The Human Operating Manual

Medical & Pharmaceutical Industries

**Working Intro**


What they get right.

What they get wrong.

What they represent and how our incorrectly placed expectations drive our disappointment in doctors.

  • Don’t complain that they don’t know anything about nutrition when they aren’t dieticians.
  • We also don’t need to take the drugs we are prescribed. We know they are mostly for removing pain long enough to use lifestyle factors to recover. 
  • The culture of victimization driving dependence on drug and media induced escapism.

How we can use them without being “taken advantage of” or demonizing them. Pharma is obviously about making money rather than looking out for what’s best for you. A scientist is usually the person you go to for morals and motivation, not the business that sells whatever they found. Occasionally the scientist is desperately scrabbling for money and will research what they are paid to research though. Just for the hope of being able to do what they love/trained for without starving or finding an unrelated/unskilled job. 

Our goal is to use these industries as an experiment in finding the signal through the noise so we don’t end up throwing the baby out with the bathwater. 

Antidepressant withdrawals:

Antidepressants lifelong dependence:

Aspirin and cancer:

Anticholinergic drugs make lead to AD:

Hunter Gatherer Notes

Heather would often get strep throat and then developed laryngitis as an adult. She gave this presentation via text to her students:

The medical profession’s response to my frequent laryngitis is that I really ought to take some pharmaceuticals, and then some more to counteract the side-effects of the first ones. Why those pharmaceuticals? Because in some cases they reduce some instances of the inflammation that can cause laryngitis. What are the shared symptoms between those cases and mine? The medical professionals don’t know. Furthermore, they don’t seem to care. Just take the drugs, they advise.

I don’t do as they ask.

The treatment of the vast majority of medical complaints with drugs, rather than with actual diagnosis, weakens the ability of the medical system even to do diagnosis. It also pollutes the data stream: who knows who is sick with what, and from what origin, if so many people are on pharmaceuticals with unknown side-effects.

When I show up on the doorstep of the medical establishment with laryngitis again, they ask me, “Are you on our drugs?” When I tell them no, they abdicate all responsibility? If I won’t just follow directions, how can they help me?

Following directions when the people giving them seem to have no idea what they’re doing, or why, is neither honorable nor smart. The medical system has been reluctant to take up evolutionary thinking, opting instead for pharmaceutical fixes that too often create new problems, and mask rather than cure the old ones. Anything with a simple biochemical switch would almost certainly have been “solved” by selection by now, if it were possible without triggering unacceptable trade-offs, and if the “problem” being solved were really a problem.

Against Reductionism

The modern approach to medicine (practically reductionist), reveals itself clearly in scientism. Friedrich Hayek observed that, too often, the methods and language of science are imitated by institutions and systems not engaged in science, such that the resulting efforts are generally not scientific at all. Not only do we see words like theory and analysis wrapped around distinctly untheoretical and unanalyzed (and often unanalyzable) ideas, but—worse—we see the rise of a kind of fake numeracy, in which anything that can be counted is, and once you have measurement, you tend to forgo all further analysis.

Once we have a proxy for something, we think we know it. This is particularly true if the proxy is quantifiable, no matter how flawed those numbers might be. Furthermore, once we have a category, we often stop looking outside of the categories for meaning, as our formal system of carrots and sticks exists solely within the categories.

This is the engineer’s approach to what humans are, and it vastly underappreciates how complex and variable we are. Everyone is susceptible to this error: We look for metrics, and once we find one that is both measurable and relevant to the system we are trying to affect, we mistake it for the relevant metric. Calories, psych drugs, etc. We also forget that our bodies are variable and that as long as a system works (blood vessels traveling different paths to the same place) it doesn’t matter. 

Considering the Risks of Reductionism as We Choose What to Put in Our Bodies

We often mistake an effect (e.g., of an action, a treatment, a molecule) for our understanding of the effect. What a thing does, and what we think (or know) that it does, are not the same thing. An example is believing vanillin is the same as vanilla or that THC or CBD is the same as marijuana. The parts are different to the whole.

From fluoridated drinking water to shelf-stable foods with unintended consequences, from the myriad issues with sun exposure, to whether GMOs are safe—we are constantly seduced by reductionist thinking, led astray by the fantasy of simplicity where the truth is complex. Reductionism, particularly with respect to our bodies and minds, is harming us. 

Early in the 20th century, fluoride was discovered to be correlated with fewer cavities. So fluoride was put in many municipal water supplies to decrease tooth decay. The fluoride in drinking water is a by-product of industrial processes, though, not a molecular form that appears in nature or has ever been part of our diet. Furthermore, we find neurotoxicity in children who are exposed to fluoridated drinking water; a correlation between hypothyroidism and fluoridated water; and, in salmon, a loss of the ability to navigate back to their home stream after swimming in fluoridated water. The quest for magic bullets, for simple answers that are universally applicable to all humans in all conditions, is misguided. If it were that easy, selection would almost certainly have found a way. Look for the hidden costs.

  • Propionic acid (PPA) inhibits mold growth, and is a prominent additive to processed foods for that reason, but its presence in utero affects fetal brain cells and is linked to an increase in diagnoses of autism spectrum disorder of children thus affected. 
  • Similarly, people who live near the poles, or who rarely go outside, can come to suffer from short stature, and weak and curved bones (rickets). Vitamin D was identified as the missing molecule for such people, and as we moderns seem to like our pills, we are provided vitamin D as a stand-alone product, or as an additive to milk. Vikings, unlike other northern Europeans, did not succumb to rickets. This turned out to be due to a diet rich in cod. 
  • The historical evidence suggests that most of us could go out in the sun for a bit every day, or eat cod, or do some combination of both, but pills are easier, and they reek of scientism, which is easily mistaken for science and for “taking control of your health.”
  • Reduce your exposure to the sun, the logic goes, and skin cancer rates fall. Guess what goes up when sun exposure goes down, though: blood pressure. And as blood pressure climbs, so do rates of heart disease and stroke. People who avoid the sun have higher overall mortality rates than do people who seek it. A research study on Swedish women reported this remarkable result: “Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking.”

Are some GMOs safe? Almost certainly. Are all GMOs safe? Almost certainly not. How will we know which are which, and can we rely on those who have created them to be vigilant on our behalf? Until we know the answer to those last questions, the Precautionary principle suggests steering clear.

Surgery, antibiotics, and vaccines—are firmly rooted in a reductionist tradition and have saved millions of lives. The problem we are highlighting is the overapplication of a reductionist approach. The germ theory of disease—in its simplest formulation, the recognition that pathogens cause much disease—led to the discovery and formulation of antibiotics, a huge health boon for humanity. Then we overgeneralized, and imagined that all microbes are bad for us.

Just as people are falling ill from lacking healthy microbiomes due to over-prescription of antibiotics, so too are our livestock. Furthermore, there are unintended side effects of many antibiotics, such as Heather’s personal experience of receiving a ruptured Achilles tendon. It is now understood that tendon and ligament injury is one side effect of Cipro (and all of the antibiotics in that class, the fluoroquinolones), which Heather took in quantity in the 1990s to ward off GI bugs while conducting research in the tropics.

From fluoridated drinking water to antifungals in shelf-stable food, from sunscreen to the overuse of antibiotics—over and over we make the same kinds of mistakes. Combine reductionism with a tendency to overgeneralize, in a hyper-novel world where quick but expensive and potentially dangerous fixes are common, and we have explained some of the major errors of modern health and medicine.

Bringing Evolution Back to Medicine

Ernst Mayr, one of the 20th century’s great evolutionary biologists, formalized the distinction between proximate and ultimate levels of explanation. In attempting to tease apart cause and effect in biology, he distinguishes two branches within biology, which many scientists themselves may not be aware of.

  • Functional biology, Mayr argues, is concerned with how questions: How does an organ function, or a gene, or a wing? The answers to these are proximate levels of explanation.
  • Evolutionary biology is concerned with why questions: Why does an organ persist, why is a gene in this organism but not that one, why is the swallow’s wing shaped the way that it is? The answers to these are ultimate levels of explanation.

How questions—that is, proximate levels of analysis, questions of mechanism—are more easily pointed to, observed, and quantified than the underlying question of why, mechanism has become most of what is studied in science and medicine. How questions also tend to be what are reported, in breathless sound bites, by the media. Too often, these proximate questions are imagined to be the level at which the scientific conversation needs to be had. This serves nobody—not those who are interested in the study of why, nor those who are interested in the study of how.

Combine a tendency to engage only proximate questions, with a bias toward reductionism, and you end up with medicine that has blinders on. Even the great victories of Western medicine—surgery, antibiotics, and vaccines—have been over-extrapolated, applied in many cases where they shouldn’t be. 

Those who break bones often get them put in a cast. This immobilizes it and causes the muscle to atrophy. For some situations a splint is all you need. The recovery process happens much quicker and the pain subsides quicker without the blunting of excessive pain medication. The pain, heat, and swelling of an injury is communication about your progress. As long as you don’t die of infection or by being eaten by carnivores (our ancestors’ typical problems), your bones should heal. If you need surgical intervention to fix the break, that’s advisable. Just don’t expect a reductionist approach to solve the whole issue. Modern medicine can be lifesaving. That doesn’t mean it can completely replace the body’s healing response.

Whom to Believe in the Era of Reductionism and Hyper-Novelty

Relying on cultural rules and reductionist thinking instead of consciousness is much more energy efficient. However, in this time of hyper-novelty we are required to be more flexible to avoid being led around. Many people’s faith in authority has been shook after recent events, due to their wavering demands.

We need a less reductionist approach, while still being able to take advantage of what incredible solutions we have engineered in the past. We need to use the hammer when a nail is the problem, rather than be forced to use a hammer for all situations.

The Corrective Lens

  • Listen to your body, remembering that pain evolved to protect you. Pain is information about the environment, and how your body is responding to it. Some injuries require professional treatment, but some can be monitored without intervention. Pain is both unpleasant and adaptive; think twice before shutting down its message.
  • Move your body every day. Take walks. Mix it up—don’t do the same thing all the time, and don’t move your body in the same way whenever you move it. And, at least sometimes, move intensely, and move outside, where the stakes are higher.
  • Spend time in nature, the less constructed and controlled the better. This has many benefits, among them the dawning recognition that you cannot control everything in your life, and that experiencing discomfort—even the slight discomforts of a too-warm day, or rain for which you are unprepared—calibrates your appreciation for other aspects of your life.
  • Be barefoot as often as possible. Calluses are nature’s shoes, and they do a far better job of transmitting tactile information to your brain than do shoes.
  • Resist pharmaceutical solutions for medical problems if you can. While antidepressants, antianxiety meds, and more improve some people’s lives, they are often not the best solution. Usually, there are alternatives available; many mood disorders, such as depression, are beginning to be understood by Western medicine to be treatable with diet, ample sleep, and regular activity.
  • Look out for mismatch diseases, such as adult-onset diabetes, atherosclerosis, and gout. These are diseases that reflect an inconsistency between (one of) your Environments of Evolutionary Adaptedness and your current life. They also tend to reflect affluence, compared to your evolutionary past. For at least some of these, bringing your modern behavior closer to that seen in an older EEA could help mitigate the damage.
  • Consider this informal test to assess certain types of ailments, and whether a modern “fix” is called for: In environments similar to the one I am living in, did people suffer from this ailment prior to modern medicine? If yes, a novel solution is warranted. If no, look to history for the solution. Take rickets as an example, for someone of European heritage living in the Pacific Northwest. Did people suffer from rickets in such northern latitudes in the past? One type of answer is that evidence suggests that at least some populations of northern Europeans did not suffer from this condition. Seek answers there (remember the Vikings and their cod). A second type of answer is that native people in the Pacific Northwest did not suffer from rickets. What worked for them might not work for someone who is not of native heritage, but it well might. Look to geographically local history for solutions.



‘Psychedelics’ Defined

Overall (it is more of a cultural term), they all have the ability to alter a person’s sense of reality. LSD, psilocybin, DMT, mescalin, etc. They tend to be tryptamine-based compounds (psilocybin, DMT) or phenethylamine structure. Agonists or partial agonists at the serotonin 2A receptor.

Also, NMDA antagonists like ketamine, PCP, dextromethorphan.

MDMA, an entactogen/empathogen (touching within). The primary mechanism is serotonin release and other monoamine release.

Salvinorin A, a kappa-opioid agonist, reality altering experiences on par with DMT smoked experiences.

Hallucinations, Synesthesia, Altered Space-Time Perception

There’s a rule that underlies a prediction. When that rule is broken, or it isn’t filtered out, it can be mind-blowing/surprising. Psychedelics may violate these assumed predictions.

Serotonin & Dopamine

Levels of analysis include biology, chemistry, physics, receptor level, post receptor signaling, downstream effects of other neurotransmitters, activation level effects, coordination levels, etc.

Ketamine & Glutamate

Ketamine is more dissociative. Less behaviorally active and go into a K-hole. 75-100mg can end up with you ending up on the ground.

Ketamine has shown high rates of recovery from heroin and alcohol addiction in the past. Enough to convince more research to be done.

An Example Psychedelic Experiment

Screening for psychiatric issues that may disqualify you (schizophrenic or mania symptoms, CVD issues). 48 hours of preparation, to get used to the participants and facilitators and build therapeutic rapport. Letting them know what the drug may be like so there are no surprises.

30mg of pure psilocybin chemical compound (looks like serotonin) administered in the form of a capsule. No need to adjust per bodyweight (brain effect).

Any emotional response is welcome. You are allowed to do whatever you need to do. In a social situation there is always that stigma and fear of being the person that breaks down and hides in the corner. In a therapeutic setting, you know you are there for recovery.

‘Letting Go’ with Psychedelics

Normally the social pressure makes us pay attention to too many things at once. One classic effect of psychedelics is that they are hyper focused on the smallest things.

The brain’s default is to jump around like crazy and to habituate to stimuli that isn’t necessary. Even feeling your heart beat and breath can feel alarming when you usually ignore the autonomic responses.

Redefining Your Sense of Self

Persisting changes in self-representation are common. Expansion of the perceptual bubble. How one defines themselves internally, not just to other people, is powerful, as we potentially reshape our psychological framing of our identity (“I am…”).

People often have profound realizations they are the cause of their own suffering and gain agency by noticing they can decide to stop smoking, drinking, etc. They have the power, when sober they are told not to think that way.

Neural networks don’t change in response to language, they change in response to experience.

Exporting Psychedelic Learnings to Daily Life

Integration – asking how the experience went and what they want to take from it. What might it mean for their life issues? When taking drugs with friends the social pressure of being laughed at for being “weird” results in a repression of experience. Whereas you really need to explore what it meant, even when emotions get extreme. Supportive therapy rather than structured. Reflective listening. Things like a relationship change or job quitting should wait a few weeks. Big realizations can be exaggerated by the desperation for change.


There is a paper of people with hallucinogen-persisting perceptual disorder (HPPD) who had never taken a psychedelic. Destabilizing people who are predisposed. It’s always the weird “other” thing that gets attributed to the problem. Smoking, drinking, bad diet, etc., often will be the cause whereas the psychedelic will get the blame. Just like xenophobia, we are always ready to latch on to judging/blaming the things we don’t understand.

Ayahuasca, & ASMR, Kundalini Breathing

People who have done ayahuasca and MDMA often report an increased sense of autonomic sensory meridian reflexes – passing a shiver up their spine/cooling perception. Even people who have done Kundalini yoga have reported feeling like their sense of self is outside their body with the feeling.


MDMA leads to a very robust release of dopamine and serotonin simultaneously, which is very unusual as they are usually seen to be exteroceptive vs. interoceptive. Seems to be used clinically for PTSD currently. The chances of having a bad trip are much lower and is probably better for the greater population in terms of trauma treatment.

Bad trips may be related to reality shattering where you need to let go but refuse to.

Smoking DMT is so strong that it forces people into letting go. Terence McKenna would say the sense of self is intact but everything else changed.

Terence McKenna’s background was essentially as a bard. An intelligent and well-read man.

Dangers of Psychedelics, Bad Trips, Long-Lasting Psychosis

Schizophrenia and bipolar disorder sufferers are always advised to be wary or completely avoid this treatment. Anybody susceptible to psychotic breaks.

Freaking out on psychedelics is atypical but bad responses do happen. At the extremes you will have problems.


LSD would be the typical example of microdose usage. Usually around 100micrograms is the start of psychedelic effects. Most people will take a standard hit and dilute into a tenth with water/vodka.

Some people take 1-2 milligrams per day for “neuroplasticity.” Which is not something you really want all the time if that was even the effect. Even claims that it is a better version of Adderall for focus or as an antidepressant. The research really isn’t there though. If anything, it just impairs time perception. Microdosing often will tend to habituate you to the feeling, meaning you will start to notice the “off” days better. It may have a mild effect as an antidepressant but we don’t know for sure yet.

They tend to be serotonin agonists and using serotonin 2B agonists can result in heart valve problems, so we need to be wary.

Risks for Kids, Adolescents & Teenagers; Future Clinical Trials

No formal research yet. The FDA is concerned about drugs that are pseudo-specific (age, gender, race, etc.). Trials are being considered.

Legal Status: Decriminalization vs. Legalization vs. Regulation

Still technically illegal but dependent on local countries and the enforcement choice of the officer. Can be charged federally.

Law at the federal level, law at the state level and local level, will it be physicians (MDs), PhDs, or master’s degrees, or a free for all?

There is a great need for regulation rather than purely legalization. It should be integrated with other therapies and administered by professionals.

Psychedelics for Treating Concussion & Traumatic Brain Injury

Anecdotes of people saying psychedelics have helped heal their brain and improve cognitive function. Neuroplasticity MAY be at play in stroke and TBI patients. Drugs that administer or control neuromodulators should alter circuitry in the brain in some way.

PTSD Treatments: Ketamine, MDMA, oxytocin

Ketamine is a dissociative anesthetic – as making a patient feel like they were getting out of a cockpit of a plane, but observing themselves doing it. It changes the rhythm of cortical activity (1-3Hz rhythm), in layer 5 of the retrosplenial cortex. Brings us to the PFC top-down input, allowing the patient to recount their trauma while feeling while feeling none or a different set of emotional experiences than the traumatic experience. A replacement of emotional experience. Diminishing the old with dissociation, extinction, then relearning.

MDMA is a powerful synthetic drug that creates a dopamine and serotonin releasing state at the same time. Dopamine is usually related to seeking whereas serotonin is more about relaxing and being satiated. The combination of these two are not that normal. People report feelings of connection or resonance with people or things. MDMA causes massive releases of oxytocin too. The dopamine release is related to the euphoria, the serotonin leads to the safety and comfort. For trauma, this allows a fast relearning of new associations to the experience, without the need for many repetitions.

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