Well I live in the nightmare that is the Dutch healthcare system [1]. There are many things that they will fix but they didn’t fix my sleep. A friend fixed my sleep. He is a doctor and prescribed me the right thing. The thing is, he shouldn’t have had to intervene. Without him I could have ended up poor and destitute as my sleep was wrecking me.
And yea, I already did all the standard things. CBT for insomnia helped somewhat. My insurance didn’t fully cover it either, unless I was willing to wait for 8 to 12 months.
And I recently met someone with slow moving metastatic cancer. Thanks to LLMs they will most likely live another 3 to 5 years extra since the Dutch conventional mainline treatment hasn’t been taken yet. But it is German doctors that helped them and Belgian doctors that pointed out in a second opinion that a lot more can be done.
LLMs have a part to play. The false positives are awful, but I have seen an average of 5 out of 10 care when things become too complicated.
Except for trauma treatment. The Dutch healthcare system is amazing once they diagnose classic PTSD.
So it’s definitely not all bad but the trust I had when I was younger has been eroded quite a bit and LLMs can meaningfully step in, in my case at least.
[1] I know there are worse systems. But from what I have heard there are clearly better systems nowadays. It has slipped a lot
For me what helped is taking 7.5 mg of mirtazapine. At higher levels it's an anti-depressant but at lower levels it's an anti-histamine. It gets me drowsy. Together with 0.3 mg melatonin it knocks me out. I only take it 3 times per week max to not have habituation kick in.
So 3 days out of 7 days I have guaranteed good sleep. The other 4 days are a toss up. But an average of 5 days of good sleep is much better than 3.5 days out of 7 days.
Interesting. There recently was an article about how premenopausal and menopausal women are taking antihistamines with pepcid to help them sleep due to it going viral on tiktok.
> Then, a few months ago, Angela saw a social-media post from a woman who took daily anti-histamines (like Allegra, Claritin, or Zyrtec) plus Pepcid AC (a common antacid) for her perimenopause symptoms. Her results, as reported, sounded miraculous: no more brain fog, no more tossing and turning all night. Even her mood vastly improved.
Technically Pepcid is also an antihistamine, but h2. And h1-antihistamines have been used for sedation for a long time tho the effect is very much ymmv (first one I tried OTC would knock me out but not let me rest at all, not a keeper).
AFAIK mirtazapine shouldn't cause habituation the way actual "sleeping pills" or benzodiazepines do. That's one of the reasons it may be preferable as a sleeping aid, especially in the longer term.
Anecdotally, when I took mirtazapine for sleeping problems, it did sometimes seem to have a stronger effect the first time I took it after not using it for a while. After that the effect stayed stable. Overall it shouldn't cause habituation, and my doctor said as much.
Of course trust your doctor and not strangers on the internet, though.
> After that the effect stayed stable. Overall it shouldn't cause habituation, and my doctor said as much.
Yea so this is where it gets murky for me. I experience some habituation actually. But my actual doctor went like "wtf is this?" and she didn't really mentioned what she knows about it. So on this particular pill my friend is my doctor. Not an ideal situation. I mean, he is an actual doctor but for him to be my doctor in this is a bit fucked up. He knows a lot more about mirtazapine than my GP though since he read up on it.
I suppose it can be quite different for different people. I stopped using it because it often (not always) made me still feel tired and unfocused in the morning, something that apparently also doesn't happen to everyone.
> But my actual doctor went like "wtf is this?"
Different country, but where I live, prescribing low-dose mirtazapine for insomnia appears to be fairly common practice even though it's off-label. I've had it suggested or mentioned by three or four different doctors, including GPs. I also know several other people who have been prescribed it.
The doctors here seem to prefer low-dose mirtazapine as safer over typical CNS depressants such as benzodiazepines for insomnia nowadays, at least if the problem may be longer-term.
So it's not really something particularly weird. Of course different countries also have different medical cultures so I guess it's not surprising if it's not that common in other places.
Is the dutch healthcare system broadly against hypnotics? Culture (of the country or its medical system) can massively influence prescriptions or their lack thereof e.g. france is pretty famous for prescribing hypnotics very easily (and having a broad range of them), while the UK is generally a lot more reluctant.
True, for example in Switzerland you can't really get melatonin, even if you do it costs an absurd amount (like 100 chf). Doctors seem to be really against it in Switzerland.
I personally take 0.3 mg, two hours before bed. I've done this for about 2 years now. It still works. I know, anecdata, but as you can tell the dose is low.
This seems like self promotion with no contribution to Hacker News. You're an account that has 2 karma, and only exists for less than a month [1]. Also, it's a bit of a weak comment in general.
The NYT did this profile a while back: "Ben Riley was already writing about the risks of chatbots when his dad started trusting A.I. over his doctor."
The dad was a retired neuroscientist who delayed cancer treatment against medical advice because he was certain he had been misdiagnosed based on his own research that he did with the help of A.I.
> I am very grateful to Teddy Rosenbluth for sharing my father's story with the world, her kindness and curiousity proved to be restorative in ways I didn't anticipate.
> The two words that everyone used to describe my dad: "intelligent" and "kind," and he was indeed both of those things. The sad irony here is that it was his human intelligence, combined with these strange new tools that purport to be a form of 'artificial' intelligence, that led to his ill-advised decision to forego the treatment he needed for his CLL. A doctor has already commented on this story with the observation that AI "confidently asserts erroneous conclusions," and we simply have no idea how often this is happening or the magnitude of the harm that results.
> Not a day goes by that I don't feel the pang of my father's absence. He might still be here if not for AI. I try not to think about that, but sometimes I can't help myself.
The context is very important: decades of a poorly-diagnosed chronic illness had left him deeply distrustful of the medical system.
This is the real root issue.
At 75 years old, he was stubborn. Is that reasonable ? Yes, perfectly. Could he have been right since the beginning ? Certainly. Did he deny evidence ? Yes.
Zero doubt that he was intelligent, everything points toward that direction, but that doesn't make a person less stubborn, because accepting the evidence, is also accepting that you were wrong if you initially postured yourself as adversarial instead of cooperative.
He would have read Wikipedia, scientific papers, etc, even without AI.
He did not want to be convinced. It works both ways:
i mean, other smart people have famously delayed cancer treatment without needing poor guidance from LLMs! that's not at all new or unique to LLM chatbots
GPT-4o, which is what that article is most likely about, was an older low param count slop model which was known for abusing emojis and sycophancy. It does not really have any relevance to latest claude frontier models.
Your comment is akin to saying "Karen from facebook who is a human pushed essential oils and ivermectin as a cure to cancer. Now doctor Y is suggesting chemo. Both are humans, humans cannot be trusted!"
I asked a clanker about symptoms I was having. (I'm not an idiot, I was already on my way to hospital, clanker was just to take my mind off symptoms during the drive.)
The clanker said I'd be fine, I just needed some rest and OTC meds.
The medical staff immediately turfed me to surgery because the same set of symptoms I told the clanker were enough to concern them that I needed emergency surgery.
Had I have listened to the clanker, I'd be dead because I did need emergency surgery. (Hell, I almost kicked the bucket because I waited for someone to wake up to give me a lift because.my insurance probably doesnt cover an ambulance ride.)
Not OP but wanted to note that you're also likely to get different results based on the language you use (it'll respond differently to dialects of English, for example) and the RNG seed of the current session. These things are still probability engines and even if you know the exact symptoms, this might not be reproducible
It's not just the second-guessing. It's the getting in the ballpark but striking out: explaining in detail why they are not correct. A little bit of patient knowledge requires a tremendous amount of doctor time to explain away the ignorance.
It's a 180 for me: While I believe doctors should explain diagnosis or treatment decisions when asked, I don't believe they should be taxed with explaining away alternatives. In my anecdotal 2nd- and 3rd-hand experience, doing that is taking at least a third of their time (on roughly 5% of the patients who think demanding answers will make things better) -- with zero improvement to diagnostic accuracy or treatment effectiveness. Doctors already consult with other doctors, and it makes no sense for them to have to consult with ignorant patients or treat their AI psychosis on top of their disease. It doesn't increase patient autonomy any more than adding a steering wheel for child car seats would help toddlers learn to drive.
Explaining diagnosis and treatment recommendations decisions inherently involves explaining away the alternatives. In this world where patients are ultimately responsible for our own care, explaining your rationale is a straightforward part of the job - otherwise there is nothing for patients to base their decisions on apart from how the options make them feel. If visits haven't been allotted enough time to get the job done, then that is something you need to take up with health plan bureaucrats rather than taking it out on patients.
I dunno man, it's one thing to have your car still be broken because you were wrong, it's a different thing poison yourself on the basis of having done your own research. The mechanic can laugh at you, it hits a doctor differently.
Nightmare because users approach LLMs with the false confidence that they're always right, and present LLM outputs as fact to Doctors who have to waste time explaining that it's wrong most of the time. It hurts more than it helps.
Hurts who ? Yes the doctor is super stressed and has maybe 10 minutes for you that's the actual problem, it's not like before LLMs they were super glad to sit there and answer all your questions.
Well it was a nightmare for my mother's do-nothing GP surgery in the UK. She had several conditions which were being handled completely separately without central coordination, and her health was in serious decline. We went in with a list of 20 AI-generated questions based on her conditions and treatment (which I was able to screen as I have a bio postgrad, but not medical training), including those related to NICE guidelines and procedure, and, frankly the GP bricked it and ordered a load of new interventions. My mother started to get proper treatment.
I wouldn't trust AI to make a diagnosis, but I would absolutely trust it to notice where procedure hasn't been correctly followed, where a treatment is counter-indicated because someone has missed a line on a health record, or where there's a clear potential alternate diagnosis which has been missed for spurious reasons. Also, unfortunately, where doctors aren't doing a decent job - often because they're overworked or underfunded.
UK has probably the worst healthcare in the developed world. In part perhaps due to UK blindly accepting any kind of medical degree (doctors and nurses) from all over the globe. Yes, you heard that right, they verify the validity of the degree but there is no formal standardized exam to sit to practice in the UK.
Her nurses frequently couldn't speak English. I had to spell out her medical conditions letter by letter so that the nurse could input it onto the medical system. She was entering gibberish / wrong info until I stepped in, as I was watching the PAS out of interest.
They effectively had tourist English. They're probably in through an agency so the financial incentive is to find an examiner who will give the right answer.
There’s more than two options here. It was already difficult to deal with self diagnosis for doctors, now we have a machine that outputs recommendations, and does it with confidence whether it’s correct or not.
The same issues that were present with search-engine self diagnosis are still present with LLMs. If you provide Google with an incomplete list of symptoms and can’t interpret the information you find correctly, you will likely get an incorrect diagnosis. The same is true for LLM output.
Everyone on the internet loves to put doctors on a pedestal, but I think upwards of 30% of my doctor visits have been misdiagnosed.
There's a reason I ask AI about absolutely everything medical and there's a reason I keep extra quantities of prescription medications around for emergencies. I've saved my own ass a lot more times than the doctors have, thanks to good doctors not being available.
That works in your case because you likely already have an analytical mindset, can reliably discard or research information further. Same thing why AI is in an enabler for people having already some skill. But it can be very dangerous or misleading for people blindly believing all output.
> It was already difficult to deal with self diagnosis for doctors
I get it. But the current system is also super difficult for the patient: getting time to ask questions, get clear answers, get the best possible diagnosis taking into account your history, symptoms etc and all that in 5-10 minute checkup when your doctor sees 50 patients a day and has very little time for you; this doesn't scale well. Patients run to A.I for a reason.
There are quite a few disclaimers everywhere that soften confidence: "always ask a medical specialist", "I'm not a doctor", "this could have been this or that but really not sure", etc.
Its a nightmare because it erodes trust. Doctors are not "always right" which is why "always get a second opinion" is codified in culture.
But AI's problem is that its completely full of shit, sometimes, and the people most qualified to evaluate whether its full of shit are the doctors, not the patients, but just like OP's original article, patients are left feeling like their second opinion from AI might be more trustworthy than their doctors opinion.
> But AI's problem is that its completely full of shit, sometimes
It's now quite unusual that it's "Completely full of shit". If it contradicts something your doctor said I don't see why you should feel ashamed to bring it up.
Sure it complicates the doctor's work, having ignorant obedient patients must be more comfortable for the doctor, but the end result could be more accurate diagnosis.
But those are obvious errors. What if the AI tells you to up your intake of X and it seems plausible? So you up your intake of X by taking some supplement, but upping the intake of X makes your body deplete more of Y and now you have a new or compounding problem.
A doctor might have never recommended upping X, because they would know what it does to your body. Or they might have suggested additional supplementation to avoid this.
The fact that LLMs are trained on all public knowledge is a huge red flag, because there are more wrong infos out there than right ones. Especially about health, diet, etc.
I was about to respond but your last statement implies fundamental misunderstanding of how LLMs work. I don’t think you even know about RLHF and you think good and bad ideas are spread in proportion to how much they are seen on the internet.
They are using the “gold standard for the evaluation of expert medical computing systems” not a proxy for what a doctor actually does when diagnosing someone.
It may have some utility after diagnosis, but this test doesn’t demonstrate utility for patients.
Not quite. An LLM generates text that would likely follow. The sky is… “blue”. A patient in pain with a bone protruding from their shin has a… “broken leg”.
The more training data, the more questions it can answer with a reasonable degree of probability of accuracy.
Throwing away a potentially useful analysis just because it’s probabilistic seems a bit like throwing the baby out with the bath water.
Yes that’s my point. An LLM can clearly accurately predict obvious cases, so it’s reasonable to assume that it can predict less obvious cases with somewhat less accuracy.
The real question is where’s the cut-off point between accuracy and utility.
Remember: a second human opinion can also be wrong, and even a wrong opinion can still be useful (especially in medicine where differential diagnoses are a common practice - if the LLM gives you a useless opinion, you rule it out and move on).
I don’t think it’s particularly unreasonable to think that an LLM would have enough literature, or enough reasoning ability, to be able to generate a plausible interpretation of the data. A human can then review and say either “yeah that’s clearly not the case here” or “hmm, actually that could explain it, maybe we should order another test”.
This is obviously going to happen. But sub-par and sloppy doctors are a thing too. Medicine has been using semi-intelligent systems for years that were nevertheless found to improve outcomes.
We need studies that quantify error rates from each source type, then we need to account for the fact that the artificial type will keep improving.
It's so much worse than some Google results: people see LLMs as a trusted friend who never talks back and never questions you, who is excellent at convincingly communicating their bs, reeling you in with "tell me more so I can really lock this down", continuing to fool you
People should've googled their symptoms and especially the prescriptions they got. It has always been a good practice. If[0] AI proves to be the new google then people should ask AI too.
Like any domain, when you have questions or need a solution, you make research first, then you ask a specialist.
If you explain well the symptoms and context you can have proper advices and then decide on the path next:
Case A) It looks benign and advices / information that you collected seem reasonable, then you go your way.
Case B) You need second opinion of a specialist because the subject is too complex, or there are medications that you need approval.
Once you have challenged LLMs, and read about the topics over and over then you genuinely become really good at understanding it (especially if you triangulate over LLMs and ask them to challenge, you start to have genuine questions). No matter if the answer is right or wrong, you have elements. Maybe you missed the point, but you come prepared.
At home you have the time to assess the options, pros and cons of each approaches, the possible questions to ask and then challenge the doctor.
Shared decision-making is an actual evidence-based model of care, and patients who arrive understanding their condition and carrying specific questions tend to get better attention and better outcomes.
Some doctors get annoyed, because they have big ego and choose to be patronizing, but it is exactly their job to answer such questions.
With LLMs, it's quite good, you get nuanced and rather useful answers.
Before LLMs, no matter the topic you searched for, the answer was the same: "you have cancer / an [obviously deadly] rare disease"
The other problem, in many places:
• The doctors are not affordable
• They are too busy for you (< 15 minutes)
• You may need to wait months to get an appointment
• They are not good (country-side is an example, and sometimes even country-level)
+ you can have all of these factors together.
So, you have something deeply bothering you, your only appointment is in 4 months. It would be insane not to take the time to explore different solutions and not to come informed about the topic.
If you express your prompt properly and do not rely on imagery, you can absolutely have top-tier advices.
Agreed. This gets worse in cultures in which Doctors have no habit or haven't been trained that educating the patient is part of the job. Whenever I am back to my birth country, I specifically avoid doctors that are older than mid 30s, because they all have the same, terrible bed manner. They might be good at diagnosing and treating, but they never, ever explain anything, even when asked. Some even have "helpful pamphlets" to hand to the patient - anything to avoid explaining. It seems that in their view their job is not helping the patient, but completing a task - running a scan, performing a procedure, administering medicine etc. The human, that is subject of the task, is invisible.
It can be helpful in your understanding the choices made by asking questions and thus in reassurance, but it requires something most people lack: understanding you are likely wrong since you are just collecting information without understanding it.
Pretty much the like most manager these days, so I understand the frustration of the GPs.
