This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
I'm going to shamelessly steal @Scimitar's post from the Friday Fun thread because I think we need to talk about LLMs in a CW context:
A few months ago OpenAI dropped their API price, from $0.06/1000 tokens for their best model, to $0.02/1000 tokens. This week, the company released their ChatGPT API which uses their "gpt-3.5-turbo" model, apparently the best one yet, for the price of $0.002/1000 tokens. Yes, an order of magnitude cheaper. I don't quite understand the pricing, and OpenAI themselves say: "Because
gpt-3.5-turboperforms at a similar capability totext-davinci-003but at 10% the price per token, we recommendgpt-3.5-turbofor most use cases." In less than a year, the OpenAI models have not only improved, but become 30 times cheaper. What does this mean?https://old.reddit.com/r/singularity/comments/11fn0td/the_implications_of_chatgpts_api_cost/
...or about $0.13 per hour. Yes technically it overlooks the fact that OpenAI charge for both input and output tokens, but this is still cheap and the line is trending downwards.
Full time minimum wage is ~$20k/year. GPT-3.5-turbo is 100x cheaper and vastly outperforms the average minimum wage worker at certain tasks. I dunno, this just feels crazy. And no, I wont apologize for AI posting. It is simply the most interesting thing happening right now.
I strongly agree with @Scimitar, this is the most interesting thing happening right now. If you haven't been following AI/LLM progress the last month, it has been blazingly fast. I've spent a lot of time in AI doomer circles so I have had a layer of cynicism around people talking about the Singularity, but I'll be damned if I'm not started to feel a bit uncomfortable that they may have been right.
The CW implications seem endless - low skill jobs will be automated, but which tribe first? Will HR admins who spend all day writing two emails be the first to go? Fast food cashiers who are already on their way out through self ordering consoles?
Which jobs will be the last to go? The last-mile problem seems pretty bad for legal and medical professionals (i.e. if an LLM makes up an answer it could be very bad) but theoretically we could use them to generate copy or ideas then go through a final check by a professional.
Outside of employment, what will this do to human relations? I've already seen some (admittedly highly autistic) people online saying that talking to ChatGPT is more satisfying than talking to humans. Will the NEET apocalypse turn into overdrive? Will the next generation even interact with other humans, or will people become individualized entirely and surround themselves with digital avatars?
Perhaps I'm being a bit too optimistic on the acceleration, but I can't help but feel that we are truly on the cusp of a massive realignment of technology and society. What are your thoughts on AI?
I predict absolutely nothing will happen to medical professionals because of AI. We've already had "AIs" (aka expert systems) that perform as well or better as trained medical professionals in diagnosis for decades, yet they're used approximately nowhere.
They don’t perform as well. Someone has to actually examine the patient, observe his state and put the findings into the expert system. The expert system cannot do that. What it can do, on the other hand, is relatively trivial for the doctor who does the examination.
I find that most people who think doctors (well, medical professionals) are easy to replace have a pretty limited understanding of what actually happens in healthcare. Sure if you occasionally have an ear infection or a sprained muscle that seems pretty easy and simple and replaceable. Even something like anesthesia, what this guy is just pushing some buttons right?
Well no.
You go into the hospital with trouble breathing, your doctor comes to see you. Your heart rate is elevated. Do you have a growing infection? Are you nervous talking to the doctor? Were you trying to work out because you have a date next week? Is this a side effect from the breathing medication we gave you? Were you just fucking your girlfriend? One of these requires immediate start of antibiotics, and patients can have more than one of them happening at the same time (and in my experience, have).
The algo is just going to start abx which is not harmless by any means. Decision support exists but it's uniformly terrible because it can't take into account the gestalt and patients usually have multiple things going wrong (both inpatient and outpatient). Young and healthy people with a single sick complaint is approximately zero percent of the work in healthcare but also 100% of what is replaceable with decisions support right now.
In a U.S. ED we have multiple layers of triage and knowledge running from triage nurses, to mid level providers, to ED physicians to IP docs and consultants. We know that the lower levels on this scale are inferior (and that includes ED physicians) because we observe it on a daily basis.
Current decision support tools can't even read an EKG, the amount of development required to deal with the messy complexity of people (including the fact that people will misinform you both intentionally and unintentionally) is immense and god help us if the people like Cim who think we aren't doing anything useful or important get their way.
Disagree somewhat.
Yes, this gestalt reasoning, this gut feeling, "does the patient look sick?" is important, but significantly this is now a thing that machines can do, and are continuously improving at.
Yes the interpretations that are printed out on those machines are shit. But this is not state of the art. It is possible to do better
I absolutely agree it will get there, and this update that we have the technology to read EKGs correctly now is profoundly unshocking, but the fact that it isn't in use is telling (healthcare has tons of barriers including the regulatory) and the ability to form a good gestalt is a very complicated and hard skill.
AI will come for us - motivation is high because of the cost (in dollars) but the level of care is high because of the cost (in lives). We'll probably be one of the later manifestations and docs won't get cut out.
This topic irks me so much because one of the strongest patterns in American healthcare is outside industries thinking it is easy, rolling in, failing miserably, and leaving behind a trial of broken lives (especially coming in from tech and finance). Winners do exist (see like PE in EM and HCA) but mostly do so through illegal activity and profoundly unethical behavior.
More options
Context Copy link
More options
Context Copy link
Thanks, this sounds more like how I was thinking about it. Like, maybe the algorithm can, or at least could, make okay decisions if it had all of the information. But then isn't actually gathering all of the information and getting it into a form that could be entered or written down somewhere like 80% of what doctors do anyways? I'm not sure if it matters how good the algorithm is if any professional could have already made the best practical decision before they even would have been able to enter all of the information into some system anyways.
So we have a ton of top of the line decision support tools right now, (including things like auto-read for EKGs, suggestions to put in antibiotic if the computer thinks someone is septic, etc.) the problem is that they suck and are intrusive and annoying. This is important, not only do they need to be more right but they also need to be consistently right - people are trained just to ignore them and if you go from being helpful from 5% of the time to 30% of the time they'll still be functionally useless. If we get to a 70% range situation people will ignore them out of habit and ingrained mistrust.
That problem aside...why is this shit so hard?
It's not because medicine is complicated (it is, but that's not the problem*), LLM are perfect for digging through a bunch of data and such. It's because people are complicated. People come in with a severe illness and complain about something else, ignore a diagnostically critical symptom, report pain in the "wrong" quadrant for the pathology (happens all the damn time).
The decision support tool needs to handle this ambiguity gracefully, have some mechanism for sussing out the correct shit from the patient, and have graceful way of handling the editorializing of whoever is recording and entering the data (and ideally in a timely fashion as you mention).
And then you have super significant but more arcane layers to the problem. Okay my patient has a kidney issue and a heart issue. My decision support tool can help and send me the most updated guidelines. Well where are we pulling from? Cards or Neph? One is shouting Blue and the other is shouting Yellow and depending on which Ivory Tower Institution you pull from the shades of those colors are going to be wildly different.
Research in medicine is difficult and fraught and ethically complicated and we don't have enough high quality recommendations to load this stuff with.
In Europe they manage appendicitis mostly medically, in the U.S. we operate. You ask a surgeon here why the difference and they'll probably say it's because we are fatter. Is that right? Fuck if I know, but we can't agree on the most simple of management.
*I have no idea why the EKG reads are bad, that's pretty damn simple and doesn't bode well for getting anything more complicated done.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Is this the GP everyone usually goes to first you mean, or hospitals? Because sure, you can have a minimum wage triage clerk taking pulse, heart rate, breathing and blood samples, and recording the data.
But then you need someone to interpret the findings. Is that muscle pain due to what? There's a lot of things it can be, and that's where the decade of training comes in. For a hospital, having the intake clerks do the grunt work while they then park you for six hours in the waiting room until the blood work comes through and The Consultant has had the chance to look at everything for five minutes before he decides to send you home is very doable. If you want to replace The Consultant with the AI, first I don't think it will do much to cut down on the six hours waiting time (organic chemical reactions go along at their own pace, plus however many tests are ranged up to be done) and second, that's fine right up until there's a mix-up in the blood work or the right test wasn't done and it turns out to be the sign of something more serious. That already happens in hospitals.
I'm not saying AI in medicine is a bad idea, I'm saying that we're likely to see it used first the way the insurance company triage phone lines are now used, and all it takes is one unfortunate death to set back the adoption of the technology. I could see it being adopted in hospitals, but for the local practitioner where people go first, you do need the level of training and expertise that can recognise "this is a muscle strain" from "this is something more serious, you need to go to the hospital right now".
More options
Context Copy link
More options
Context Copy link
agree. Robotic surgery hasn't put a dent in salaries either.
Not the same at all though. Robotic surgery enhances the power of the human surgeon, making more different types of surgery possible and thus increasing demand.
On the other hand, with near-term AI advancements, specialties like radiology could be completely eliminated. Radiologists wouldn't gain more power. They would be completely useless.
Come to think of it, are radiologists starting to sweat? IIRC, radiology is one of the hardest specialties to get a residence in. Is that starting to loosen?
I recall hearing about radiology in particular, how it's already been subject to being upset by telehealth and cheaper overseas competition. But radiologist is still a good living.
More options
Context Copy link
I'm not sure you understand what anesthesiologists actually do. Gas providers are pilots, if you assume 100% of the work is when the plane is on cruise control, sure... But take off and landing are a thing. And emergencies. And routine (and emergent) prep and post work. Also the other things gas does in the hospital (especially for OB and EM but also general procedural work).
This post on meddit outlines some specific.
https://old.reddit.com/r/medicine/comments/10wj8ma/anesthesiologists_how_well_could_crnas_do_your_job/j7ohdyo/
It depends on the region but the average is more 300-500.
And because you don't know anything about Anesthesia. To some extent this is fair, patients don't interact with gas much and medical TV shows are uniformly misinforming, but you haven't show any evidence for the idea that they don't do anything complicated or useful to be a reasoned and informed belief.
The pilot analogy is apt. Most people intuit that takeoff and landing are harder, and that emergencies sometimes happen. They don't know about ground prep and the other stuff pilots do. I'm not sure you are naturally making those connections here and "lol nah I'm not going to read that" does not help you become better informed.
To be maximally charitable to you it is reasonable to figure this guy is talking up what gas does (or more realistically is ignoring the difference between lazy docs and hard working ones) but that doesn't change the fact that their are multiple fundamental every shift job roles you aren't aware of.
More options
Context Copy link
More options
Context Copy link
I'd love to see an AI try and intubate someone, or deal with a difficult airway. Or give spinal anaesthesia, or an epidural, or a brachial plexus block. Anaesthesiology is much more procedure oriented than you think. There is no chance it could be done by a robot without tremendous technological advances.
More options
Context Copy link
How? I imagine the person making sure you are anaesthetised, breathing, and not having a heart stoppage during surgery is a bit necessary? Or are you saying this is something that could be completely automated?
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
The AMA cartel will ensure Doctors get paid 400k a year even a century after the Singularity.
You do realize the AMA primarily lobbies in support of lower salaries for doctors right?
More options
Context Copy link
surely the AMA can't prevent these innovations from being used in other countries?
Would be the ultimate example of "America leads the way in new medical tech, the rest of the world leads the way in making it not break the banks of patients." Medical tourism would skyrocket.
More options
Context Copy link
More options
Context Copy link
Imagine craft guilds having more influence centuries ago, imagine laws ensuring that every newfangled machine had to be operated only by fully trained and qualified Master Spinner, Master Weaver and Master Tailor.
Your clothes would cost half of your yearly income, but they would be awesome.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link