Last night, I booted up a Linux desktop from System76 for the first time. Not one hour after that, I had my very own LLM running on it — Qwen 3, if you are interested in those sorts of things — and through the magic of Tailscale and Open WebUI I can access my own personal chatbot from any of device.

Are the answers I get on the level of Anthropic and OpenAI’s latest? Of course not. But it took merely a glance at some of my previous interactions with the frontier models of two and three years ago to realize that what I have now, running under my desk, plugged into a regular electric outlet, is better, and for many uses significantly better, than what got me singing praises back then.

Take my standard question, on how many total lymphocytes there are in the human body. It is a multi-step calculation that requires good literature search. ChatGPT’s 2023 attempt was decent, but had wonky math, strange formatting and no references. By December 2024, it had significantly improved, but still lacked citations. my home-spun chatbot gave the perfect answer: its own calculations first, then checking the result against the published literature and explaining any discrepancies.

True, it may have had the benefit of an October 2023 review article which answered the question directly. But at least it was able to link to it, and provide a separate explanation for calculating each step.

Then I asked both Claude (Opus 5.5) and my homebot [Note: Yes, that’s what I’m calling them. My own homebot also has a personal name, which I will not share just yet. ] what the best office chair was, regardless of price. Claude spat out what I already knew was common knowledge: Herman Miller Aeron, duh, and here is why. Homebot gave me four options, one of which was the Aeron, one seemed to be quite a bit more affordable but not as high quality, one was a fully motorized “smart” contraption (no thanks) and the fifth was a Steelcase Gesture, which is now on its way to my own home office. ⊕ [Note: Or rather will be, in 2-3 weeks, because only the uncanny valley equipment that lies between Temu and the likes of Herman Miller and Steelcase can arrive overnight from your local Amazon warehouse. This uncanny valley used to be called premium mediocre, but it’s been almost a decade now that those things have shed any semblance of even mediocre quality while keeping the premium prices. But let’s leave that for another post. ]

Spinning up agents for doing menial tasks is next on the list. More notes to come.

• Derek Sivers meets 30 people in Istanbul. One of them is a dear friend of mine.
• After a long break, Kyla Scanlon has a new book-length post out, about the American economy. There is a bone-chilling graph tucked in the middle of Part 4. It ends on a hopeful note. It’s good.
• Ted Gioia recommends seven Philip K. Dick novels.
• A ridiculously detailed history of Lemmings, the game.
• Surgeons behaving badly.
• Ada Palmer has a podcast.
• I miss The Elder Scrolls. Apparently, the new one is in production but not out until 2028 at the earliest. I predict the bubble bursting before release, and the odds of the game ever being available pretty much a coin flip. Get bought by Microsoft, die by Microsoft.

A return to form from Vinay Prasad with two short and sweet articles on AI in oncology:

• Terrence Tao does not understand cancer medicine
• Can AI ‘hack’ a cancer clinical trial

If mathematicians want to complain that computers are replacing them, they should seek the comfort of chess Masters complaining that they have been bested. But they should not look for comfort from doctors. We would do anything to help our patients. We would do anything to extend survival. We already do things on a wish and a prayer and a mechanism of action and a hint of bioplausibility.

True.

A propos of nothing in particular, a memory came back to me this morning. I was a first year — more precisely, first month — oncology fellow at the National Cancer Institute, and had the dubious honor of having bone marrow transplants as my first rotation. This was back when NCI did not require proof of legal residency to enter the campus, so we had quite a few referrals from all around the country for people who otherwise would never have been able to afford one. These were clinical trials of bone marrow transplants, but the risks of the research procedure — whether to use drug A or drug B, bot approved, to prevent graft versus host disease — were minor compared to the risks of a standard full-on allogeneic transplant, so before you think “but isn’t this undue influence?” let me reassure you that, for the most part, it was not.

Anyway, one of these patients was a young woman with Burkitt lymphoma not responding to any chemotherapy you threw at it. I saw her in clinic early on during the rotation and despite having this rapidly progressing cancer didn’t look all that bad. She had just finished the last round of Hail Mary chemotherapy meant to control the disease before the transplant so had to wait a couple of weeks before being eligible for the trial, and so she went home somewhere in the Midwest to be with her family during this “washout period”.

She did come back, with a portruding belly and a hollowed out face, both of those tells that the lymphoma did not care an iota about any hail marys her doctors threw at it. Her labs, from blood counts to kidney and liver function, looked great, but true enough her PET scan had more areas lighting up than not, lymphoma everywhere.

In most other places this would have prompted a discussion about hospice and end-of-life care, but not at the NIH. She was admitted to the largest research hospital in the world to get some more chemo followed by, let’s hope, the life-saving transplant.

So I got to see her and talk about her at rounds each morning, and each morning that I saw her, belly stil protruding, face still hollow, I’d paint an uggly picture and at first hint then overtly ask, what were we doing here and why wasn’t she already in hospice?

One of those mornings, the inpatient attending who was by the luck of the draw also the primary investigator of the clinical trial she was supposed to be in had enough. All of her organs were functioning. She didn’t have an infection. The cells will be ready in a few days. “What exactly do you think will be the mechanism of her demise?”, he asked, and the phrase struck me as so out of touch that I remembered it to this day. This was a scientist first, maybe a great scientist, asking the question, but a piss-poor doctor.

The point of much of medicine is that we have no clue what the exact mechanism of someone’s demise will be, but we have seen enough and read enough to know that a quick demise was the most likely outcome. There were many things that could have gone wrong at any second: tumor eroding into a large blood vessel causing her to exsanguinate; massive infection taking over after her bone marrow was completely wiped out by our chemotherapy and her lymphoma combined; a large blood clot clogging up her lung’s blood vessels… It was a long list and I wasn’t a fortuneteller, so I shrugged my shoulders and moved on. She died a few weeks after I left the inpatient BMT service.

So anyway, when people ask how exactly the AI bubble will burst, in a way that’s challenging the very idea that it is a bubble that may burst, I remember this patient, shrug, and move on.

The book is a quick read if you are familiar with Doctorow’s other writings, and/or have listened to a few of his interviews. He is nothing if not consistent and, in the case of AI, consistently correct.

Style

You may, if you feel particularly carmudgeonly, argue that this is a book that could have been a blog post. You would be off by only a degree: each chapter does in fact resemble a piece or three from Pluralistic, his decades-old blog. You may notice that each daily article there starts off with an appropriate picture collage of Doctorow’s own making. “Reverse Centaur’s Guide” is his blog post collage. But he is so good at hiding the seams.

Substance

No arguments there. AI of the day, which is to say LLMs, are a real technology with real uses that is overhyped beyond any reason. Unless Anthropic and/or OpenAI do great a general supper-intelligence — which they won’t — we will witness (if we are lucky) or suffer their fall.

There are now material ways in which LLMs have improved my life.

At work, it is mostly by transcribing the first patient visits so that I can focus on listening to the person in front of me rather than scribbling in a notepad or staring at a screen while nodding my head pretending I am paying attention. ⊕ [Note: It is not that you get worse at multitasking with age, it is that you realize you were never particularly good at it so you stop pretending. ] Occassionally, for someone recently discharged and with a million notes, tests, and imaging data in the aftermath of their hospitalization, I may use EPIC’s crude but useful built-in summarization tool. I will even use OpenEvidence in preparation for a visit, but I maintain that free and unrestricted search through NCCN, NEJM and JAMA archives would have yielded the same result, and with fewer linguistics tics.

Personally, I have barely moved from my original use case, which was solving household problems. Having installed Meta’s Muse, sandboxed, locked out of any personal information, I do understand agents have their uses:

• Sorting out children’s school emails from two different institutions and for three separate grades and turning them into something actionable.
• Filtering out automated consulting requests and pre-filling answers on availability and general experience.
• Dealing with the administrative wonders that are part of being a small landlord in DC.

In other words, infrastructure-of-life stuff, the exact opposite of what the big mind of Muse espoused. Plans for self-hosting are in progress.

If your reaction to the above was largely negative, you should read the book. Doctorow makes a much better case than I ever could for why it is not morally abhorent to use this new technology. After all, are you boycotting the interstate system because Hitler championed the first autobahn?

May I propose “BSI”, for Bullshit Intelligence?

Dictated the first draft of this from an Index 01. Integration with Micro.blog isn’t there yet but at some point I might be “writing” blog posts with only my left index finger.

Without having seen this week’s Apple event, I can feel it in my bones that the future of pocket devices is something small that can on demand turn into something big. No, I’m not preordering — for reasons — but surely the matte screen and other crease-hiding trickery will at some point trickle down to a sub-$1,000 inflation-adjusted level.

I can wait.

Alex Tabarrok writes that it doesn’t matter if the workers’ share of GDP shrinks because of AI. As long as the pie is bigger — and our AI oligarchs say it can be as much as 10% bigger each year! — the average worker will have a bigger share in absolute terms if not in relative.

Hogwash. The one who has the bigger slice has the power to lord over the ones with smaller slices so the relative size does in fact matter. Never mind that our sense of wellbeing is itself ties to how we perceive ourselves in the overall community. What Tabarrok proposes is voluntary serfdom. I think not.

• Dan Luu: Ed Zitron’s AI prediction track record. Not great. I have linked to Zitron a few times, to articles that were short enough for me to actually read and understand. Most of them were just too long and/or too angry. Fitting that a critique of Zitron’s writing is just as long, though much more even-keel.
• Lilly Lynch: Sympathy for the Devil? Lindsay Clancy, Mercy and Maternal Filicide in History. The less I know about this case the better, but this was some good context.
• Ernie Smith: Wanted: Some Cheap Computing. Issue No. 1 of Smith’s mini-PC newsletter. I am in the market for both a heavy-duty primary machine and some satellite servers, and thanks to the ramapocalypse the latter — and therefore this newsletter — is much more appealing.
• Derek Sivers: Bangalore India hospital flow. Today I learned Sivers was a fan of “executive health checks”. Yikes! As I wrote in a comment to the article:

The human body is not a car. We don’t know how most of it works. There are a handful of labs you should start getting once you hit 40 (or earlier depending on family history), and a few cancer screenings we know work. Anything else is a needless waste of money at best, and a recipe for an iatrogenic disaster if an incidental finding from a whole-body MRI leads to a wild goose chase, biopsies, surgeries, etc. Not to mention the false sense of security these things can give.