How about the opportunity cost of people dying because they don’t have access to any treatment? It can be very challenging to find a qualified professional, even if you have the necessary funds, insurance, and determination.

LLM mental health treatment can’t come soon enough.

Yes, it is ugly!

The thing is bad actors are essentially forcing arguably unethical tools onto people in need.

Our current Healthcare struggle is completely unnecessary.

A good percentage of our economic struggles are equally unnecessary.

The only reason we are even having these discussions is too many people with means are not employing those means in ways that make it worth allowing said means at all.

Greed, psychopaths, ignorance and more are the problem.

People are saying:

Basic health care can't come soon enough.

Drug price reform can't...

Mental health

You get the idea.

I get it. Lots of us are desperate.

I lost a home over this health care shit. Basically traded more time with my wife for our home. Brutal as fuck. I currently pay close to $2k in premiums and have difficulty finding options because I fall into what Franken called the "doughnut hole."

Have considered some sort of crime, or leaving the country many times too.

Like I said, ugly.

> LLM mental health treatment can’t come soon enough.

If you think LLMs perform at a level that they can help resolve the mental health crisis in the US, you are very much a part of that problem. They can’t even always produce functional code without heavy steering, let alone negotiate the fraught domain of psychological and psychiatric health.

Foisting people in crisis off on unpredictable text generation engines is IMO a textbook example of the fundamentally anti-social character of American society that produces so much of the mental health problems this country faced.

> If you think LLMs perform at a level that they can help resolve the mental health crisis in the US, you are very much a part of that problem.

Bogus. How do you know an LLM isn’t better than human led treatment because the patient can be honest and have privacy, free to discuss anything without data leaving their premises.

Alternatively, how do you know that a high level of care is needed for all patients? There are waiting rooms filled with people trying to get a chance to talk to someone about their problems who will listen, and others who don’t come in at all because they have no insurance.

> Bogus. How do you know an LLM isn’t better than human led treatment because the patient can be honest and have privacy, free to discuss anything without data leaving their premises.

This has the evidentiary burden entirely backwards. We have evidence for the efficacy of various forms of psychological and psychiatric interventions and none for that produced by LLMs. I’m not even sure if it’s possible or ethical to test them for this purpose, as it would require OpenAI levels of RLHF training to get them to adhere to current guidelines and standards of care.

I agree that this is unknown. In terms of finding the answer, I guess you’ll have to wait and see what optimistic or curious scientists, engineers, and doctors build and what they find.

For ethics, how is this more dangerous than trials for a new heart medication that might kill patients? In fact, the only way to know for sure, is to try and see.

In terms of early results, these kinds of toy projects will be the frontline since any lawyer would tell you to not touch this with a 10ft pole. But I doubt a Github project would face that scrutiny since it takes technical skills to setup which requires knowledge and intent on the part of the user.

> how is this more dangerous than trials for a new heart medication that might kill patients?

Clinical trials happen through an established regulatory framework to minimize harm to participants, for starters…

Sure, but one of those harms is death and that risk cannot be fully eliminated. Not to mention the ethical concerns of experimenting on animals for the riskiest testing.

Knowing that hundreds of people end their lives /after/ seeking care in our current mental health system, I’m not afraid of exploring other options.

I do believe, however, that developers in this space must not over-represent the capability of their systems and have a duty to strongly warn users that the system can act unpredictably and give harmful advice. Resources to contact health professionals and warnings to contact 911 if there is a life-threatening emergency are also obligatory.

With those disclosures, I don’t see how a self-directed discussion with a language model could be overly harmful.

Hey, I'm responding to this a week later on the off chance you'll see it. "You are very much a part of that problem" doesn't sit well with me.

> They can’t even always produce functional code without heavy steering

Right, but you and I both can appreciate that it can produce functional code a lot of the time, sometimes with only light steering.

> let alone negotiate the fraught domain of psychological and psychiatric health.

I agree with you to a large extent. This is a sensitive area to operate in and introducing an unpredictable, unemotional, unwieldy language model into the loop has the potential for disastrous results.

>Foisting people in crisis off on unpredictable text generation engines...

I do not want this. I just want an additional option.

I personally have found relief through GPT-4. Despite its limitations, the LLM offers (the illusion of?) empathy, understanding, and clarity at a level that most mental health professionals simply do not. It helps me, and for that reason I know it can help others. An LLM isn't a substitute for healthcare, but it's absolutely a supplement.

I hope you'll reconsider your view and tone down the rhetoric.

We can rely on AI just for basic preliminary advices just like we rely on Google Search. Google Search also contains lot of blog posts that are untrue. Do they kill a lot of people? No, Right? Similarly, AI can be used for basic guidance. After that one can consult psychiatrist if he/she is having money in their pocket.

"It won't happen to me."

But it could! You may feel it makes sense. And for some of us it may make sense too.

What happens when it doesn't and you do not know?

Yes, you are right about it. It can happen to anyone. We need to cautiously develop AI models related to healthcare.

I don’t know I have a side in this, but it does seem strange to take the side that “we should talk about people not getting health care” and “self diagnosis is going to kill them too.” So, passive death is better than active death? No one specifically being at fault is somehow morally superior to some LLM being at fault?

Talking about something with no expectation of it being fixed is doing nothing, and people are still dying. If some people die due to bad advice from a machine, but some people survive, is that better then everyone dying due to inaction of any sort?

We won’t get getting universal health care in the US. Maybe there’s something to a democratization of subpar, but at least available, medical advice and care?

Talking about it, sharing our stories, making sure people get just how shitty it really is happens to be a great way to set an expectation for change.

And there is this: The change, if there is to be one, will have to come from us. A whole lot of us.

Most great things do.

This idea of using an LLM in some meaningful way is as laughable as watching the world burn while people squabble over baubles and trinkets is maddening.

Talking about it doesn’t help people who are sick. It’s something we’ve done for decades and we are no closer to universal health care. We can continue to talk and bemoan the state of things. But when you’re sick, you personally, the great mass talking about how shitty it is that you’re sick matters not one bit. No one doubts change would come from us - but if there is to be a change, it’ll be over a sea of misery. Sitting around taking a medical ethics stance that everyone must die unless a licensed medical professional billed you with correct billing codes to an insurance company is on the surface absurd. People received and gave medical advice and care without both of those things for almost all of humans existence, yet here we all are, the world didn’t end. It would be a hell of a lot better if medical care weren’t rationed by death panels, but it is rationed by the death panels of Congress.

I take it you’re on the “LLM can’t do anything but hallucinate.” However an awful lot of folks use LLM for quite a lot successfully already. I’ve found in the space of medical advice GPT4 is already fairly sophisticated. I wouldn’t use it without double checking it’s output, but I can ask it fairly complex questions about physiology, biochemistry, medicines, and many other subjects and it almost always provides a concise, detailed, and insightful answer. I’ve not yet found it hallucinating so long as I don’t ask it questions that are essentially information retrieval questions (who wrote the paper about blah will often induce a wrong answer, while, say, what medicines shouldn’t be mixed with ibuprofen will not). I personally believe LLM’s are not the answer as well, but I believe LLMs are a major missing piece in the assembly of partial answers we’ve built to date. I think LLM’s combined with information retrieval, optimizers, constraints systems, goal based agents, and other classical AI and information techniques forms a powerful combination greater than the sum of its parts. And I definitely think the way to scale medical care is for most medical questions that don’t need an expert to be serviced by a machine. The vast majority of our medical systems time is taken up by people with colds, GERD, and other questions and conditions that can be handled without a human.

We haven't been talking seriously for decades.

Anyway, people will try this, others will get hurt or killed, and I along with others will get our "I told you so" moment, which will get added to the "when the fuck do we make health care a priority" advocacy library and the fight goes on.

Fact is, far too many people ignore health care.

When that changes, we will see progress.

That’s untrue:

https://pnhp.org/a-brief-history-universal-health-care-effor...

There have been meaningful efforts that keep reverting to insurance schemes since the late 1800s, with the first real legislative passage in 1915.

Universal healthcare has actually been pretty popular and enjoyed broad support. Most people are acutely aware of health care and the lack of it. In fact it typically ranks near the top in the concerns for most Americans:

https://www.pewresearch.org/politics/2023/06/21/inflation-he...

The issue is more the business lobby against expansion of health care and the insurance lobby against expansion of universal solutions like single payer and Medicare / VA expansion to everyone. In fact the concerns aren’t false - insurance and the billing industry are huge employers of relatively low skilled but well paid workers.

We haven't had conversations with real teeth yet.

I agree with what you said.

Changes to this state of affairs will only come from us.

Otherwise, they have position and are fat 'n happy.

This means we need to speak in more basic terms. Expensive terms.