are doing far more than showing off, they are in fact paid employees of high revenue corporations.

With that said I don't think athletes should be using anabolics nor do I think doctors should be using anti depressants except under the recommendation of a neutral psychiatrist.

[derefr]

> society does in fact value professional athletes on an individual basis more than doctors as they are paid far more

Yes, we value professional athletes more as people. However, we value the work of doctors more. In fact, the doctors themselves value the work more. That's why—like firefighters, or rescue workers, or police, or soldiers—they're willing to "burn their lives" (or risk their lives) to get the job done.

Micro-econ 101 isn't enough to explain this effect. You need an understanding of the desirability of jobs (and preference-functions that go into making jobs desirable), and how people are willing to trade off capturing less value as pay, for satisfying more of their other preferences.

You're right that professional athletes are paid employees of high-revenue corporations. Which is to say: they're paid a lot because 1. the corporation is getting a lot of benefit from their work, but 2. the athlete themselves is not getting much terminal-preference-satisfaction from the job itself, and so the athlete demands high monetary compensation for the work. (Compare: coal miners, oil-rig workers, etc. These people have risky jobs that they don't have any intrinsic desire to do; they're highly paid jobs because nobody would do the job if they weren't.) In the case of professional athletes, it's not quite that nobody would do the job, but rather that nobody with as much skill would do the job—the talent pool as a whole is large, but the top of the talent pool (the people everyone wants to see, and so the only valuable people from advertisers' perspectives) is small enough to create a seller's market for that talent.

Doctors, meanwhile, want the job (saving lives) to get done more than anyone else. That's often a large part of why they became doctors—because their preference-function ranks "saving lives" quite highly, so they will enjoy a little "saving lives" more than a large amount of something else. Thus, even though we as a society also value saving lives, we don't have to compensate doctors as much as professional athletes for doing it.

[wonderwonder]

I hear what you are saying but I think your argument is flawed. Very few professions burn lives, physical and mental well being to the level that professional sports do. Athletes in the martial sports very much put their lives at risk, even at the amateur level for essentially nothing knowing that most of them will not make it. These athletes train and risk their well being from an early age for the chance to 'go pro'. Also judging from the number of athletes busted for using PED's they are more than willing to risk their future health for current rewards as they love what they do.

I would also argue that while doctors do indeed want to help people, most of them would not go into the profession unless they were well compensated.

But the number of professional athlete jobs are limited enough that the only the best need apply while there are far more roles for doctors so you get a variety of skill levels and the market prices them as such.

Don't get me wrong I would much rather my money go to educating doctors to the maximum of their ability rather than paying to watch sports. I just don't think the based on the way pro athletes are praised and viewed that society feels the same way. Doctors have unfortunately become a commodity in much the same way as the police and fire departments or sanitation. But doctors have the distinction of working in a very much for profit industry so they are paid more than police, firemen etc. Society does indeed value the role they as a profession play overall more than they do sports but not as individuals but as a service.

[derefr]

> These athletes train and risk their well being from an early age for the chance to 'go pro'.

My understanding is that there isn't much overlap between the sports with the most highly-paid athletes, and the sports with the highest risk to long-term health. Martial athletes, or even participants in full-contact sports like American Football or Rugby, aren't nearly as well-paid as participants in sports like basketball, baseball, or soccer. Heck, e-sports "athletes" are highly paid as well, and there is next to no long-term health risk in what they do.

I'm not sure why this is true, but I'll hypothesize anyway: corporations don't want to invest in athletes who can't retire to a life of being a charismatic PR mouthpiece for said corporation. If you get permanent brain damage, your value as a spokesperson goes way down. So corporations don't tend to be as interested in those sports—at least, from the POV of sponsoring the athletes.

There's probably an interesting curve you can compute by summing up the "athlete sponsorship expenses" for a given sport, and then dividing it by sum of the expenses of other market-interest-correlated activities that said corporations engage in, like franchise merchandizing or sports video-game production. I would bet that, the more risky a sport is, the less they spend on branding the athletes, in proportion to how much they spend on branding the teams, the country's league as a whole, or the sport itself.

And certainly, kids want to be athletes, regardless of the risk. I would argue that 1. many kids choose this path long before they can accurately weigh the risks and rewards of a career path, and then 2. they get stuck in it, because they (and their parents) have invested so much effort into cultivating their talent in the sport. (It's not simply loss aversion, but more like being 1% of the way into cornering the market on a lottery drawing by buying all the tickets. If you stopped there, you almost certainly wouldn't win, and would just lose all the money you put in; but if you continue, there's a clear point at which winning becomes increasingly probable, so as long as you can continue down that path, you feel incentivized to do so.)

This still means, though, that when you interview the average olympic athlete (the people who have "won" this competition) and ask them what they do for fun... they don't have much to say. They've put everything into this one bet; they have no other talents or hobbies or passions, because they never had time to cultivate them.

> Society does indeed value the role they as a profession play overall more than they do sports but not as individuals but as a service.

Yes, correct, that's closer to what I meant than what I said myself. :) Look at it like buying a smartphone: just because there's huge demand for the product, doesn't mean the average worker at a Foxconn factory is getting rich.

The middle-man—the hospital, in this case—is satisfying the societal demand, and therefore is "getting rich"; the doctors, meanwhile, only get rich to the degree that they manage to negotiate better pay from the hospital. That negotiation is sometimes explicit, but is frequently implicit, with a kind of collective bargaining going on just by social-status moves of doctors as a group causing the salary-level which no doctor with their "pride" would accept, to go up and down. (You can tell that this is happening because of the existence of "free clinics." Voluntary work is different-in-kind, so it frequently crops up in industries where the workers are too prideful to ever work "for cheap." Without this pride, you wouldn't see "free clinics", but rather budget clinics.)

[betenoire]

By that reasoning, then we should give police, soldiers, and firemen those steroids instead

[pesmhey]

To add to your devil’s advocate arguement:

Educated and physically capable men with some wealth typically became warriors in the past. They certainly didn’t become blacksmiths/builders/engineers/whatever. Maybe there’s something to be said for an entire industry and culture around letting this type of person act out their aggression in a less violent way. Probably serves a huge good to a stable society in general, so that the builders can build in relative peace. If you believe that prices reflect value, then definitely more good to pay these dudes to tackle each other than it is to pay for doctors and teachers - Can’t care for the raped and pillaged.

Funny though that now we get the less-fortunate rungs of society to fight the wars now.

[anomaloustho]

It feels odd to say that athletes are intrinsically valued more by society over doctors. It seems more like an effect of scarcity.

There are 2.5 doctors per 100 people. I would imagine there are far less high percentile world-class performance athletes.

Corporations then bid on those scarce high performance athletes against other coporations.

[wonderwonder]

I agree it does seem very odd to say that, but I would say if one looks at our modern society and the way athletes are paid and idolized that for the most part the statement is true. Most people could not name 5 doctors, but they could name ten athletes. I'm not saying I like it but I think its correct.

[eberkund]

That's one way to look at it, but are "they" (as a group, not individually) really paid more? I think the total amount of money spent on medical services far exceeds the total amount spent on professional sports or even entertainment as a whole.

[rscho]

And if payers had their life depending on your 100m dash, they would absolutely do nothing to prevent it and its exactly what would happen.

[jackpirate]

Plenty of soldiers' lives depend on other soldiers' 100m dash times in combat... yet the military is quite good at preventing illegal drug use... and the drugs that soldiers most want to take are drugs that would harm physical performance

[Permit]

No they don't. The marginal running ability (or strength) of a soldier does not save lives. That is, a solider who runs a 12.5s 100m dash will not save more lives than a soldier who runs a 12.6s 100m dash.

Obviously there are minimum physical requirements to serve in the military, but once you're in you are not going to start saving more lives because you can run a little bit faster.

[strken]

https://en.wikipedia.org/wiki/List_of_drugs_used_by_militari...

Modafinil, one of the common study drugs that med students are known to use, is used by quite a few militaries.

[FiveSquared25]

And also see morphine use during Vietnam war

[nradov]

Anecdotal reports indicate that illegal steroids and similar performance enhancing drugs are quite common in ground combat units. The military doesn't routinely test for those.

[kvee]

Soldiers use stimulants too -

https://www.nytimes.com/2012/04/22/opinion/sunday/why-are-we...

https://en.wikipedia.org/wiki/History_and_culture_of_substit...

[rscho]

Yes, except that people who care for soldiers' lives outside of other soldiers are few and far in between.