The medical student as ChatGPT

by reestheskin on 26/05/2023

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I am amused that people are slow to realise that large language models (ChatGPT etc) do not understand what they are saying, or that they make things up — that is, they hallucinate. Performance on “surface layer” testing does not equate to competence. Anybody who has taught medical students knows that humans are quite capable of exhibiting the same behaviour. It was one of the values of the old fashioned viva. You could demonstrate the large gulf between understanding (sense)on the one hand, and rote — and fluent rote at that — simulation on the other (garbage).

The medical educationalists, obsessed as they are with statistical reliability, never realised that the viva’s main function was for the benefit of teachers rather than learners. It is called feedback.

The medical student as ChatGPT

Look up, not down

“in a mammoth bureaucracy obsessed with its own secrecy, the fault lines are best observed by those who, instead of peering down from the top, stand at the bottom and look up.

Absolute Friends by John le Carré

True of the NHS.

The Crumbling of a World Order

The New Age of Tragedy – New Statesman

Good article, with contributions from Robert Kaplan, Helen Thompson and John Gray.

Helen Thompson

Faith that creative human agency can triumph over nature’s limits has been a central feature of most modern political projects, not least liberalism. Missing the fact that technology cannot create energy, this conviction has long proved overly sanguine. Those who assume that the political world can be reconstructed by the efforts of human will have never before had to bet so much on technology over energy as the driver of our material advancement.

We are now a long way removed from the revolutionary hopes of the 19th and 20th centuries that the transformation of collective life would mean the complete development of all natural resources and an end to scarcity

Robert D Kaplan

To keep from destroying ourselves in this Malthusian world, we will have to husband fear without being immobilised by it. We cannot assume that technology will come to the rescue of every dilemma. The Ancient Greeks argued that no man is lucky until he is dead, since catastrophe can befall any of us at any moment. To carry that over into humanity at large, we should not assume that catastrophe cannot befall us at any moment or in any historical period. That is, we will need to think tragically in order to avoid tragedy. And precisely because our civilisation is rubbing up against limits of resources and space, such tragic thinking is more vital than ever before. (Robert D Kaplan)

Yet, it is less in evidence. Rishi Sunak and Keir Starmer in Britain are technocrats in spirit and background, and technocrats assume there is a solution to every problem, which leads to a certain arrogance. Meanwhile, the American political elite is more ideological than ever before, and this leads to another form of arrogance; the world’s problems will not go away if only all of humanity became democratic – as the American elite seems to believe.

I fear that the elites in both Britain and the US will have to learn about tragedy the hard way, by actually living it, due to their failures in seeing it ahead of time.

From the editorial:

Mr Kaplan’s recent book The Tragic Mind is an attempt to grapple with his past support for the Iraq War, which led him to suffer clinical depression for years afterwards. Having visited Fallujah in 2004 and found anarchy far worse than Saddam Hussein’s tyranny, he concluded: “I had failed my test as a realist… I helped promote a war in Iraq that resulted in hundreds of thousands of deaths.”

It’s bleak out there.

The danger isn’t that AI destroys us. It’s that it drives us insane

by reestheskin on 26/04/2023

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The danger isn’t that AI destroys us. It’s that it drives us insane

Tech guru Jaron Lanier: ‘The danger isn’t that AI destroys us. It’s that it drives us insane’ | Jaron Lanier | The Guardian

Although many of the digital gurus started out as idealists, to Lanier there was an inevitability that the internet would screw us over. We wanted stuff for free (information, friendships, music), but capitalism doesn’t work like that. So we became the product – our data sold to third parties to sell us more things we don’t need. “I wrote something that described how what we now call bots will be turned into these agents of manipulation. I wrote that in the early 90s when the internet had barely been turned on.” He squeals with horror and giggles. “Oh my God, that’s 30 years ago!”

Horses for courses

Unseen Camilla: the five ages of a future queen – from mistress to monarchy | Camilla (Queen Consort) | The Guardian

Public schools exist to create the material they need for the class they want to build. When Eton needed soldiers, it was a very harsh environment; later, when it needed shysters and chancers, it adapted successfully to produce Boris Johnson and David Cameron. The girls’ estate is no different – and in the 50s and 60s it needed hostesses and broodmares. The last thing you would have wanted them to emerge with was a bunch of O-levels.

A home that no longer feels like it

Farewell to Dubravka Ugrešić, a fearless prophet | Financial Times

In 1993, Ugrešić went into voluntary exile, first to Berlin and then the US, finally settling in Amsterdam and taking Dutch citizenship. In a 1999 article, she repeated what she had often said: “I myself am neither an émigré nor a refugee nor an asylum seeker. I am a writer who at one point decided not to live in her own country anymore because her country was no longer hers.”

Fellow writers relished her work — Susan Sontag called her “a writer to be cherished” — but unlike many of her contemporaries, Ugrešić predicted the future of publishing too. In 1997, she saw that literature had, fatally, acquired an “aura of glamour”, and that publishers wanted writers to be chiefly “content providers” (the term was new enough then to be carried in quotes). What would become, she asked, of the “outsiders, bookworms, romantics and losers” who used to make up the despised and neglected profession of writers?

Gosh, Mr Raab: how terrible

Florence Sutcliffe-Braithwaite · Puny Rump: Sick Notes · LRB 13 April 2023

In a debate on the Labour government’s plans for National Insurance in 1946, Beveridge said that it ‘did frankly send a chill to my heart to realise that it was contemplated that the only way in which most people would get their sickness benefit would be through the post.’ Working through friendly societies would guard against malingering, but it would also make the system more humane: ‘I am not going to say a word … to suggest that civil servants are not human … But while civil servants are perfectly human, the unfortunate fact is that anything as big as the civil service, merely because of its size, tends to become inhuman.’

Gosh, Mr Raab.


Jonathan Meades · Let’s go to Croydon · LRB 13 April 2023

Architects’ dialect comprises delusional boasts that cast them as philosophers and their trade as at best a social service, at worst a particularly dodgy branch of alternative medicine or new age bunk: sustainabulous, green, responsible, liminal, wellness, community, performative, holistic, participatory, community (again). Mind mange? Ghosts in the infrastructure? Boney’s or Bogey’s or the Bears’ advance through the gaps between the paving stones? Architecture will get it sorted. As Reinier de Graaf noted of a speech by Richard Rogers: ‘With each new sentence a new location, topic or domain is added to the theoretical competence of architecture.’

Intellectuals as protectors of integrity

Via Adam Tooze

On the courage of Vladimir Kara-Murza (his words below are via Tooze)

At one point during my testimony, the presiding judge reminded me that one of the extenuating circumstances was “remorse for what [the accused] has done.” And although there is little that’s amusing about my present situation, I could not help smiling: The criminal, of course, must repent of his deeds. I’m in jail for my political views. For speaking out against the war in Ukraine. For many years of struggle against Vladimir Putin’s dictatorship. For facilitating the adoption of personal international sanctions under the Magnitsky Act against human rights violators.

Not only do I not repent of any of this, I am proud of it. I am proud that Boris Nemtsov brought me into politics. And I hope that he is not ashamed of me. I subscribe to every word that I have spoken and every word of which I have been accused by this court. I blame myself for only one thing: that over the years of my political activity I have not managed to convince enough of my compatriots and enough politicians in the democratic countries of the danger that the current regime in the Kremlin poses for Russia and for the world. Today this is obvious to everyone, but at a terrible price — the price of war.

In their last statements to the court, defendants usually ask for an acquittal. For a person who has not committed any crimes, acquittal would be the only fair verdict. But I do not ask this court for anything. I know the verdict. I knew it a year ago when I saw people in black uniforms and black masks running after my car in the rearview mirror. Such is the price for speaking up in Russia today.

But I also know that the day will come when the darkness over our country will dissipate. When black will be called black and white will be called white; when at the official level it will be recognized that two times two is still four; when a war will be called a war, and a usurper a usurper; and when those who kindled and unleashed this war, rather than those who tried to stop it, will be recognized as criminals.

The pleasure of electronic medical records

Digital Minimalism — An Rx for Clinician Burnout | NEJM

It’s easy to see how digital minimalism’s first tenet, “clutter is costly,” applies: the average patient’s EHR has 56% as many words as Shakespeare’s longest play, Hamlet. Moreover, half these words are simply duplicated from previous documentation.

Progress isn’t inevitable. Not even likely in some domains over working lifetimes.

The glory of science

The Economist

The great joy of science and technology is that they are, together, the one part of human culture which is genuinely and continuously progressive.

This is from the science and tech editor at the Economist who is standing down from that role at three decades. Science: Stop and starts — not continuous. And that is just for starters. Discuss!


She said…

Is France on the road to a Sixth Republic? | Financial Times

It was said of US President George HW Bush that he reminded every woman of her first husband. Macron reminds every French person of their boss: an educated know-it-all who looks down on his staff.

“Honest” Boris

Johnson looks done for from TheEconomist

Boris johnson is an honest man. It is possible to tell this by the sheer number of times he declares his honesty.

In his written submission to the committee of mps investigating whether he intentionally misled Parliament over Partygate, the word “honest” popped up around 20 times in one form or another. In a three-hour hearing on March 22nd he offered yet more honesty, at one point even “hand on heart.” And little speaks more of honesty than declaring your honesty 20-odd times in two days.

Feels like it

The England that awaits the young Mundy is a rain-swept cemetery for the living dead powered by a forty-watt bulb.

Absolute friends, John le Carré

Intellectual property

Adidas backtracks on opposition to Black Lives Matter trademark request | Business | The Guardian

Adidas has withdrawn a request to US authorities to block the Black Lives Matter movement from trademarking a design featuring three parallel stripes.

Because of how the politics of it looked (pun noted)…

I dare not show the image, but the BLM had the eponymous words in a black font, with three horizontal parallel lines in green underneath the text.

What next: the whole of geometry?


A deceit

A deceit at the heart of democracy.

No politician would fly in a plane built by politicians.

No more big letters

Just a suggestion after looking at newspaper headlines at a news stand. That feeling of despair at the world and those who pour dirt upon it.

Could we limit the font size of headlines to no more than size 14 on an A4 page. So, small, but readable. More whitespace can surround the letter above and below. This might make the context come into where it belongs: dead centre.

The penalty for clarity

via John Naugton

‘I’d been reading Clive James’s essay on Stefan Zweig in his magnum opus, Cultural Amnesia’ (writes John Naughton).

“Zweig’s own achievements,” James writes, are nowadays often patronised: a bad mistake, in my view. Largely because of his highly schooled but apparently effortless gift for a clear prose narrative, he attained, while he lived, immense popularity not just in the German-speaking countries but in the world entire, and he is still paying the penalty for it. Except in France, where his major works are never out of print, it is usually safer to call him second-rate. Safer, but not sound.

No offence

‘Dirty wee torturers’: Northern Irish man tells of British army abuse during Troubles | Northern Ireland | The Guardian

A doctor examined Auld and declared him fit for interrogation. For at least seven days and nights he was subjected to what became known – in reports by Amnesty International and other organisations – as the five techniques: the stress position, hooding, white noise, deprivation of sleep and little food and drink. When Auld moved from the stress position he was beaten. Occasionally the hood was removed and lights were shone into his eyes.

Several of the men, including Auld, were bundled on to a helicopter and thrown out, thinking they were high up. They were a few feet from the ground.

Auld assumed he would eventually be killed so tried to end his suffering by hurling himself at heating pipes to break his neck. “But I just hurt my head. That, for me, was the worst because I couldn’t die. That sense of helplessness and isolation was horrendous.”

Auld was eventually transferred to a prison, then a mental health hospital, before returning home. He was not charged with any offence.

In a case taken by the Irish government, the European court of human rights ruled in 1978 that the treatment of the “hooded men” was inhuman and degrading but not torture. Auld received £16,000 in compensation. After 9/11 the Bush administration cited the ruling to defend its “enhanced interrogation” policy.

End of an error

The SVB debacle has exposed the hypocrisy of Silicon Valley | John Naughton | The Guardian

The first thing to understand is that “Silicon Valley” is actually a reality-distortion field inhabited by people who inhale their own fumes and believe they’re living through Renaissance 2.0, with Palo Alto as the new Florence. The prevailing religion is founder worship, and its elders live on Sand Hill Road in San Francisco and are called venture capitalists. These elders decide who is to be elevated to the privileged caste of “founders”.

Error? Era? Hope so.

VIP capitalism

Banks are designed to fail — and they do | Financial Times

But few people are capitalists when threatened by losing money they regarded as safe and nobody is better than a capitalist at explaining how essential their wealth is to the health of the economy.

A long-handled personal earthmoving implement

We should all be asking more questions | Financial Times

As a beloved journalism handbook of mine puts it, you have to be able to “call a spade a spade, instead of bringing in someone from Harvard to solemnly declare it a long-handled personal earthmoving implement”.

Rear view mirror only

Ikea boss says Brexit has caused ‘chaos’ | Financial Times

Shapps bemoaned the lack of homegrown technology giants and promised to ape Silicon Valley, saying he would organise a “scale-up summit” later this year to bring tech and finance expertise together.

Well, that’s alright then.

The head of a sovereign wealth fund, who declined to be identified, said the recent political history of the UK including Brexit was “an unmitigated disaster”, and the country had made a “catalogue of policy mistakes” that would take years to unwind, if ever.

Vaclav Havel

There is always something suspicious about an intellectual on the winning side.

Makes me feel better already. I used to read Havel a lot, but this line had fallen from my RAM. Sadly, not applicable to rugby.

Your rights are guaranteed, but not your teeth

Rotten, with no quick fixes: the state of our mouths reflects the plight of NHS dentistry | George Monbiot | The Guardian

Every child in the UK is entitled to free treatment by a nonexistent dentist. Some people on benefits, pregnant women and those who have recently given birth also have free and full access to an imaginary service. Your rights are guaranteed, up to the point at which you seek to exercise them.

It’s just business

The painfully high price of Humira is patently wrong | Financial Times

But nearly half of new drugs launched in the US in 2020-21 were priced at more than $150,000 a year, so others have followed its lead. An entire industry has moved towards making products that are breathtakingly expensive.

Please, please, start thinking about reining in IPR.

The Need for an Organised Ambulance Service in 1904.

I came across this article by chance while trying to track down same old papers on skin cancer. It was published in the Lancet in 1904. A few days ago I heard a story about a colleague’s problem in trying to order an ambulance for somebody having a MI.

It is remarkable how institutions can fail, and competence be something that now only exists in the past. This is not a difficult issue to solve. We no longer have a functioning health service. We have stepped back in time. But, hey, it only affects other people.

At an inquest held at Lambeth on nov. 21st Mr.Troutbeck inquired into the death of a girl, named Alice Wood,aged 17 years, of Camborne-road, Southfields, who died in a laundry van as she was being removed to st. Thomas’s hospital to undergo an operation for perforated gastric ulcer.

On Nov. 16th she complained of severe pain in the chest and about midnight Dr. E. A. Miller of Upper Richmond-road was called. He found the girl collapsed and, having diagnosed the condition, decided that an operation was her only chance. No cab could be obtained but at about 2A.M.on Nov.17th a laundry van was procured and in this she was driven to the hospital where on arrival she was found to be dead. Dr. L. Freyberger, who made the post-mortem examination, said that death was due to heart failure following acute peritonitis caused by the rupture of an internal ulcer and that it was accelerated by the jolting of the van. The coroner’s officer said that a horsed ambulance was kept at the Wandsworth Infirmary but that a relieving officer’s order was necessary for its use. The jury returned a verdict of “Death from natural causes,” and added a rider expressing the opinion that there was urgent need for an improvement in the system of providing horsed ambulances for the various metropolitan districts. With this we quite agree and we earnestly hope that the London County Council, which recently received a deputation from the Metropolitan Street Ambulance Association, will see its way to make proper provision.

Blat: the British way.

Blat, the Soviet art of getting by, comes to Britain | The Economist

But it is also corrosive. Blat compounded the inefficiencies of the Soviet system and rendered its boasts ridiculous. It does the same in Britain. Nine in ten dentists have no space for new nhs patients, yet the nhs website boldly declares that it will “provide any clinically necessary treatment needed to keep your mouth, teeth and gums healthy and free of pain”. This is fiction fit for a May Day banner. Blat is a declaration of distrust in a system that only sometimes does what it promises. To queue is to be taken for a fool. Better to shed that English reserve, and push to the front.

We all have trapdoors in our life

Metamorphosis — a magical memoir of a life in pieces | Financial Times

We all have trapdoors in our lives,” says Robert Douglas-Fairhurst on the opening page of his memoir, Metamorphosis: A Life in Pieces. His own trapdoor opened on a visit to a neurologist’s office in 2017. Sometimes, as he points out, we escape: the car swerves, we turn away from an argument. The terrible moment eventually comes for us all, though, and we are “on the trapdoor when the lever is pulled”.

From a review.

Not all can be learned

The fertile hatred had dried up in Grosz’s headlong attempt transform himself into an American and get into the spirit of the place. ‘Nobody really needs art anymore, since everybody is practising it,’he wrote in his autobiography. ‘I really love the American optimistic believe that everything can be learned; but I don’t quite believe it.’

Thomas Meaney on the artist, George Grosz, in the London Review of Books, 16th of February 2023