self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
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A friend to everyone is a friend to no one.
User ID: 454
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
41m ago
I can't say that I've ever intentionally tried to get someone to do that experiment in front of me, but I have, on request, reviewed the advice given by various LLMs and haven't really seen any egregious errors in a longtime.
Poor information will degrade performance in anyone, including human physicians. Our usual approach is to assume honesty and then update towards the possibility that someone is lying or mistaken when further evidence comes in. Of course, it depends on what exactly someone says and how they present. If a clearly twitchy, disheveled guy shows up and claims to have never done alcohol or drugs, I would be rather suspicious. If you have herpetic lesions on your cock and claim you've never slept with anyone but your wife, I will not take your testimony entirely at face value.
I am obviously at an advantage asking ChatGPT questions, because I have at least a vague idea of the kind of information that is important to disclose even outside psychiatry, I know the kind of issues that would make a cardiologist or ophthalmologist sit up straight and lock in. Yet it will consistently ask me for clarification or for more information to narrow down the answer-space, and I have no reason to assume it wouldn't do this for a layperson. In fact, it might even be more thorough, because it might (correctly) assume that there's more room for error or misunderstanding in that scenario.
Right now, a Doctor-LLM cyborg is probably superior to either alone, at least in realistically messy scenarios. But even just the LLM will, at least with the exact same information and affordances, perform quite well. Most of the edge cases can be covered by the assistance of a mid-level or a junior doctor.
I can tell you that my bosses are too old to have learned to rely on AI as heavily as I do, so assuming they don't, I can match their performance while using it. Similarly, a smart med student might be able to match my performance if I was stripped of AI assistance while they got to use it. This gap is, as far as I can tell, becoming increasingly narrow with time.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1hr ago
I am sorry to say this, but you are woefully underestimating the ability of AI.
I threw your hypothetical into ChatGPT, the paid version, and even before it finished thinking (it's doing a lot of thinking, and it all seems relevant) it immediately noted:
The big early split is whether he “can’t move it” because of pain/mechanical disruption, because the limb has lost perfusion or nerve function, or because the problem is actually central, such as spine or stroke. That distinction changes the whole pathway immediately.
Emphasis added.
In the full workup, it mentions:
“Is it too painful to move, or does it feel weak/dead/numb?
Seriously, try this for yourself. Get a paid subscription and try and find a clinical scenario where the evidence you have provided has a definitive answer, which the AI is unable to diagnose even after the same amount of effort a human clinician would devote.
Here's the full conversation, if you want to take a look:
https://chatgpt.com/share/69be7d62-ad60-800b-a335-bf527ee5168e
Someone needs to get clean data to give to the AI for outsourcing to work (for now).
AI can't do a lot of clinical work, because it lacks hands. But it can borrow someone else, say an NP or PA or just a nurse. And then it can do things that would otherwise take a human doctor.
I don't want to undermine our profession, but you have to understand that I value probity over professional solidarity, at least if challenged. When I do disclose how close we are to replacement, it's where it doesn't matter, I don't want to lose my job either, but I can rarely bring myself to mislead when I genuinely believe otherwise. I'm not accusing you of being misleading, by any means, but consider this example a data point that you're not considering how scarily good LLMs can be. We can take this to DMs if you prefer.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2hr ago
I can't really argue against you, can I? It's been like 25 years and change since I was in the States, and would have been like 6 months if my visa didn't bounce. Perhaps American patients genuinely are more demanding and entitled, I can promise you I have seen more than my fair share of demanding and entitled patients in the UK (while the NHS is free, a doctor is not considered that different to a bus driver). I have seen demographic disasters/marvels that have simultaneously made me lose hope in humanity and rekindled my optimism for medical progress. Like seriously, how the fuck are some of these people still alive?
However, I am confident that there is a severe physician shortage when you leave urbanity. Several states, from memory including Texas and Mississippi, have quite recently massively relaxed the requirements for foreign doctors to come and practice as long as they go to underserved areas. They don't even need to have cleared the whole USMLE, let alone have completed a residency. You bet I follow that kind of stuff like my life depends on it, in a very meaningful sense, it does.
The fact that this happens at all, let alone in like 3 or 4 states (could be more) is suggestive of something. Of course the typical doctor wants to be in the Big City and will fight to go there. In India or the UK, where doctors are more abundant, the sheer competition will force some of them to take up less than ideal appointments, albeit not at major loss to earning potential.
I've worked in for-profit systems, in not-for-profit setups, and plenty in between. I would be rather surprised if the US was qualitatively different and not merely quantitatively so. I would happily take the hassle of insurance and the extra medicolegal liability if I could double or triple my income. I'll take the risk of getting shot or knifed. You guys have it very good, by global terms, at least when done with residency.
This is not really an argument that we should let every dude with half a frontal lobe practice medicine, or that doctors should be paid worse. But I think you heavily discount the risk posed by AI, both present and future. I have had senior doctors, family and otherwise, try and flummox recent versions of ChatGPT. They can't pimp it. It will out-pimp them. It's not going to do surgery for you today, or even next year, but many branches of our profession do not rely on procedural skills to make a living (I say, while crying that I have to do cannulations, catheterization or conduct ECGs because our nurses are useless).
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3hr ago
COMP006, if you care to check. My personal experience is documented in one of the posts in my profile, which links to Substack.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3hr ago
I have a pedigree of medical practice that stretches back 4 generations, probably longer if we're willing to accept qualifications that aren't formal. I would volunteer, as long as they give me a VPN and part of Kim's food budget. That is probably the best job security I can aspire to with AI breathing down my neck.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
5hr ago
Nah, I am fond of you, even though I agree we have our disagreements. I can't even be mad at the AMA, they're not responsible for my med school being subpar and lazy.
I was just in a very bad place yesterday, largely to do with the fact that I work in the UK, where I ended up at precisely because I'm still not eligible for the USMLE. That makes the whole situation somewhere between academic and painful to engage with, what difference does it make what I think?
(This standard, applied fairly, would preclude most engagement on this platform. I will cop guilty to mild hypocrisy.)
For what it's worth, I think American doctors are world class, only closely rivaled by places like Singapore or other very rich First World countries. The UK is far more uneven, even if I regularly meet doctors who are both better than me and are at a level I would consider well past competent. India? All I can say is that there are plenty of doctors who are world-class, and I know many who would easily fit in in the US. And a lot of idiots who would find a way to kill a cadaver.
Where am I in the grand scheme of things? Idk. My confidence is shot in many ways, but I think the objective evidence, at least from exam results, is that I am above average with respect to my peers in India or the UK. I am not a senior physician, so I suppose that is good enough. I can handle most things in psychiatry, at least if I have time, Google and ChatGPT to help me. I absolutely can match my bosses if I have those tools at hand, which I do have in most scenarios that aren't academic assessments.
However, the medical training pipeline in the US is a bad joke. Mandatory pre-med? What the absolute flying fuck. I don't need my surgeon to have read Seneca in order to harvest my appendix. Even harder stuff like chemistry or microbiology is a waste of time, the syllabus covers everything we need to know. There is very good reason that the rest of the world doesn't do this.
Then there's the fact that the sheer explosion in mid-levels is because of the doctor shortage. I think that, in objective terms, there is nothing wrong with making tradeoffs between quality and availability. Otherwise we could have only the single most talented med student per year become a doctor, and have them train for 50 years so they can handle their own geriatric care right before the next candidate takes them off for MAID.
If you can't legally do that, since the quality of medical training is sacrosanct, then the system will try very hard to route around doctors. I have no reason to think the US has found the global optimum, and I think you guys are too strict. Obviously, I wouldn't endorse any measures that dilute physician wages to the point nobody bothers, but that is very unlikely to happen anyway.
If you float a bill that says: all global physicians who come from a very specific med school in India, have practiced in the UK, are at least six feet tall and right-handed, are welcome to enter the US? It would have my vote. But I am obviously biased.
Anyway, you needed up coaxing me into a more substantial reply than intended, so I hope both you and @DirtyWaterHotDog are happy. Still not everything I have to say, or could say, but it's something.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
20hr ago
I have been intentionally sitting this whole conversation out. It hits too close to home. There is also a lot going on atm, but if you do want my full take I can come back to this, probably as another comment. This only serves to let you know I noticed.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
23hr ago
I am sorry to hear that you're depressed. I'm in the same boat, last time I felt entirely fine was after I enrolled in a study on psilocybin for treatment resistant depression. It was like the sun had come out again, and it lasted for months. I miss it desperately. And yes, being depressed is probably the main reason I don't play video games as much as I used to.
As for Factorio? It's one of those games that appeals to me greatly, in theory, but I would need to use my prescription stimulants to be able to play it. If I need medication to enjoy a game, that is annoyingly close to work. Shame, I love the idea.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
I genuinely wonder if you've ever been mistaken for an LLM. If you weren't a longstanding account that we were confident is human, say you'd just shown up as a new user, I'd have my doubts.
I don't mean this is a bad way! Quite the opposite, you display a level of diligence and effort that LLMs are trained to perform (not quite as successfully), but which is sadly rare in humans. Look at the Markdown tables, look at the tasteful insertion of a rare unicode character. My god, I'm looking even closer, and that is a lot of fucking work you put in on a random thread about video games. I only put in half as much effort when I'm AAQC-farming.
(Of course you play Opus Magnum, I'd kill to see your Factorio builds)
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
Nothing, I haven't played a videogame I weeks :(
Maybe when Menace gets a new content update, or when something like Mars Tactics comes down. Otherwise I just can't be arsed.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
I just learned of the existence of the Codex Alimentarius.
Absolute banger of a name, the world needs more organizations and artifacts that could be thrown as-is into the world of 40k. I wish I worked in an Apothecarium of the Corpus Sanitas Imperatoria instead of a hospital in the NHS. I wish I corresponded with the Sisters of the Eternal Vigil instead of sleepy nurses with too much lip-filler. A man can dream.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
Look, I piss clear all the time, so I'm pretty sure it's fine. I drink when I'm thirsty. I'm sure when it's a hot summer day and I don't have AC around, I do hit 3 liters plus in India.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Hmm. I tend to go for the heaviest weights I can, as soon as I can. The sense of progression is encouraging, but I might be overdoing it. I also avoid deadlifts because I have the impression the risk of injury is concerning, and I would not pretend to have perfect form. Thanks! This is helpful.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
I did have a trainer, sadly he was very expensive and I did not go often enough while I had him to benefit significantly. But I do have a gym-freak brother, who does his best to keep me honest, and I'm well past the annoying few days of DOMS that often cuts my return to the gym short.
You may be able to convince your insurance to help.
I don't have insurance, at least in the UK. There's probably a plan in India, now that I think about it. But this strikes me as unusual, is insurance known to cover a trainer or PT in the absence of a clear medical indication? I am merely lazy, not physically unwell!
Thanks for explaining. I am surprised that someone named lagrangian doesn't extend the principle of least action to not going to the gym, but I'm not complaining,
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
I could lift 1 kg for longer than I could bother to keep counting the reps, but I get what you mean haha. Thanks!
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
The advice seems reasonable, but I'm a chronic noob and I'd appreciate clarification on what exactly counts as a hard set. Does it mean that I'm spent by the time I reach the last set?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
I've noticed I don't sweat much during strength training, and not very much during cardio. I can get away with maybe 300ml intake within an hour without feeling the need for more.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Moving from India to Scotland made me dramatically less thirsty. I used to gulp down at least a liter or two in the former, in the latter, I can get through a whole day with maybe 3 or 4 glasses of water. Well, I guess I can assume that my internal hydration detectors are reasonably well calibrated.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Question for those more experienced at the gym: If focusing on hypertrophy, is it better to start with the heaviest weight I can lift and manage 6-8 reps before having to do a drop set, or is it better to use a lower weight where I can do 10x3 without becoming absolutely exhausted till near the end? To clarify, the initial approach doesn't involve a single extended set, but I find that if I do this, I have to use progressively lower weights to finish.
My understanding is that my approach is likely suboptimal, unnecessarily fatiguing at the very least. But I'm curious about experiences.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
I had an ex-girlfriend who was, among other things, a Biblical scholar with a focus on Dante. I recall her telling me that his approach to theology was... unorthodox, even if some aspects have been normalized.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3d ago
I am doubtful that we would let him back in. I'm not saying he has literally zero hope of being forgiven, but it would require a very sincere apology and a strong promise of doing better before we might consider it. He's been given significantly more initial leeway than the average brand new poster, and what do we have to show for it?
If he made an account just to circumvent the ban, then we would ban first, and ask questions later.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3d ago
I see that there's research out there where they did use modified adenoviruses to demonstrate pathology seen in Ebola.
But that is not the technique used to make the only FDA approved vaccine, ERVEBO. That was made through recombinant VSV. I will grant that they did try and make a an adenoviral-derived vaccine, which kinda sorta worked okay in monkeys.
Also, I am not claiming that GOF has zero utility, my core contention is that whatever actual and potential utility it might have is more than canceled out by the risks.
These researchers seem to have tried to produce only a single Ebola protein, they didn't try to make super-Ebola spread through sneezing. They didn't select for virulence or transmissibility, which is what people usually complain about when criticizing GOF. At least I do.
Also, I do not think you have supported your original claim. You said that "the" vaccine was made through GOF, which it was not. I would believe that those specific choice of words strongly implies the only vaccine actually being given to people. And making a modified adenovirus is very, very far from "airborne Ebola". Nothing of that sort seems to exist. I would go so far as to say it's misleading, a very large stretch of the facts as far as I can see them.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3d ago
I am probably not the right person to ask for an authoritative answer here, but since you did:
There is immense selection pressure for any pathogen to become one that spreads through airborne routes. I imagine the typical virus or bacteria would be very happy to not need direct contact or very close proximity.
But the fact that this almost never happens is strongly suggestive of the innate difficulty involved. Millions of people have caught and transmitted HIV for several generations, but it has yet to figure it a way to fly. Fucking is a far poorer alternative, but it's what the virus has. Flying fucks? Can't say.
I suspect that this is mostly because evolution is retarded and doesn't think ahead, and diseases become strongly optimized for whatever mode of transmission they started with. Plus factors like sunlight or heat are not kind to airborne pathogens, UV light reliably kills most of them. The sheer volume of air around dilutes them to the point that they struggle to reach critical mass by the time they reach the respiratory tract of the potential host.
Look at the amount of adaptation that fungal spores require to survive for more than few minutes while floating, it takes a lot of work.
Also, and very importantly, there is a rather artificial distinction made between airborne vs aerosol spread/direct deposition. Aerosol spread disease particles are suspended in air, they just tend to settle or disperse beyond close proximity.
I think the risk of Ebola naturally evolving to the point it spread primarily through air for more than a dozen feet and not very close proximity or contamination is negligible in our lifetime. We'd be so fucking screwed if the average disease could pull that off, so the fact we're still around is insightful in of itself.
(I wrote all of this myself, and later used ChatGPT to check in case I was making some kind of stupid mistake. ChatGPT tells me I'm basically right, though it's scolding me for leaving out some nuance. It can piss off, it's not the boss of me.)
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
3d ago
Seemed like good old-fashioned human ranting. I've seen plenty.
Not really. My personalization settings tell it I'm a psychiatry resident and a transhumanist. I have some stylistic instructions, such as to never do calculations without tool-calls, but nothing that should make it act in an unusual manner. There is nothing in recent chat history that should change this, I do have memory enabled. It's on the default tone and personality settings too.
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