Safe injection sites don't create a moral hazard: they are a response to a public health and safety crisis that exists whether or not you have them. Your neighborhood drug dealer won't convince anyone to start abusing drugs just because there's a safe injection site nearby.

Charging for any FDA regulated drug or therapeutic (or anything) before marketing approval, however, is a cardinal sin in the pharmaceutical industry because it incentivizes the exact kind of snake oil salesman behavior that the FDA was created to curtail. Gathering any kind of useful data (let alone keeping patients safe) for a few self-experimenters will be extremely expensive so unless this infrastructure is publicly funded, you're just recreating the conditions of the 1800s, except now with entire businesses built on finding gullible people who will try literally anything because... "science". Even if it's publicly funded, it will almost certainly end in disaster.

All it takes is a few desperate parents, a dead autistic kid, and some clickbait for an entire generation to lose trust in our pharmaceutical and healthcare industries. That loss of trust will lead to orders of magnitude more death and suffering than would be prevented by letting desperate people play Russian Roulette with what is essentially a fully loaded gun (that they think is empty).

The first phase of human clinical trials is literally giving a small group of healthy patients under constant supervision a steadily increasing dosage until more than half of them can no longer safely handle it. That's only after a safe dose has been established in animal trials so we're talking about serious complications or death in the single digits percent of cases after tens of millions of dollars have already been spent. Individuals hoping for a positive outcome have a better chance of winning the lottery.

Winning the lottery is 1:140,000,000

I think those individuals have much better chances!

I can think of a number of reasons why this isn't done:

* You can't run a randomized control trial in this fashion, which makes it harder to collect meaningful data.

* You can't select the populations of people who are in your test groups. It's possible the drug will only work well in certain populations.

* You can't monitor people as well for things like adherence or control their other behaviors. Perhaps they are taking 5 other compounds simultaneously which are having an effect or interfering with your compound of interest.

* You can't screen for toxicity or determine dosing meaning the drug could kill people en masse before the ideal dose is determined.

I think it's fine for people to take any compound they want as long as it's an educated decision, but I don't think what you're describing is a great source of data or a good substitute for animal trials.

> You can't run a randomized control trial in this fashion, which makes it harder to collect meaningful data.

You can, it just needs to be organized properly. You sign up for a test of a new drug/nootropic online, you get the pills, but you don't know if they work or not.

Then, you have to report the results.

> * You can't select the populations of people who are in your test groups. It's possible the drug will only work well in certain populations.

First of all, you can. Require filling a questionaire (or even genotyping) before sending the drug. Not only you will be able to analyse the statistics across populations, but you will no longer have problems with many drugs being only tested on white males.

If certain populations are missing from the data, the company could afford the therapy to them for free, or even pay them.

> * You can't monitor people as well for things like adherence or control their other behaviors. Perhaps they are taking 5 other compounds simultaneously which are having an effect or interfering with your compound of interest.

What has a higher chance - experiment subject lying about other meds he's taking, because he wants to get the drug (or money for participation in experiment), or a person who stands nothing to gain or lose from filling in the questionnaire truthfully?

> * You can't screen for toxicity or determine dosing meaning the drug could kill people en masse before the ideal dose is determined.

The idea would be to allow only drugs that passed initial trials to estimate toxicity and safety. But open the drug to public before efficacy is established.

By the way, every single day doctors prescribe drugs with "unproven" efficacy. While every drug had to be proven that it's good for "something", many of them have off-label use, which is currently totally not tracked.

I was prescribed Modafinil for ADHD. It's off-label, and there is some research proving that it helps. I feel it's helping me too.

Unfortunately, I have no way of filling any kind of detailed description of perceived effects, or my history. Nobody offered me an option for participation in double-blind study. There is so much lost potential there.

>> Then, you have to report the results.

"The drug gave me a headache and made me feel moody, and increased my cravings for white chocolate and potato crisps."

That's what you're likely to get from self-reporting in that sort of trial. Especially given the scale implied by the interest in an anti-ageing agent, you can expect to gather bazoodles[1] of data, most of which will be absolute garbarge.

______

[1] Bazillions of oodles.

Sure, I'd support "self-experimentation sites" where experimental subjects bring their own drugs and get better supervision/instrumentation. Just like self-injection sites let people who already have heroin inject it there but don't provide it on-site.

Volunteering and bringing your own drugs with you is a much stronger signal of intent and capability than just volunteering. You don't need a large cohort to find exceptional effects, negative or positive, so the bias toward stronger filtering seems fine to me. If you're looking for subtler effects, self-selection won't work anyway; you'd need double blinded clinical trials like usual.

Because nobody wants to experiment on themselves and your experiment doesn't follow any scientific protocols?

Er, the context of this subthread is about people who already do experiment on themselves. People in the "nootropics community." There are a lot of them.

You could try teaching these individuals experimental protocols if you like, but if you enforce them, that means you're the experimenter. You're not allowed to be the experimenter. You just have to hope they're doing something useful. Probably you'd point a lot of automated instrumentation at each room, rather than having any human observers giving anyone (costly) individual attention, because most of the experiments would be too mired in sources of error to tell you much.

But keep in mind that the point wouldn't be to capture subtle things like drug efficacy. The point would be to find out about side-effects that might otherwise not be found, by having people around when they suffer adverse reactions to the drug to help the person not-die, and then being able to pull reports directly from the people who helped the person not-die, to find out (in clear medical terms) what the adverse reaction was.

> Er, the context of this subthread is about people who already do experiment on themselves. People in the "nootropics community." There are a lot of them

They are not "experimenting" on themselves, they are simply engaging in a chemically-mediated attempt at wish fulfillment. There are few, if any, actual experimentation protocols being used and whenever I check out the scene to see if it is any better Instill find a random collection of anecdotes and poorly gathered "data points." I see no baseline data, no blinding or controls, the worst sorts of confirmation bias in data gathering and assessment, and people entering these "experiments" with a random selection of pre-exisiting conditions for which they are attempting self-medication. This is just an exercise in generating noise, not data.

Yes, that is exactly why it was proposed by ~derefr to

> [offer] "safe self-experimentation sites", complete with medical researchers + monitoring equipment to capture data, and nurses to help with bad reactions?

That's what this whole subthread is about.

The point is that there would be no useful data captured at such sites beyond 'what is the LD50 of this random shit someone ordered from China?' Such a site would possibly increase safety for individuals, but not much else.

You obviously haven't heard of the biohacking community.

I've read my share of gwern reviews, and he does double-blind testing on himself and all, but there's an obvious bias that all the tests are done on gwern. Similarly, if you let people submit their own data you're still only getting data from those people, and in this case it wouldn't even be blinded.

A real experiment has access to much better populations, tendency of psych experiments to be done on psych students aside.