Throwaway05
2d ago
Every kernel of medicine has room for controversy, as Nybbler points out below. Where to prioritize resources, how research works (what do you do about males disproportionately signing up to be test dummies? ....a million other things. Some of it is certainly the "social" end of medicine like how to train and teach (is advocacy required?) but the hard science parts of it have plenty of dimensions.
Ethics are also fundamental to medicine and fundamentally on the spectrum of controversy.
Throwaway05
3d ago
I mean Medicine for instance is an example of a STEM field which can't function with the level of ideological mono polarity currently present in it - anything remotely politically controversial is super unreliable.
Throwaway05
3d ago
You feel really, really sad about that and want to undergo surgery to make them larger. Is that mental illness?
No real dog in the rest of this fight but I should point out that some of the plastic surgeons I've met believe that ANY desire for their services is fundamentally body dysmorphia (and therefore mental illness).
Even things as simple as nose jobs.
Throwaway05
4d ago
Holy shit. In the U.S? I know of a few but very very few at this point.
Even the VA figured this shit out.
Throwaway05
4d ago
Please do!
Throwaway05
4d ago
That may or may not be already starting to happen.
I hope so!
In any case what I wanted to make clear is that the experience some people have had with academia is so terrible that no level of alarmism is an exaggeration. Your corner (and in fact many or most corners) may be reasonable but a large enough chunk of it is not reasonable that it causes real problems and for those of us who have seen it - .....well burning everything to the ground doesn't sound terribly unreasonable.
Throwaway05
4d ago
I mean, quite a few of the authors are doctors, and I presume they'd also have a stake in us being gainfully employed.
Nah most of us Get Too Excited About Making A Difference.
Sidebar- I was watching "In Good Company" at lunch today (podcast in which the manager of Norway's sovereign wealth fund interview the most successful people in the world) and the CEO of Goldman asked Nicolai about the best features in leaders - empathy was one of them! And this was noted in the context of LLMs taking over other parts of the job for many things!
Empathy and leadership are core to being a physician (at least in the U.S.) and if two of the world's most successful people are going to emphasize the importance of that I'm going to imagine we will be well positioned lol.
Throwaway05
4d ago
Do keep in mind how terrible most medical research is, and that includes research into our replacements. This isn't from lack of effort but from the various systems, pressures, and ethics at play.
How do you simulate a real patient encounter when testing an LLM? Well maybe you write a vignette (okay that's artificial and not a good example. Maybe you sanitize the data inputs and have a physician translate into the LLM. Well shit, that's not good either.
Do you have the patient directly talk to the LLM and have someone else feed in lab results? Okay maybe getting closer but let's see evidence they are actually doing that.
All in the setting of people very motivated to show the the tool works well and therefore are biased in research publication (not to mention all the people who run similar experiments and find that it doesn't work but can't get published!).
You see this all the time in microdosing, weed, and psychedelic research. The quality is ass.
Also keep in mind that a good physician is a manager also - you are picking up the slack on everyone else's job, calling family, coordinating communication for a variety of people, and doing things like actually convincing the patient to follow recommendations.
I haven't seen any papers on an LLMs attempts to get someone to take their 'beetus medication vs a living breathing person.
Also Psych will be up there with the procedurealists in the last to be replaced.
Also also other white collar jobs will go first.
Throwaway05
4d ago
I think that is just a failure state of all belief systems, like when I came "out" as an atheist, I heard a lot of "but you're a good person, how can you want to be an atheist" and the like, and many Christians say they don't think atheists can be moral people at all. That is basically the same argument you are getting.
I think the greater problem is not that identity politics is filled with lack of introspection and hypocrisy, those are not new inventions.
Over the last several thousand years society has developed an insufficient but ultimately extant immune system for dealing with overreach by religions. That's an infectious memeplex that leads to lack of introspection and hypocrisy and all kinds of bad outcomes. We are reasonably good at dealing with that.
Marxism and Cultural Marxism though.... we haven't figured that out yet. We've seen what happens with communists every time, and it still has major proponents. Woke stuff is similar and we seem to have a completely absent immune system to it.
Downstream of that is the Rs lashing out with immense fury and toppling everything they can when they finally have a chance to strike back in the slightest.
While I do think medicine is probably worse than academia in general, I've also had a number of conversations with people in academia who thought anti-whiteness or whatever was overblown and what was happening was that they were drinking the koolaid, doing well and not realizing the ladder had been kicked over behind them, not used to thinking of the possibility of discrimination being aimed at them, and so on. I've also met people who it seemed to not be happening for them at all. It is tricky because both exist.
Throwaway05
4d ago
I'll PM you for opsec reasons but for others who might be reading it's not too dissimilar.
I'm amenable to the idea that the problem is in medicine specifically, since one of the biggest issues as far as I can tell is that conservatives are "known" to not be tolerant, and "tolerance" is a core and required part of being a physician. If you are assumed to be intolerant...well your license should be taken away (at least from the academia side of medicine, and as long as you aren't bringing in enough money that you are immune haha (this is how surgeons save themselves)).
The left seems to have no conception of the idea that they may be intolerant in general or have areas in which they are intolerant, or that some right leaning people (classically: good Christians) can be very tolerant.
Even when arguing with my own family members, some of whom are elected officials or otherwise deeply intwined with the Democratic Party I get a lot of "I don't understand, you are so kind and tolerant with your patients but not when we talk about politics." Admittedly some of it is "intolerant" but most of what I say is just...not woke.
I guess what I'm getting at is that there seems to be an assumption that certain good attributes are definitionally associated with woke politics and the greater left as far as some are concerned, and some of that drifts into beliefs of competence and descriptions of such. Likewise bad attributes can never apply to team blue.
Throwaway05
4d ago
Actually I think it might be more helpful to emphasize the natural history of a lot of my interactions with students and faculty these days.
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On meeting me they assume and worry I'm conservative based off of my physical appearance, demographics, and superficial temperament.
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They then express relief (sometimes explicitly) when they find out I'm calm, caring, have a good bedside manner and am overall not an asshole and am a good teacher - because someone with these features couldn't be conservative.
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Sometimes, I later reveal heterodox opinions (generally because the person appears right leaning and needs support or because the person is pretty moderate and needs to know that nice heterodox people exist). I frequently hear "I would never believe you were one of those people."
It certainly reminds me of how some people treated minorities back in the day.
I'm sure what is happening is that high end institutions and certain "other" institutions are particularly bad (I've observed the former uniformly and the latter seems centered around institutions that have been criticized for what is in essence, inadequacy - plenty of places have small dick energy) ...and some others are not.
I'm also coming from the place of medicine which I'm willing to admit might be more vulnerable to these games.
But the reason why I responded is my morning report this morning, in which the Elon Musk/Immigration stuff was talked about, their were zero facts to be had, total spouting of contextless fake news (and that's in the setting of news stories which sound plenty bad enough to many people). Several people were visibly uncomfortable and wanted to correct things but clearly didn't, and their was a noticeable subtext of "obviously nobody here for this would be stupid and evil enough to be Republican, since our job requires caring for people and being intelligent."
In other settings I've seen that evolve into - well if you are Republican you can't be a doctor because you don't care about people. That has a massively chilling effect on conservatives as you'd imagine.
Some departments are better at avoiding this (Periop specialities for instance) but the closer you get to teaching responsibilities the more that goes away.
Republican identifying people can't be trusted with the students is Known To All.
Edit: actually I want to try a difference answer frame to this, will reply to above.
Throwaway05
4d ago
99% of the time or more, what current models say in my field of expertise (medicine) is correct when I check it. Some people claim to experience severe Gell-Mann amnesia when using AI models, and that has not really been my experience.
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Okay can we get people to start using delusions or confabulations instead of hallucinations. This always irks me.
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I know we've bickered about this in the past but I think you have to be very cautious about what decision support tools and LLMs are doing in practical medicine at this time - fact recall is not most of the problem or difficulty.
The average person here could use UpToDate to answer many types of clinical questions, even without the clinical context that you, I, and ChatGPT have.
That's not the hard part of medicine. The hard part is managing volume (which AI tools can do better than people) and vagary (which they are shit at). Patients reporting symptoms incorrectly, complex comorbidity, a Physical Exam, these sorts of things are HARD.
Furthermore the research base in medicine is ass, and deciding if you want a decision support tool to use the research base or not is not a simple question.
Throwaway05
4d ago
Now I don't work for an an Ivy League school or indeed any of the top ranked schools so maybe its more common and problematic there. But I think people have skewed ideas about academia as a whole, by looking at say Harvard or Columbia.
I don't know about that, I've been attached to X academic institutions in the last X years (sorry, vague, opsec blah blah) and while I've never had to write a diversity statement I also don't know any faculty who are "out" as a Republican and I know of exactly one student (who was widely criticized and socially censured).
I know plenty of students and faculty who hide their affiliation (in fact...it is a lot), and I've seen how both are treated when they are assumed to be Republicans (often by demographics and shallow stuff like owning a truck) and the way they are treated is about even with how old school racists treated Blacks.
In my experience academia is even worse than you'd guess from the stories.
Throwaway05
5d ago
As much as the right complains about this, the wound is entirely self-inflicted.
I think this line of thinking misses where the wound actually is - it isn't that conservatives are absent from the academy (although we do focus on that a lot, in part because it is easier to point at when it comes to data), it is that the academy can't function in their absence.
Gender studies can be a real discipline in the absence of conservatives, in the same way that most theological work can. But it isn't.
The current lack of representation would be unfortunate but otherwise benign, instead it has become an existential threat as most academic institutions can't manage to be anything other than a lobbying arm of the progressive wing of team blue.
Asking the conservatives to be there to intervene is about as dumb as saying "why weren't you there to stop me from shooting myself????"
Maybe they kicked themselves out maybe they got kicked out. That might be a problem but it isn't the root of the issue.
Throwaway05
5d ago
Do you have a citation for this? Asking because it makes sense to me and I'd like to be able to use this while arguing lol.
Throwaway05
5d ago
paper drug charts
plz no. I thought I had escaped
Throwaway05
5d ago
I'm just put off by the mild logistical headaches I might face if someone asks me why existing samples on various documents don't match what I put elsewhere
As is the doctor classic, my signature is so bad that nobody can forge it...not even me. It has never caused problems.
Throwaway05
6d ago
....don't tell my partner how much this intrigues me lol
Throwaway05
6d ago
My guess is that "trans stuff" is a mixture of:
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Legitimate trans, whatever that means.
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Social contagion in various forms.
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Malingering (see: prison).
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A manifestation of some other mental illness (most commonly cluster-b pathology like borderline personality disorder).
Anybody who works in a prison will "know" that trans is just inmates looking for special privileges or being super crazy. Anybody who works in an inpatient psychiatric unit "knows" that it's all personality disorders. Most people who live in SF will be convinced that the real people are out there or will note that everyone seems to have some level of social disaffection.
Scholarly sources are biased and refuse to unlump these things despite identity disturbance being a DSM feature for BPD.
The media conversation is no better.
Until we can have a healthy conversation about this we have zero ability to untangle the phenotypes and figure out when they are applying (especially for vulnerable populations like children) and what to do with that information.
Throwaway05
6d ago
Most women I know can't move a couch or other large furniture (yes some of this is driven by social class and racial dynamics and so on) but if she can you are doing good! I suspect in upper-middle class and upper class groups the women are less athletic, less practical, and when athletic lean more towards running builds.
And perhaps the person in OP's link also cannot so he assumes that is normal.
Throwaway05
6d ago
Lower weight classes offer different opportunities to view excellence - supreme speed, reaction time, endurance, doggedness. Big Man Smash Good certainly looks more attractive and brings eyeballs, but the other stuff is entertaining and a showcase in its own way, and in a way that women's classes aren't.
Throwaway05
6d ago
It's not a very serious thing, the "award" offers no material benefits, but it would be nice to have any kind of reminder that my efforts were appreciated every now and then. Welp, just a signal to try even less hard next time.
External validation is important but often forgotten - however you can try and focus on the good you did though. You helped out that client no? Quite a bit in fact. You did good in the world. How many people can say that about the job they do?
A pat on the back from your job is certainly satisfying but you just did something to help someone. That's amazing!
Use that to motivate you.
Throwaway05
6d ago
"Will somebody please think of the children" has always been the refrain of moral busybodies lol.
I was terrified when the democrats stopped listening to the court system (ex: gun control), ignored violent protests (BLM) and engaged in unprecedented law fare against individual politicians and an entire voting block (ex: anti-BLM, J6).
This is just more of the same or better than all that.
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