The FDA Has Punted Decisions About Luvox Prescription To The Deepest Recesses Of The Human Soul

Two essays in one. First, the case for fluvoxamine (Luvox) for COVID: the 4,000-person TOGETHER trial showed ~30% fewer hospitalizations (Scott's 60-40 it works); it's a bog-standard SSRI given to 10% of Americans, so the risk-benefit clearly favors trying it; Johns Hopkins recommends it. The FDA won't add COVID to the label because there's no pharma sponsor to shepherd the off-patent drug through (the bureaucracy assumes one), but Luvox is already legal and prescribable off-label. So the pivot: why don't doctors just prescribe it off-label, like they already do for gabapentin/beta-blockers/trazodone? Because they're scared of looking weird in front of colleagues. The CS-Lewis/Screwtape framing: the Devil doesn't tempt doctors with hard self-sacrifice (they love that) but with the prospect of looking slightly weird -- and Scott confesses his own failures of this kind of courage (the ventilator-oxygen-concentrator punt; the months he delayed prescribing intranasal ketamine until he learned someone else did it, costing some patients extra months of depression).

Quality 73 · Strong. Strong. A characteristic Scott blend -- a specific medical case, an FDA-dysfunction critique, and a genuinely moving meditation on courage-vs-conformity in medicine ('moral battles happen in ordinary decisions about slightly-unusual things that affect our social status'), made vivid by honest personal confession. Mid-Strong as a topical, single-case piece.

Claude’s paradigm shift 50 · Moderate. Moderate. The fluvoxamine case is topical; the fresh, sharp contribution is the Screwtape framing of medical courage as resistance to social-status anxiety rather than to hard sacrifice.

Real-world impact 2 · Minor. Minor. Topical COVID-treatment advocacy plus a courage critique within the medical-twitter/rationalist discourse; the post's own reach is discourse-level. 2.