The Social Dilemma - Sounds to me like a medical problem.

Social media feed algorithms are not entertainment. They are unlicensed medical products — psychoactive software engineered to maximize engagement regardless of what that engagement costs the user's mental health. We regulate every other substance that affects the brain this intensely: caffeine, alcohol, nicotine, prescription drugs, illegal drugs, even GMO foods. Feed algorithms are currently exempt.

This post is about five regulatory frames — any one of which would help — and why Section 230 is the leverage point that makes all of them possible.

If you're not familiar with the plot of docudrama "The Social Dilemma", go watch it now. If you haven't seen it, the short summary is the following: Social network sites get paid for you to watch their ads. The more ads they get you to see, the more they get paid. Their entire capitalistic incentive is to make you watch more of their ads. They work very, very, very hard to make this come true. They're really good at it. They suck you in and keep you doom-scrolling as long as they can. They don't care if it's bad for  your health, they want those ad dollars. They want to increase their feed's 'stickiness.' They want your attention and they'll get it any way they can. 

And how do they get it? They don't create their own content... they entice you to scroll for content you've 'signed up' for. Content that your friends publish. Content that your favorite authors publish. Content that other famous people publish. That seems reasonable. Show me my subscribed content and show me some ads... seems just like TV. But no! The Social Networks are much more insidious. You don't actually get what you signed up for. They attempt to charge famous people money to show their published posts to their followers. In other words, wringing the audience for money from both ends... charging to show published musing, and charging for and showing ads to the audience. 

This is not only a side effect that penalizes famous people and people who want to hear what they are saying: This is the Social Networks business model. The Social Networks actually hide the feeds you've subscribed to from you and try to raise money from the publishers to show it to you. But wait, it's even worse. Not only are they screwing you by hiding what you've subscribed to, they're also inserting random pseudo-ads to see if you want to subscribe, to keep you interested in scrolling and to steal your attention from anything but watching their ads. They purposefully manipulate your feed to keep you glued to the screen.

There's serious, refereed, peer-reviewed scientific papers published that show that this manipulation of your stream is injurious to your health.

I'll say that again: Social Network feeds have been proven to be injurious to your health.[2]

It's time they were regulated [1] , way past time.

But wait, you ask, how can  you regulate feed algorithms? On what basis? There's some very obvious ones. First, these ideas are applicable to all Artificial Intelligence algorithms that interact with humans. It's way past time to control these amoral capitalistic killer robots that rob you of your attention, your money and your health. 

1. It's not okay for an AI algorithm to be biased by race, religion or any other category protected by law. The AI algorithm must prove it is unbiased before its predictions are used. It's the law. We need to enforce it.
2. You should not be allowed to practice medicine without a license. These AI algorithms have more affect on your life than prescription drugs. They should be regulated as prescriptions drugs. You should not be allowed to apply these recommendations unless your physician agrees that they are beneficial to you. No more letting the Social Networks prescribe dangerous medicine.
3. If not as a drug, at least these AI algorithms should be regulated as Medical Devices. They are software systems meant to affect your mental health. They need to prove they are safe.
4. Finally, as a medical treatment, only a physician can prescribe a medical treatment. 
5. Another option is to regulate them as an addictive drug. A drug that is more prevalent than, and for adolescents potentially as harmful as alcohol, nicotine, cocaine or other highly addictive drugs. If you deal in one of these drugs without guaranteeing its purity, under a doctor's care, you go to jail.
6. The last resort is that we should treat these feeds as intellectual food that must be regulated and have proven safety like we do for GMO foods. They must be regulated, transparent (what did you filter? what did you add? why did you do it?), registered and reviewed.

How can we apply these proposed remedies?

• Primary: Regulate as a **medical device** (FDA 510(k) framework): algorithms meant to affect cognitive/emotional state must prove safety and efficacy.
• Supporting: Anti-bias law enforcement is the existing legal baseline and costs nothing.
• Escalation: If the industry resists medical-device framing, **addictive-substance** regulation is the fallback.
• Lever: Section 230 immunity is the political mechanism for all of the above.

It's way past time we regulate Social Networks; before they regulate us into oblivion.

Thanks for reading

 -DrMike

The post is from May 2021. The Section 230 debate has continued: Gonzalez v. Google (2023) addressed the issue without resolving it, and state-level legislation (Utah, California) has emerged. In early 2026, social media feeds were declared to be addictive drugs.

For the 2025 update on tech-oligarch impunity and how these regulatory gaps metastasized, see: The Techno-(Lord) Optimist Manifesto (2025).

For the political dimension of algorithmic manipulation, see: What Technology Does for Politics (2019).

For why corporations systematically behave this way and why Limited Liability Corporations need external constraint, see: Capitalism is Not Inherently Bad: LLCs Are the Problem (2023).

[1] https://www.nytimes.com/2021/07/29/technology/big-tech-profits.html 

Here's a similar series in Time: https://time.com/5872868/big-tech-regulated-here-is-4-ways/ that agree the best way to regulate Big Tech is to use the Section 230 protection as a trade for public health concerns. Otherwise, Section 230 might just disappear? This is the use of power for the good of the people. Progressivism. 

[2] Hunt et al. (2018, Journal of Social and Clinical Psychology): limiting social media to 30 min/day reduces loneliness and depression

Haidt & Twenge meta-analyses on teen mental health decline correlated with smartphone/social media adoption (2010–2015 inflection) and other papers and talks.

Allcott et al. (2020), American Economic Review: paying Facebook users to deactivate improves subjective well-being