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self_made_human

Kai su, teknon?

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joined 2022 September 05 05:31:00 UTC

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!

Friends:

I tried stuffing my friends into this textbox and it really didn't work out.


				

User ID: 454

self_made_human

Kai su, teknon?

16 followers   follows 0 users   joined 2022 September 05 05:31:00 UTC

					

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!

Friends:

I tried stuffing my friends into this textbox and it really didn't work out.


					

User ID: 454

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.

I expect this would work. You could have the AI be something like GPT-4o Advanced Voice for the audio communication. You could record video and feed it into the LLM. This is something you can do now with Gemini, I'm not sure about ChatGPT.

You could, alternatively, have a human (cheaper than the doctor) handle the fussy bits. Ask the questions the AI wants asked, while there's a continuous processing loop in the background.

No promises, but I could try recording a video of myself pretending to be a patient and see how it fares.

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!).

I mean, quite a few of the authors are doctors, and I presume they'd also have a stake in us being gainfully employed.

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'd take orders from an LLM, if I was being paid to. This doesn't represent the bulk of a doctor's work, so if you keep a fraction of them around.. People are already being conditioned to take what LLMs take seriously. They can be convinced to take them more seriously, especially if vouched for.

I haven't seen any papers on an LLMs attempts to get someone to take their 'beetus medication vs a living breathing person.

That specific topic? Me neither. But there are plenty of studies of the ability of LLMs to persuade humans, and the very short answer is that they're not bad.

The main reason is that we invented neuroleptic drugs that worked. It's cheaper and easier to treat a raving, flagrantly psychotic schizophrenic with antipsychotics instead of surgery, and you don't have to cause nearly as much collateral damage.

At some point it seems we decided that it wasn't actually worth it, as far as I can tell.

They made violently mad lunatics docile. While risking destroying higher cognition, being dangerous surgery, and so on. The drugs sometimes suck donkey cock, but they're better than that. Lobotomies were also often used for people who weren't violent lunatics, just to make them easier to handle, which certainly didn't help their reputation.

These days, in rare cases, we perform surgeries like stereotactic cingulotomy, which is a far more targeted technique of cutting or destroying aberrant parts of the brain. Same theory as lobotomy, if you squint, but nowhere near as messy. Works okay, if nothing else does.

Medicine isn't my wheelhouse, but the repeated failure to turn what should be lots of test data into verifiable claims of strong evidence suggests that the evidence isn't as glowing as the rhetoric would require. Which colors me cynical about much of the whole movement, but that's just my opinion.

I happen to share that opinion, presuming you're talking about gender affirming/reassignment care.

I apologize for the hyperbole, and those are mostly valid considerations. I don't think traffic, driver behavior and crime matters, if they can work in SF at a profit. The other three are solvable or quasi-solved, regulation definitely is.

I'm a doctor. I think LLMs are very "pragmatic" or at least immensely useful for my profession. They could do much more if regulatory systems allowed them to.

On the topic of hallucinations/confabulations from LLMs in medicine:

https://x.com/emollick/status/1899562684405670394

This should scare you. It certainly scares me. The paper in question has no end of big names in it. Sigh, what happened to loyalty to your professional brethren? I might praise LLMs, but I'm not conducting the studies that put us out of work.

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.

I expect that without medical education, and only googling things, the average person might get by fine for the majority of complaints, but the moment it gets complex (as in the medical presentation isn't textbook), they have a rate of error that mostly justifies deferring to a medical professional.

I don't think this is true when LLMs are involved. When presented with the same data as a human clinician, they're good enough to be the kind of doctor who wouldn't lose their license. The primary obstacles, as I see them, lie in legality, collecting the data, and the fact that the system is not set up for a user that has no arms and legs.

I expect that when compared to a telemedicine setup, an LLM would do just as well, or too close to call.

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.

I disagree that they can't handle vagary. They seem epistemically well calibrated, consider horses before zebras, and are perfectly capable of asking clarifying questions. If a user lies, human doctors are often shit out of luck. In a psych setting, I'd be forced to go off previous records and seek collateral histories.

Complex comorbidities? I haven't run into a scenario where an LLM gave me a grossly incorrect answer. It's been a while since I was an ICU doc, that was GPT-3 days, but I don't think they'd have bungled the management of any case that comes to mind.

Physical exams? Big issue, but if existing medical systems often use non-doctor AHPs to triage, then LLMs can often slot into the position of the senior clinician. I wouldn't trust the average psych consultant to find anything but the rather obvious physical abnormalities. They spend blissful decades avoiding PRs or palpating livers. In other specialities, such as for internists, that's certainly different.

I don't think an LLM could replace me out of the box. I think a system that included an LLM, with additional human support, could, and for significant cost-savings.

Where I currently work, we're more bed-constrained than anything, and that's true for a lot of in-patient psych work. My workload is 90% paperwork versus interacting with patients. My boss, probably 50%. He's actually doing more real work, at least in terms of care provided.

Current setup:

3-4 resident or intern doctors. 1 in-patient cons. 1 outpatient cons. 4 nurses a ward. 4-5 HCAs per ward. Two wards total, and about 16-20 patients.

?number of AHPs like mental health nurses and social workers triaging out in the community. 2 ward clerks. A secretary or two, and a bunch of people whose roles are still inscrutable to me.

Today, if you gave me the money and computers that weren't locked down, I could probably get rid of half the doctors, and one of the clerks. I could probably knock off a consultant, but at significant risk of degrading service to unacceptable levels.

We're rather underemployed as-is, and this is a sleepy district hospital, so I'm considering the case where it's not.

You would need at least one trainee or intern doctor who remembered clinical medicine. A trainee 2 years ahead of me would be effectively autonomous, and could replace a cons barring the legal authority the latter holds. If you need token human oversight for prescribing and authorizing detention, then keep a cons and have him see the truly difficult cases.

I don't think even the ridiculous amount of electronic paperwork we have would rack up more than $20 a day for LLM queries.

I estimate this would represent about £292,910 GBP in savings from not needing to employ those people, without degrading service. I think I'm grossly over-estimating LLM query costs, asking one (how kind of it) suggests a more realistic $5 a day.

This is far from a hyperoptimized setup. A lot of the social workers spend a good fraction of their time doing paperwork and admin. Easy savings there, have the rest go out and glad-hand.

I re-iterate that this is something I'm quite sure could be done today. At a certain point, it would stop making sense to train new psychiatrists at all, and that day might be now (not a 100% confidence claim). In 2 years? 5?

You're in luck, because just a day or so ago I went into a lengthy explanation of why I'm not an advocate of gender reassignment surgery, and why transhumanism is as distinct from trans ideology as cats are from dogs:

https://www.themotte.org/post/1794/culture-war-roundup-for-the-week/311661?context=8#context

When I want to be a 6'9" muscular 420 IQ uber-mensch, I want that to be a fact about physical reality. There shouldn't be any dispute about that, no more than anyone wants to dispute the fact that I have black hair right now.

I do not think that putting on high heels and bribing my way into Mensa achieves my goal. I do not just want to turn around and say that because I identify as a posthuman deity, that I am one and you need to acknowledge that fact.

This explains why I have repeatedly pointed out that while I have no objection to trans people wanting to be the opposite sex, that they need to understand the limitations of current technology. I would have hoped that was obvious, why else would I pull terms like ersatz or facsimile out of my handy Thesaurus?

Looking back, I didn't even mean it as an analogy. I sought to show that the standard he was advancing ruled out something considered benign or noble. It's the equivalent of someone pointing out that a No Parking prohibition on a street should make allowances for emergencies or an ambulance.

Hence that if you want to condemn such a procedure, you need different considerations. Which there are, which I haven't denied.

I was being literal, sufficiently bad cyanotic heart disease can literally make your heart blue. You'd have more pressing concerns at that point other than the color.

I'd be a tad bit concerned if my heart was, for example, a shade of blue. I'm not quite sure how I'd find out in the normal course of things, but it can happen, and represents a rather concerning situation.

Note that I'm objecting to the standards being used by the person I was replying to. I'm not a fan of gender reassignment surgery, or hormones, or putting on a dress.

You're welcome! I'm not the best doctor around, but I have an unusual amount of time to spare for people on the internet. The better ones are probably doing heart surgery or something haha.

What if it's a surgery that doesn't solve a life-threatening problem, but holds the possibility of significantly improving quality of life? There are no end of heart conditions that won't kill you, but will make you miserable and make a normal life hard.

Most analogies are imperfect, few things are perfectly isomorphic to other things. I stand by mine as relevant and useful.

https://www.quantamagazine.org/how-computationally-complex-is-a-single-neuron-20210902/

They started by creating a massive simulation of the input-output function of a type of neuron with distinct trees of dendritic branches at its top and bottom, known as a pyramidal neuron, from a rat’s cortex. Then they fed the simulation into a deep neural network that had up to 256 artificial neurons in each layer. They continued increasing the number of layers until they achieved 99% accuracy at the millisecond level between the input and output of the simulated neuron. The deep neural network successfully predicted the behavior of the neuron’s input-output function with at least five — but no more than eight — artificial layers. In most of the networks, that equated to about 1,000 artificial neurons for just one biological neuron.

But something is clearly lost: what else would explain the great efficiency of biological versus human systems in terms of power consumption.

I really don't see this as a good explanation. We know that there are brains that are more efficient, by volume. Avian neurons are smaller, packed more densely, but can create a very smart animal that uses tools. You can find a wide range of "efficiency" values in biology, the human brain isn't particularly special.

I think it's far more likely that the brain's architecture is just very well optimized for its constraints, and power draw is a very important constraint. Running an LLM that is human level in reasoning (or close enough) uses a lot more power, but an 8B model can be surprisingly smart and run on a smartphone. I bet a model like that is "smarter" than a human child in relevant domains for far less power. Silicon computers are also far faster in terms of clock speed. They are incredibly reliable in terms of error rate and consistency. You've chosen IQ/watt as the metric in advance (and it's important), but silicon computers have enormous advantages that biology can only dream of. You can imagine the analogous situation, trying to convince people that it's important to simulate things like electron tunneling causing power draw in very small transistors (which is true), when that has no relevance to actually emulating a computer.

None of this requires quantum effects to be an irreducible aspect of human computation. Nor that it's responsible for the relative efficiency.

I mean, I assume both of us are operating on far more than 2 data points. I just think that if you open with an example of a model failing at a rather inconsequential task, I'm eligible to respond with an example of it succeeding at a task that could be more important.

My impression of LLMs is that in the domains I personally care about:

  1. Medicine.
  2. Creative fiction
  3. Getting them to explain random things I have no business knowing. Why do I want to understand lambda calculus or the Church Turing hypothesis? I don't know. I finally know why Y Combinator has that name.

They've been great at 1 and 3 for a while, since GPT-4. 2? It's only circa Claude 3.5 Sonnet that I've been reasonably happy with their creative output, occasionally very impressed.

Number 3 encompasses a whole heap of topics. Back in the day, I'd spot check far more frequently, these days, if something looks iffy, these days I'll shop around with different SOTA models and see if they've got a consensus or critique that makes sense to me. This almost never fails me.

And I don't get your example, wouldn't the NICE CKS be in the dataset many times over?

Almost certainly. But does that really matter to the end user? I don't know if the RS wiki has anti-scraping measures, but there's tons of random nuggets of RS build and items guide all over the internet. Memorization isn't the only reason that models are good, they think, or do something so indistinguishable from the output of human thought that it doesn't matter.

If you met a person who was secretly GPT-4.5 in disguise, you would be rather unlikely to be able to tell at all that they weren't a normal human, not unless you went about suspicious from the start. (Don't ask me how this thought experiment would work, assume a human who just reads lines off AR lenses I guess).

These tools are amazing as search engines as long as the user using them is responsible and able to validate the responses. It does not mean they are thinking very well. Which means they will have a hard time doing things not in the dataset. These models are not a pathway to AGI. They might be a part of it, but it's gonna need something else. And that/those parts might be discovered tomorrow, or in 50 years.

This is a far more reasonable take in my opinion, if you'd said this at the start I'd have been far more agreeable.

I have minor disagreements nonetheless:

  1. 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.
  2. This means that unless it's mission critical, the average user can usually get by with taking answers at face value. If it's something important, then checking is still worthwhile.
  3. Are current models AGI? Who even knows what AGI means these days. By most definitions before 2015, they count. It's valid to argue that that reveals a weakness of those previous definitions, but I think that at the absolute bare minimum these are proto-agi. I expect an LLM to be smarter and more knowledgeable and generally flexible than the average human. I can't ask a random person on the street what beta reduction is and expect an answer unless I'm on the campus of a uni with a CS course. That the same entity can also give good medical advice? Holy shit.
  4. Are the current building blocks necessary or sufficient for ASI? Something so smart than even skeptics have to admit defeat (Gary Marcus is retarded, so he doesn't count)? Maybe. Existing ML models can theoretically approximate any computable function, but something like the Transformer architecture has real world limitations.

And I don't see why reality will smack me in the face. I'm already using these as much as possible since they are great tools. But I don't expect my work to look very different in 2030 compared to now. Since programming does not feel very different today compared to 2015.

Well, if you're using the tools regularly and paying for them, you'll note improvements if and when they come. I expect reality to smack me in the face too, in the sense that even if I expect all kinds of AI related shenanigans, seeing a brick wall coming at my car doesn't matter all that much when I don't control the brakes.

For a short span of time, I was seriously considering switching careers from medicine to ML. I did MIT OCW programs, managed to solve one Leetcode medium, and then realized that AI was getting better at coding faster than I would. (And that there are a million Indian coders already, that was a factor). I'm not saying I'm a programmer, but I have at least a superficial understanding.

I distinctly remember what a difference GPT-4 made. GPT-3.5 was tripped up by even simple problems and hallucinated all the time. 4 was usually reliable, and I would wonder how I'd ever learned to code before it.

I have little reason to write code these days, but I can see myself vibe-coding. Despite your claims that you don't feel that programming had changed since 2015, there are no end of talented programmers like Karpathy or Carmac who would disagree.

Thanks for the comment btw, it made me try out programming with gemini 2.5 and it's pretty good.

You're welcome. It's probably the best LLM for code at the moment. That title changes hands every other week, but it's true for now.

Beta blockers have mild effects on memory, and do make you very slightly dumber. It's not the biggest deal in the world, but they're also not the first choice for anxiety or someone who wants to be able to relax more.

They've got a slew of other side effects, but I agree that they're not particularly dangerous. I can see the more avant-garde doctor prescribing them like this, with coaxing.

That is an entirely different objection, and at least in the UK, doctors have the ability to override parental decisions if deemed in the best interest of parents, especially if the child agrees. And the definition of child here is 16 and below, no line in the sand, as long as the doctors think they're able to understand the risks and benefits.

In less politicized contexts, if not heart surgery, kids can be taken away if their parents are doing an egregiously bad job at handling their health.

This is all true, and for all the many failings of British governance, things seem to work fine here.

I make no comment on whether or not gender affirming care is something that should be treated in this manner, only that the previous standard suggested was poorly formed.

The same argument applies for signing up for experimental heart surgery.

You can do that right now if you cared to.

Find a site like piaotian that has raw Chinese chapters. Throw it into a good model. Prompt to taste. Ideally save that prompt to copy and paste later.

I did that for a hundred chapters of Forty Millenniums of Cultivation when the English translation went from workable to a bad joke, and it worked very well.

(Blizzard arc was great. The only part of the book I recall being a bit iffy was the very start)

You're correct that I'm being generous. Expecting a system as macroscopic and noisy as the brain to rely on quantum effects that go away if you look at them wrong is a stretch. I wouldn't say that's impossible, just very, very unlikely. It's the kind of thing you could present at a neuroscience conference, without being kicked out, but everyone would just shake their heads and tut the whole time.

If this were true, then entering an MRI would almost certainly do crazy things to your subjective conscious experience. Quantum coherence holding up to a tesla-strong field? Never heard of that, at most it's incredibly subtle and hard to distinguish from people being suggestible (transcranial magnetic stimulation does do real things to the brain). Even the brain in its default state is close to the worst case scenario when it comes to quantum-only effects with macroscopic consequences.

And even if the brain did something funky, that's little reason to assume that it's a feature relevant to modeling it. As you've mentioned, there's a well behaved classical model. We already know that we can simulate biological neurons ~perfectly with their ML counterparts.

I've done dozens, or even a hundred pages with good results. An easy trick is to tell it to rip off the style of someone you like. Scott is easy pickings, ACX and SSC is all over the training corpus. Banks, Watts and Richard Morgan work too.

Taste is inherently subjective, and I raise an eyebrow all the way to my hairline when people act as if there's something objective involved. Not that I think slop is a useless term, it's a perfectly cromulent word that accurately captures low-effort and an appeal to the LCD.

Then again, that same man recommended a Chinese web novel with atrocious writing style to people, so maybe his bar is lower than many.

Fang Yuan, my love, he didn't mean it! It's a good novel, this is the hill I'm ready to die on.

I've enjoyed getting Gemini 2.5 and Grok 3 to write a new version of Journey to the West in Scott Alexander's style. Needs an edit pass, but it's close to something you'd pay money for.

PS: You need to @ instead of u/. That links to a reddit account, and doesn't ping.

This is highly speculative, and a light-year away from being a consensus position in computational neuroscience. It's in the big if true category, and far from being confirmed as true and meaningful.

It is trivially true that human cognition requires quantum mechanics. So do everything else. It is far from established that you need to explicitly model it at that detail to get perfectly usable higher level representations that ignore such detail.

The brain is well optimized for what's possible for a kilo and change of proteins and fats in a skull at 37.8° C, reliant on electrochemical signaling, and a very unreliable clock for synchronization.

That is nowhere near the optimal when you can have more space and volume, while working with designs biology can't reach. We can use copper cable and spin up nuclear power plants.

I recall @FaulSname himself has a deep dive on the topic.

I always keep an eye out for your takes. You need to be more on the ball so that I can count on you appearing out of a dim closet every time the whole AI thing shows up here.

I see no particular reason that a copilot for writing couldn't exist, but as far as I can tell it doesn't (unless you count something janky like loom).

I'm a cheap bastard, so I enjoy Google's generosity with AI Studio. Their interface is good, or at the least more powerful/ friendly for power-users than the typical chatbot app. I can fork conversations, regenerate responses easily and so on. It doesn't hurt that Gemini 2.5 is great, the only other LLM I've used that I like so much is Grok 3.

I can see better tooling, and I'd love it. Maybe one day I'll be less lazy and vibe code something, but I don't want to pay API fees. Free is free, and pretty good.

And then instead of leveraging that we for whatever reason decided that the way we want to use these things is to train them to imitate professionals in a chat room who are writing with a completely different process (having access to tools which they use before responding, editing their writing before hitting "send", etc).

Gemini 2.5 reasons before outputting anything. This is annoying for short answers, but good on net. I'm a nosy individual and read its thoughts, and they usually include editing and consistency passes.

The stricter and stronger your Prune filter, the higher quality content you stand to produce. But one common bug is related to this: if the quality of your Babble is much lower than that of your Prune, you may end up with nothing to say. Everything you can imagine saying or writing sounds cringey or content-free. Ten minutes after the conversation moves on from that topic, your Babble generator finally returns that witty comeback you were looking for. You'll probably spend your entire evening waiting for an opportunity to force it back in.

I'm always glad that my babble usually comes out with minimal need for pruning. Some people can't just write on the fly, they need to plot things out, summarize and outline. Sounds like a cursed way to live.

This got a report, though I don't think it's mod worthy.

Why single out whites? I'm pretty sure that current SOTA models, in the tasks they're competent at, outperform the average of any ethnic group. I can have far more interesting conversations with them than I can with a 105 IQ redditor.

Cheer up, that particular scenario seems quite unlikely to me. Most things get cheaper with time, due to learning curves and the benefits of scale if nothing else. I expect that once we establish working life extension at all, it won't be too long before it's cheap and/or a human right. You'll probably live that long.