A treasure hidden in the bushes near the Dumbarton Oaks garden. Glad to have had an actual camera on me, for once.
There is no definitive evidence linking the new F.D.A. guidance to the lunch, the donation or specific lobbying. But the episode represented a victory for an industry that mostly had been on the defensive for years.
The now former FDA Commissioner Mary Makary quit in protest, and this isn’t the first time lobbying has led to FDA turnover. Yes, lobbying is great again! Say what you will about Makary or his recent subordinate (and, full disclosure, my co-fellow, co-author and friend) Vinay Prasad — as I have — at least they had principles. Those who pay for a STAT+ subscription can get the opposite take from Matthew Herper, who called Makary the worst FDA commissioner in 25 years. [Note: And before you ask what poor Jane E. Henney (FDA commiss 1999–2001) did to him, 25 years is how long Herper has been covering biotech. The headline could have used an “at least” for accuracy. ]
The basement of a brand new house being filled with oil-smelling, oil-appearing sludge and the government agencies are calling it “water”; a personal and bureaucratic nightmare. This is the wider context:
The Frontier and ProPublica’s reporting on oil and gas pollution in Oklahoma over the last year has shown how old oil wells abandoned by the industry pose severe public and environmental health risks. Officially, the state lists 19,000 orphan wells that state regulators are responsible for cleaning up, but the true figure is likely over 300,000, according to federal researchers.
Drill, baby, drill! Preferably through an LLC, so that you can forget about the holes you left behind once the boom busts. This is why I am surprised by otherwise sensible people like Casey Hendmer being so frustrated with lack of drilling [Note: X-post ] in oil-rich California. Could it be that even the smart Californians who would prefer not to live above an abandoned well? I mean, even the ones with just water in them can be scary. Or is it the case of Eden for the rich and stinky sludge for the poors? Let them have oil!
This is one of many reports from Google I/O which focuses on the new prices without mentioning the severely restricted token limits for all tiers. Here is an example of what lower limits mean in practice. I would like to commend Google’s marketing team for this PR sleight of hand: does it count as shrinkflation is the prices have also gone down? And how on Earth would those lower prices help the already abysmally low revenue? Maybe the relative cost of tokens will have increased, but who knows? It’s not like Alphabet is a publicly traded company that should report that kind of information. Good thing AI is its own thing and isn’t affecting anything else around it. Asbestos indeed.
There is now a one-year ban from posting on arXiv for all (co-)authors whose preprint have references that LLMs conjured out of thin air, or other signs of passing on LLM-generated content without human review (such as paragraphs starting with “Here is a 200-word summary of…”). [Note: A question to readers more style-minded than me: is stringing these four — an ellipsis, quotation mark, right parenthesis, period — one after another a typographical faux pas? ] Note that this is for physical sciences only, life sciences-minded bioRxiv and medRxiv have not (yet) instituted such rules. Which didn’t stop some life scientists from defending [Note: X-post ] the practice of not checking one’s own references: who has the time? Apparently not people with current or former NIH funding. Having once spent a full day finding the correct reference to back up a non-essential introductory claim in one of my least-cited papers (7 as of today) I empathise with the suggestion that references should be more of a guide than firm fact, but empathy is one thing and truth another and in matters of science I will stand behind the truth because if not then what on Earth are we even doing? Unsurprisingly, Andrew Gelman has a good take on the matter.
DEVONthink Pro — henceforth DTP — is one of those Swiss Army Knife applications that is different things to different people. [Note: At one point or another DTP has also been my app for journaling, structured note-taking (even bought a book about it), managing journal references, reading RSS feeds, archiving podcast episodes, batch renaming and automated file wrangling à la Hazel. Phew. ] After a dozen or so years of dabbling, I have pared down its use cases to a single one: managing documents both electronic (office files and emails, mostly) and physical (thanks to the now discontinued but still phenomenal ScanSnap iX500). The only reason I used DTP and not say Finder was its “intelligent” file sorting, or rather sorting recommendations paired with fast search. So, that was the only thing I had to replicate to get my DTP replacement on Linux now that I am making the slow jump.
And with quite a bit from Google Gemini — again — I think I have this one licked:
Rube Goldberg-y? Yes. Does it work? By golly, it does. For 95% of things I need it for it works even better and faster than DTP, which required mouse-dragging to move a file whenever I wasn’t happy with the recommended classification. The only wrinkle left to address is naming conflicts: DTP didn’t care if two completely different files had the same name as it had its own way to track them. Trying to copy a file to a folder that already has it right now doesn’t work, but that should be a quick weekend fix.
A marvelous overview of various pitfalls in thinking which I will have to read again and with great care to fully understand. As is often the case, the concluding paragraph gives one a good idea of the flavor of the whole text:
At the least, the difficulties of understanding should make all scientists both skeptical and humble, knowing that ‘truth’ is an ever receding goal. We must realize the full range of possible illusions and appreciate that they occur in all approaches. We can reduce false insights and achieve better understanding by embracing diverse theoretical perspectives, research methods, and modes of analysis. This requires constant intellectual humility towards our own theories, models and methods. This recommendation unfortunately competes with forces in scientific societies that foster overstated claims and conclusions: Faced with millions of publications each year, scientists must fight for attention, readers and citations in the research marketplace, and journal editors must seek impact factors, submissions, and readers. In addition, scientists’ beliefs in overstated claims are subject to biases that occur more broadly. Thus, scientists can exhibit trust that increases beyond what is justified for mentors, friends, colleagues, same institutions and affiliations, famous scientists at leading universities and research centers, and decreases for women and minority authors. Do scientists realize the extent to which such factors operate and are they adapting to their existence?
The subtitle is “How GLP-1 Development Was Abandoned in 1990”, and it attests to a 30-year delay in bringing these revolutionary drugs to patients, because someone at Pfizer thought they understood what was going on. So the pipeline is even more broken than I thought.
A series of well-referenced historical vignettes whose purpose is to bring tech-adjacent people closer to worldviews other than “the toxic strain of neoliberal capitalism favored by venture capitalists and their gushing fans in the tech media.” But you don’t need to know any of that to enjoy his notes on selfishness, corporate psychopathy or people being human in a crisis, to pick a few recent ones.
🕹️ Battlestar Galactica: Scattered Hopes seems to be a game I would enjoy, and this “review” in Aftermath is laudatory enough, but what on Earth made its author call it a “rougelike”? Tower defense, yes. Roguelike? Nuh-uh. Gaming journalism is going from bad to worse.
A treasure hidden in the bushes near the Dumbarton Oaks garden. Glad to have had an actual camera on me, for once.
Back in September 2023 I noted that the biggest hurdle for AI completely replacing physicians is the physicality of the job. Sure, LLMs are good at giving differential diagnoses and faking empathy once somebody’s problem has been reduced to text, but the art of medicine is in the act of seeing, feeling, smelling, etc. [Note: Although increasingly less so, as doctors and trainees are becoming experts at treating patients in the chart and not those in front of them, making themselves the perfect foils for replacement; queue photo of the old man yelling at clouds. ] If clankers have any hope of replacing humans, they’d better get some senses.
At first glance, a recent Nature Medicine paper aimed to do just that by introducing what the group of authors — all of them Google employees based in the UK and California — call “multimodal reasoning” but is in fact the chatbot being able to interpret images, ECGs and lab reports in addition to the pre-digested clinical pearl. The topline result, one that the journal itself felt obligated to headline, was that “AI had superior performance compared with physicians for almost every metric (29 of 32 axes)”. But at what?
You would think that the question would have been easy to answer, this being a peer-reviewed paper and all, but no. In fact, I am still not completely certain what interactions were performed and whether they completely match what was reported. What is certain is that a set of primary care physicians and patient-actors from Canada and India — countries different from the author’s own countries and let’s wonder conspiratorially for why that may be the case — interacted via an instant messaging-like service. This is the first oddity: even remote health visits are performed using video calls, and yes you may occasionally get a text through the EMR or if you are a VIP/boutique physician maybe your phone, but that is far from the norm.
The primary report is on what happened when the patients uploaded the skin photos, ECGs, lab results, etc. and then asked the physician or LLM on the other end questions about it. Pretty standard fare for a human-to-LLM interaction, but not exactly natural for a doctor-patient relationship which usually starts with questions being asked of the patient. This is the second way in which the setup was made to fit the computer and not the human.
But then the last section of the paper is about what happens when there is, in fact, a back-and-forth by the way of taking a history. The extended figures — “extended” here meaning not worthy enough of being included in the main paper — say it improves the performance of the LLM. They do not say how it affected the human performance, or how the patient-actors rated humans versus LLMs in history-taking. I would call that strike three.
To the journal’s credit, they did not allow Google to get away with it completely. “To evaluate the performance of our finalized system, we conducted a randomized, blinded human evaluation that emulates an objective structured clinical examination”, says the final paragraph of the introduction, only to end with:
We note, however, that our study is not a randomized clinical trial with prespecified endpoints and preregistered statistical analysis. Rather, it is an exploratory study investigating the properties of multimodal diagnostic dialogue.
Peer review is at least good for something, even if it does result in self-contradiction.
Meanwhile, in the world without motivating reasoning, more objective assessments of the usefulness of AI in medicine show that it is in fact still quite bad. This does not prevent the massively funded hordes of AI researchers from flooding the field with sloppy work, creating the impression that the rise of the machines is imminent. Comply or relegate yourself to the permanent underclass, serf MD. But of course, relegation will only be possible to the extent doctors — or any other profession, really — has already debased itself and abandoned its core professional principles in the service of electronic ease.
After dissecting the minutiae from the ongoing battle of the bozos [Note: To save you a click: it is about the Musk-Altman trial. ] , Andrew Sharp’s weekly column ends with this paragraph:
The reality is knottier. Had the OpenAI founders not launched with a nonprofit structure in 2015, they probably never recruit the talent required to compete with Google. And had they done anything else other than exactly what they did in 2018 and 2019, all of computing would be less interesting today, and the company probably wouldn’t exist eight years later. Musk’s trial has been clarifying on that point, at least for me.
The AI side of technology is one of those rare occasions where biotech may indeed be like tech: people with knowledge, skills and ambition to make the early steps towards creating something new generally don’t do it for the money. Accolades, titles, a few more increments on their h-indices sure, but unless they are seriously delusional a lab postdoc coming in on a weekend to split the cell culture generally has no hope of getting into the top percentile in income. Up until a few years ago AI research was much like that, until it wasn’t.
Sharp writes that OpenAI had to flip the switch if it were to survive in these shark Google-infested waters once they smelled blood profit an opportunity to tell a new story to investors. Same can be said about any biotech: become successful enough, and there will come a time when the academic founders are asked to step away and let someone with different motivations run the show, lest they be lost in a sea of copycats, smoke-peddlers and competitive intelligence officers. The whole business has just become too expensive for some Jonas Salk-wannabe to dabble in.
A person of bad intent may propose that the adults coming to run the show once it becomes too expensive are the ones making it expensive in the first place to justify their existence, contributing the health care cost ouroboros on the way. But that is of course nonsense. The proof is in the pudding, what with famously efficient drug development pipelines, low health care costs and improving lifespans.
So let’s do what a genuine financial scion once proposed: invert. Instead of asking ourselves how to make drug development more efficient and cost-effective, let’s see how we could make it more expensive. Number one thing to do would making it all about the money: let’s portray people who don’t capitalize on their inventions as losers not heroes, make Nobel Prize winners notable only if they are billionaires (who won the Nobel Prize in Physiology or Medicine last year, again?), measure success of drugs in dollars earned not lives improved, extended or saved, have everyone skim a percent or five of the money swishing around in the ecosystem as their primary source of income without any penalty for ultimate failure [Note: For more on this, do read Nassim Taleb’s Skin in the Game, which is about much more than the titular phrase which has become — much like his The Black Swan — a phrase people throw around without having any idea of the underlying concepts. ] guaranteeing that they will have every incentive possible to grow the pie, and I think you see where this is going because the system functions as designed so why should you complain? After all, there is no alternative.
Except that, of course, there is. It would be a big lift, to remove incentives of skimmers to inflate the balloon, stop various influencer platforms from inducing FOMO in everyone and anyone, recalibrate the median science journalist’s value system from Mr. Market to something more reality-based. Big, but not impossible, provided there is a will.
Therein lies the problem: that kind of thinking is somewhat at odds with the shared American culture, at least as recently described by Chris Arnade, that “you can live how you want, eat what you want, live (up to a point) how you want at a thin level, as long as you ultimately believe in making big money through hard work and playing by the rules.” Determining if the other two legs of the three-legged money/work/rules American stool are performing as intended I will leave as an exercise for the reader.
Though I agree with his stance on smartphones in schools and social networks in general, I fear that Jonathan Haidt of The Anxious Generation is now the useful fool for every US state senator with autocratic tendencies; Rindala Alajaji of the Electronic Frontier Foundation has a good write-up of how that came to be. Has parental guidance ever been successfully legislated?
Glenn Fleishman is singlehandedly keeping me interested in Kickstarter. Just this week he has set up another campaign: the proposed book title is “That One Matt Bors Comic” and it is a book about a meme which was supposedly viral but I don’t remember seeing until two days ago. Still, the concept is interesting and I would like to learn more.
And just as I finished backing Fleishman’s, I noticed that Cory Doctorow also a campaign. It is for The Reverse Centaur’s Guide to Life After AI, a book based on a similarly-named essay about “reverse centaurs” — people whose job it is to augment AI instead the other way around — i.e., potentially, all of us proles. Yes, even doctors. Particularly doctors.
Note that the anti-enshittification (anti-platform?) crusader Doctorow used Kickstarter. The company is indeed a “public benefit corporation” of around 60 employees and an interesting history of unionization. A dissenting opinion from senior staff that forming a union would be “misappropriation of unions for use by privileged workers” is a delightful example of cognitive dissonance in people who tell themselves that they are good but also want to run a successful business.