Artificial “Intelligence”. RRiigghhtt!

I have been reading about “artificial intelligence”, and how it will supplant human knowledge workers (think law, and medicine, among others). I have my doubts.

There are several reasons for this. First of all, “artificial intelligence” is based upon “large language models”, wherein the developers feed into their databases tremendous amounts of, well, data. I have read that this takes the form of essentially sweeping up information from the internet (remember this part: it will be relevant) and programming their “AI” to address this information to provide a response to a query.

I have read that long, long ago, in galaxies far, far away, there was a Programmers Axiom, which went “GIGO”, or, Garbage In, Garbage Out. As I understand it, your computer output will not be of higher quality that that which you use to program it. If your program’s assumptions are bullshit, your output will be bullshit as well.

So, should you assume that the temperature observations recorded since the invention of the thermometer (Fahrenheit invented the mercury thermometer around 1714. according to worldhistory.org) reflect the planet’s temperature baseline, then you would notice, with alarm, the warming documented by such readings. Of course, should you factor in the Maunder Minimum, and The Year Without A Summer (1816 ), along with the historical record of Roman occupiers of Brittania growing grapes for wine (a feat not currently A Thing in 21st century England, due to the coolness of the present climate), you might come to different conclusions.

Adding in reports that present “AI” appear to some observers to have a left wing bias (feel free to define that however you want), well, impartiality does not seem to be A Thing.

I have read reports of attorneys presenting legal filings in court that have been written by, or with “assistance” of AI. To my point, it has been reported that these filings have been found to contain case citations that refer to cases that DO NOT EXIST. In addition, upon occasion, case citations refer to cases in support of one legal point or another, said citations that do exist, may DIRECTLY CONTRADICT THE POINT THE ATTORNEY IS ATTEMPTING TO MAKE.

I m certain that legal clients everywhere are filled with confidence at that thought.

To my internet point: Is there anyone of us who, coming across some gem of information on the internet, concerning some topic with which we have some familiarity, shake our heads with how ignorant and ill informed this foolishness is? How many of us have this response every day? Ladies and gentlemen, may I introduce the Gell-Man Amnesia Effect?

So, if I am creating an artificial intelligence, and populating that dataset with “information” from the internet, well, exactly what outcome should I expect? Again, GIGO. Bullshit in, Bullshit out.

Finally, speaking of medicine, a topic with which I have some familiarity, even assuming that the “AI” which takes my job KNOWS ALL with regard to Evidence Based Medicine, there is the issue that some patients did not read the evidence, and might not present with their (let us say) heart attack, in accordance with The Evidence. What will AI make of the relatively fit 60 year old man who complains of a sore throat for weeks on end, worsened by activity? Or the diabetic black woman who complains of tooth pain?

Will the AI inspect her teeth, and, finding them sound appearing, order a troponin and EKG?

After all, what evidence exists that a test for heart muscle injury will reveal information relevant to a dental complaint? Or that a recording of the electrical impulses of one’s heart, will assist in diagnosing and treating their dental disorder?

Finally, “evidence based medicine” assumes (veterans: care to chime in with what happens when we “ass-u-me”?) that all the relevant information-the studies-have, indeed, been published.

How is “AI” to know that studies exist, unpublished, that demonstrate findings contrary to The Narrative?

Should you wonder what that might look like, consider how JAMA and the British Medical Journal had been positively FILLED! with scholarly articles documenting the adverse reactions, contraindications, and adverse drug interactions of the mRNA covid vaccines!

I kid! I kid! Any such studies were unpublished. Perhaps they were erroneous, perhaps they contained facts that prudent clinicians might have wanted to know prior to recommending mRNA vaccines. We will never know, because THOSE studies never saw daylight, and therefore were never subjected to criticism, and scrutiny, and opportunities to be re examined in light of discovery of weaknesses in methodology or technique, so that the truth (NOT ‘my truth”, not “your truth”, but real, objective, third-person-verifiable truth) could be established and documented.

All this to point out that, in my view, “Artificial Intelligence” is NOT ready for prime time. Hell, it ain’t ready for Off Broadway. Indeed, in a show business metaphor, AI likely is not ready for High School Play Competition. (and, I mean no insult to high school thespians: some of their productions are smooth, engaging and entertaining.)

So, I sleep easily, considering that AI appears to be poised to have a significant role in national defense, in medicine, in law.

And, by “sleep easily”, I mean “sleep as if my cold wet bed had been filled with shards of broken glass soaked in pepper spray”, easily.

Covid And Why Nobody Listens To “Experts” Anymore

I read a blurb, recently, for a story on a website. I’ve abstracted some portions, here:

“…nursing became a calling. The meaning and purpose in life were to look after others. In times of trouble, Covid comes to mind, we clapped and cheered for the nurses who put their lives on the line for us. But at the end of the pandemic, nurses demanded more hands at the bedside and higher wages. So much for our dream of a selfless calling. Nurses work for a paycheck, and It feels like many are just in it for the money. …”

My response follows

“Of course, nurses are in it for a paycheck: if nurses do not need a paycheck to support themselves and their families, who on earth would subject themselves to illness, grotesque injuries, and the fact that 9 out of ten people are assholes? (not that I am cynical, or something….)

Where the commendable part comes into the discussion, is that nurses do, indeed, address all those things, and (nearly all of the time) agitate for enough personnel “on the floor” to provide the care that those injured/ill folks require.

Unless, of course, you are speaking of all the individuals who fought their way to the front of the line, to work night shifts, holidays, to care for folks who, we all were told at the time, had a highly transmissible, highly lethal disease? For free? And, of course, had no regard for the possibility that that very transmissible/lethal disease could be brought home to their families?

Every one of THOSE volunteers, you mean?

(BTW, were YOU one of them?)

I was (and am) in daily, in person, in contact, patient care. I was, in 2020, and subsequently. (and for decades prior).

Want to get more nurses? This one weird trick solves your nursing staffing woes: PAY THEM! And, staff your hospitals adequately. (OK: so, that’s Two! Weird! Tricks!)”

Yep, I was snarky. I was irritated.

In contrast, the original author replied, and was graceful, and did respond to my actual points. He related that he, himself, was in “the sick people business”, and had been for quite some time. He was articulating the whipsaw effect of changing from “Nurses are heroes!”, to “How dare they want money! And staffing!” He was commenting on one of the things that sets my own nerves on edge.

Another website spoke of the death of our susceptibility to the opinions of “experts”, who, now we know, had No. Fucking. Clue. of what they were doing, whether what they were straight facedly assuring us was lifesaving, or not, and promulgated unprecedented totalitarian controls on nearly every basic human right, including most of those enumerated in The Bill of Rights.

Years later, this website (actually a substack) recounted how surprising maladies (heart disease in young and presumably healthy folks, for only one example) could ONLY! be due to infection from the covid virus.

My comment follows.

“If they received the COVID shot, which we were ASSURED would prevent COVID (shortly before we were ASSURED that that COVID shot would mean we’d got COVID, but less, shortly before we were ASSURED we’d get COVID, but couldn’t transmit it, which was shortly before we were ASSURED … I’ve lost track!), so, if they had received the COVID shot, how could their symptoms be due to COVID? 

Didn’t All The Very Smartest People (because they told us that they were) guarantee that this was impossible?”

By this point (of covid’s emergence) I had held a license as an RN for approaching 40 years. I had been licensed as a midlevel for 10 years. I knew me a few things about “vaccines”, and “medications”, and (pay attention to this last bit) medication package product inserts.

Real vaccines (with a couple of exceptions: like yellow fever, or influenza, although for different reasons) actually PREVENT you developing the disease against which they are targeted. I present tetanus immunization as an example.

Medications arrive at the pharmacy in a box (isn’t THAT surprising!), containing the medication as well as a (large!) piece of paper documenting the brand name, generic name, chemical name (that poly syllabic Greek appearing mess, that tells an organic chemist what the molecule looks like) (Tylenol is  N-acetyl-para-aminophenol). It continues to recount the indications, means of action, particular (generally liver) enzymes that break it down, drug interaction, contraindications (why would you not want to prescribe this medication, and who might be the individual you would not want to prescribe it for).

In short, an awful lot of information, in very small type, on one sheet of paper.

I hunted down, and secured, a copy of the product insert for the Moderna MRNA vaccine.

On the one side, in the middle, were the words, “This Side Intentionally Left Blank”.

On the other side, in the middle, were the words, “This Side Intentionally Left Blank”.

Not another word.

When Covid was at the peak of it’s “popularity”, my medical director briefed me on the benefits of the (mrna) vaccine. I asked her about side effects? I was told that “it was safe”.

I asked about long term adverse effects. I was told, “there are none”

I asked her how anyone could know that about a vaccine that had been in existence for, at that point, something like a year?

I reminded her of the notorious history of Thalidomide (look it up. Awful story), in the context of “no long term side effects” assertion.

I received no answer.

Da City Housing Inspection

So, This Is No Shit!

Long, long ago, and far, far away, I lived in Da City. It had come to my attention that one of the neighbors of the flat I was renting, desired to cash out and move to California. (One can only hope that this soul is presently happy with how THAT has turned out!)

So, a couple of thousand dollars changed hands, and I assumed his land contract. (interestingly in today’s real estate market, I acquired a two flat, three bedrooms, kitchen, full bath downstairs, and three bedrooms, kitchen and full bath in the upstairs unit. For $85/month, not including property taxes and house insurance. Funny how things change, innit?) (the internet reports that $85 dollars in 1977, is $454 today)

Time passed, events happened, and I graduated from RN school, left the fire department, and eventually moved to Rural The Un Named Flyover State.

I rented out the bottom apartment where I had lived, having already had a tenant in the upstairs. Nice little dollar, right there.

So, one day I received a letter from Da City office in charge of inspecting property, informing me that I owed them something like $120 for an inspection by the Housing Department.

I phoned each tenant, asking them if they could recall interacting with the housing department, or any of it’s employees?

Nope, and again, nope, neither tenant had seen any inspector.

To put this in perspective, allow me to invoke Decker’s Law: When responding to an EMS call, and you are pretty sure that you are on the correct block, but, for some reason, folks in this neighborhood do NOT have any house numbers, seek out the most tumbledown anonymous house on that block, appearing most likely to be a pile of rubble around the time you call back in service. Your patient awaits inside.

And, Ciaramataro’s Corollary Number One: The one house on the block with ghetto gates (bars on the doors and windows), is your call.

Corollary Number Two: Occupants of the house with the gates KNOW who is performing all the neighborhood B & Es.

Corollary Number Three: There is nothing inside the grilled house worth stealing. The decor is milk crates, cast offs, soiled mattresses on the floor. Even odds that the smell makes the place a haz mat scene.

So, having personally experienced the above, in Da City, I was, well, amused, at the thought that Da City would inspect my property, of the fresh paint, and new roof, etcetera. So, I phoned the Housing Department.

I identified myself, identified the subject property, and our conversation went something like this:

(City Worker)(“CW”) “Oh, yes. You owe us $120 for our inspection.”

(me) “I have spoken with my tenants, and they report no in person inspection occurred.”

(CW) “Hmmm. (ruffles papers) Yep, that looks correct.”

(me) “So, are you telling me you are charging me for an inspection that never happened?”

(CW) “Well, lets consider this. I see you have upgraded the electrical a couple of years ago, your roof was new last year, when our inspector drove past he saw fresh paint. Do you mean to tell me that the inside is a wreck, when you obviously put so much time, money and attention into the outside?”

(me) “Of course not! I’ve painted the inside, a few years ago, and regularly repair faucets and whatnot!”

(CW) “I’m not surprised to hear that. Look, here’s how this works: what is the point of inconveniencing you, simply so we can see what you are obviously doing? I mean, if you really want, we can schedule an in person inspection, but, I don’t really think that we will find anything surprising: you are clearly keeping your place up. Don’t you live a couple of hundred miles away? It seems to me that this is a better use of your time, rather than spending 4 or 5 hours on the road, and a couple of hours here. And, to be honest, our inspectors can do a lot more good inspecting some of these death traps we have people living in, not so very far from your place. So, what do you think?”

I spent a few seconds digesting the Good! Sense! this gentleman was sharing with me.

(me) “Hmm. So, I’ll mail you my check tomorrow! Thanks for your time, have a pleasant day!”

It’s All In How You Tell ‘Em

Expanding upon my Cat Triage post, allow me to tell you about how properly presenting the patient facilitates proper care.

So, after my cardiac cath, and stent, my cardiologist placed me on anticoagulants (blood thinners). When one is a geezer, as I am, and has, let us say, occasionally has had mishaps, one’s joints will ache from time to time.

I had been in the practice of taking ibuprofen, and my (back)(knees)(elbows) very much appreciated this. On the other hand, when one is taking NSAIDS, such as ibuprofen, one has increased risk of bleeding from the stomach: and, simply to make things more exciting, only 20 % of patient who DO develop bleeding from their stomach, have symptoms.

Remember this.

So, after a couple of months, I asked my doctor if I could take motrin even while taking anticoagulants. I was told yes, and then did so.

Months later, I developed the dizziness with position change, rapid heart rate set of symptoms that I had noted in the referenced post.

Ya know, if you should be tachycardic (fast heart rate) and dizzy, and elderly, and visit your local ER, when you announce to the registrar, “Ma’am, would you please call the triage nurse and let her know that you have an elderly, tachycardic, dizzy heart patient at your desk? Please?”, well, their eyes do, indeed, get THIS WIDE, and the triage nurse not-quite sprints out to see you.

And, you find yourself the proud owner of a BFN type IV. (That would be a Big Freaking Needle, such as the nurse administering your blood infusion will need to have).

Once the lab had reported my results, the ER doctor sat down and told TDW and me that, after she had administered a couple of liters of saline IV (which had beneficial effects on both my heart rate as well as my dizziness), my hemoglobin was around 7. This is unsatisfactory, as normal runs around 13-15.

Oops.

Since I had not had any symptoms of gastric bleeding, everybody was puzzled. There was no puzzlement regarding the future place of ibuprofen in my medication list: NFW, none at all. (No Freaking Way).