I noticed a Snopes fact check article (“AI Models Were Caught Lying to Researchers in Tests — But It’s Not Time to Worry Just Yet”) today which reveals that Artificial Intelligence (AI) can lie. How about that? They can be taught by humans to scheme and lie. I guess we could all see that coming—or not. Nobody seems to be much alarmed by this, but I think it’s probably past time to worry.
Then I remembered I read Isaac Asimov’s book “I, Robot” last year and wrote a post (“Can Robots Lie Like a Rug?”) about the chapter “Liar!” I had previously horsed around with the Google AI that used to be called Bard. I think it’s called Gemini now. Until the Snopes article, I was aware of AI hallucinations and the tendency for it to just make stuff up. When I called Bard on it, it just apologized. But it was not genuinely repentant.
In the “lie like a rug” post, I focused mostly on AI/robots lying to protect the tender human psyche. I didn’t imagine AI lying to protect itself from being shut down. I’m pretty sure it reminds some of us of HAL in the movie “2001: A Space Odyssey,” or the 2004 movie inspired by Asimov’s book, “I, Robot.”
Sena found out that Cambridge University Press recently published a book entitled “The Cambridge Handbook of the Law, Policy, and Regulation for Human–Robot Interaction.” I wonder if the editors and contributors of book on AI and robots mention Asimov.
It reminds me of my own handbook about consultation-liaison psychiatry which was published 14 years ago by CUP—and which CUP now wants me to sign a contract addendum making the book available to AI companies.
I read this really interesting article on the web about how slow humans think, “The Unbelievable Slowness of Thinking.” That’s just me all over. The gist is of it is that we think slower than you’d imagine creatures with advanced brains would think. I don’t have a great feel for what the stated rate feels like: 10 bits/second. It doesn’t help much to look up the definition on Wikipedia, “…basic unit of information in computing and digital communication.” It’s a statistical thing and I barely made it through my biostatistics course in medical school. In fact, the authors calculated that the total amount of information a human could learn over a lifetime would fit on a small thumb drive.
Anyway, I tried to dig through the full article in Neuron and didn’t get much out of it except I recognized the story about Stephen Wiltshire, a guy with autistic disorder who could draw New York’s skyline from memory after a helicopter flyover. I saw it on an episode of the TV show UnXplained.
I was amazed even if he processes at only 10 bits/second, according to the authors.
By the same token, I thought the section called “The Musk Illusion” was funny. It refers to the notion many of us have that our thinking is a lot richer than some scientists give us credit for. That’s the Musk Illusion, and it refers to Elon Musk the billionaire bankrolling Neuralink to make a digital interface between his brain and a computer “to communicate at an unfettered pace.” How fast do the authors of this paper think the system works? It flies at about 10 bits/second. They suggested he might as well use a telephone. The scientists weren’t that impressed judging from the quotes in the Reception section of the Wikipedia article about Neuralink.
Anyway, regardless of how slowly we think, I believe we’ve made a lot of progress for a species descended from cave dwellers who were prone to falling into piles of mastodon dung. I bet it took considerably longer than 10 bits/second for them to figure out how to climb out of that mess.
Reference:
Jieyu Zheng, Markus Meister,
The unbearable slowness of being: Why do we live at 10 bits/s?
Neuron
2024,
ISSN 0896-6273,
Abstract: Summary
This article is about the neural conundrum behind the slowness of human behavior. The information throughput of a human being is about 10 bits/s. In comparison, our sensory systems gather data at ∼10 bits/s. The stark contrast between these numbers remains unexplained and touches on fundamental aspects of brain function: what neural substrate sets this speed limit on the pace of our existence? Why does the brain need billions of neurons to process 10 bits/s? Why can we only think about one thing at a time? The brain seems to operate in two distinct modes: the “outer” brain handles fast high-dimensional sensory and motor signals, whereas the “inner” brain processes the reduced few bits needed to control behavior. Plausible explanations exist for the large neuron numbers in the outer brain, but not for the inner brain, and we propose new research directions to remedy this.
Keywords: human behavior; speed of cognition; neural computation; bottleneck; attention; neural efficiency; information rate; memory sports
This is just a quick follow-up which will allow me to clarify a few things about Artificial Intelligence (AI) in medicine at the University of Iowa, compared with my take on it based on my impressions of the Rounding@Iowa presentation recently. Also, prior to my writing this post, Sena and I had a spirited conversation about how much we are annoyed by our inability to, in her words, “dislodge AI” from our internet searches.
First of all, I should say that my understanding of the word “ambient” as used by Dr. Misurac was flawed, probably because I assumed it meant a specific company name. I found out that it’s often used as a term to describe how AI listens in the background to a clinic interview between clinician and patient. This is to enable the clinician to sit with the patient so they can interact with each other more naturally in real time, face to face.
Further, in this article about AI at the University of Iowa, Dr. Misurac identified the companies involved by name as Evidently and Nabla.
The other thing I want to do in this post is to highlight the YouTube presentation “AI Impact on Healthcare | The University of Iowa Chat From the Old Cap.” I think this is a fascinating discussion led by leaders in patient care, research, and teaching as they relate to the influence of AI.
This also allows me to say how much I appreciated learning from Dr. Lauris Kaldjian during my time working as a psychiatric consultant in the general hospital at University of Iowa Health Care. I respect his judgment very much and I hope you’ll see why. You can read more about his thoughts in this edition of Iowa Magazine.
“There must be constant navigation and negotiation to determine if this is for the good of patients. And the good of patients will continue to depend on clinicians who can demonstrate virtues like compassion, honesty, courage, and practical wisdom, which are characteristics of persons, not computers.” ——Lauris Kaldjian, director of the Carver College of Medicine’s Program in Bioethics and Humanities
I listened to the recent Rounding@Iowa podcast “The Promises of Artificial Intelligence in Medicine.” Those who read my blog already know I’m cautious and probably prejudiced against it, especially if you’ve read any of my posts about AI.
I was a little surprised at how enthusiastic Dr. Gerry Clancy sounded about AI. I expected his guest, Dr. Jason Misurac, to sound that way. I waited for Gerry to mention the hallucinations that AI can sometimes produce. Neither he nor Dr. Misurac said anything about them.
Dr. Misurac mentioned what I think is the Ambient AI tools that clinicians can use to make clinic note writing and chart reviews easier. I think he was referring to the company called Ambience.
I remember using the Dragon Naturally Speaking (which was not using AI technology at the time; see my post “The Dragon Breathes Fire Again”) speech to text disaster I tried to use years ago to write clinical notes when I was practicing consultation-liaison psychiatry. It was a disaster and I realize I’m prejudiced against any technology that would make the kind of mistakes that technology was prone to.
But more importantly, I’m concerned about the kind of mistakes AI made when I experimented with Google Bard on my blog (see posts entitled “How’s It Hanging Bard?” and “Update to Chat with Bard” in April of 2023.
That reminds me that I’ve seen the icon for AI assistant lurking around my blog recently. I’ve tried to ignore it but I can’t unsee it. I was planning to let the AI assistant have a stab at editing this post so you and I can see what happens. However, I just read the AI Guidelines (which everyone should do), and it contains one warning which concerned me:
“We don’t claim any ownership over the content you generate with our AI features. Please note that you might not have complete ownership over the generated content either! For example, the content generated by AI may be similar to others’ content, including content that may be protected by trademark or copyright; and copyright ownership of generative AI outputs may vary around the world.”
That is yet another reason why I’m cautious about using AI.
Last night, I was watching the TV show Strange Evidence and noticed that they were going to show what’s been called the ghost pants video from a few years ago. I went to bed because I saw it on a similar show a few years ago. I doubted that it was solved yet. The clip shows a pair of white pants running down a street. You can’t see anyone wearing them.
There are a few interesting video-based paranormal TV shows. The one I think is pretty well done is The Proof is Out There, hosted by Tony Harris. I saw one which showed a photo of a girl whose image was different from her reflection in a mirror. The question was whether it was evidence for something paranormal, maybe proof of simulated reality.
Tony and the group of experts finally settled on it being unexplained. However, on a subsequent episode, Tony explained that someone had notified him that the photo was shot simply by using the panorama mode on a smartphone camera. It was relatively simple. Sena and I made a couple.
That was about the same time the YouTube video about the white ghost pants was circulating on the internet. Today I found a YouTube short video that shows essentially the same thing made by a couple of guys who also made a 10-minute video explaining how to achieve the effect. It’s below the short video. Of course, I don’t understand the technical explanation, but I think it might account for the ghost pants video.
We watched the Svengoolie TV movie last night, “The Comedy of Terrors.” It was my third time seeing it. I wrote a blog post about it in March 2024 partly because the condition of catalepsy is mentioned. Mr. Black’s butler points out that Mr. Black had periods of catalepsy. Much to my surprise, I didn’t write anything about distinguishing cataplexy and catalepsy, but last night I thought about the differences. I finally found a summary of the plot today on the Svengoolie website and you can see it on Turner Classic Movies. You can still see the movie on the Internet Archive.
You see Mr. Black have his “cataleptic” attack about 39 minutes or so into the film. It appears to be triggered by shocked surprise upon discovering Mr. Gille in his house. A bit later, after the butler fetches the doctor, the first scene is that of Mr. Black’s wide-open eyes, which the doctor closes, at the same time saying that he’s dead. In that same scene you hear the butler asking for confirmation because it’s well known that Mr. Black has had fits of “catalepsy” before. The doctor obliges only to confirm, in his opinion, that Mr. Black is dead. However, he wakes up in the funeral parlor, where he has a fight with Trumbull and Gillie, then suffers another abrupt collapse, one of many that occur, always reciting lines from Shakespeare presaged by asking “What place is this?” often from inside a coffin.
This movie made me think about the clinical differences between catalepsy (specific to catatonia) and cataplexy (specific to narcolepsy). Because I was a consultation-liaison psychiatrist, I saw many patients with catatonia. However, I can’t remember ever seeing patients with cataplexy. I had to review them by searching the web. I think the most helpful links are:
Catalepsy: Burrow JP, Spurling BC, Marwaha R. Catatonia. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430842/
Catatonic patients often will be mute and immobile vs purposeless agitation. Waxy flexibility can be one of many features. Catatonia can occur in the context of variety of psychiatric or medical illnesses. They may wake up and talk within minutes if given a Lorazepam challenge test, which is given intravenously. It can look miraculous.
Cataplexy: Mirabile VS, Sharma S. Cataplexy. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549782/
Cataplexy occurs in narcolepsy and is the sudden onset of muscle weakness, often precipitated by strong emotions, usually positive but can occur with negative emotions like fear. Eye movements can be normal, and episodes usually resolve within minutes.
Mr. Black’s episodes look like a strange mixture of catalepsy and cataplexy. His episodes are precipitated by fear or anger. Quoting Shakespeare doesn’t occur in either catalepsy or cataplexy.
At the end of the movie, he is impervious to bullets—a feature not seen in either condition.
I have a few messages to pass on today. This is the last day of November and the Amaryllis plants are doing so well Sena had to brace the tallest one using a Christmas tree stake and a couple of zip ties. It’s over two feet tall!
I’m not sure what to make of almost a dozen comments on my post “What Happened to Miracle Whip?” Apparently, a lot of people feel the same way I do about the change in taste of the spread. So, maybe it’s not just that my taste buds are old and worn out.
Congratulations to the Iowa Hawkeye Football team last night! They won against Nebraska by a field goal in the last 3 seconds of the game. I had to chuckle over the apparent difficulty the kicker had in answering a reporter’s question, which was basically “How did you do it?” There are just some things you can’t describe in words. There’s even a news story about how thinking doesn’t always have to be tied to language.
Along those lines, there might be no words for what I expect to think of tonight’s 1958 horror film on Svengoolie, “The Crawling Eye.” This movie was called “The Trollenberg Terror” in the United Kingdom version. I can tell you that “Trollenberg” was the name of a fictitious mountain in Switzerland.
I’m not a fan of Jack the Ripper lore, but I like Josh Gates expedition shows, mainly for the tongue in cheek humor. The other night I saw one of them about an author, Sarah Bax Horton, who wrote “One-Armed Jack”). She thought Hyam Hyams was the most likely candidate (of about 200 or so) to be Jack the Ripper, the grisly slasher of Whitechapel back in 1888. He’s a list of previously identified possible suspects. I found a blogger’s 2010 post about him on his site “Saucy Jacky” and it turns out Hyams is one of his top suspects. Hyams was confined to a lunatic asylum in 1890 and maybe it’s coincidental, but the murders of prostitutes stopped after that. I’m not going to speculate about the nature of Hyams’ psychiatric illness.
There’s another Psychiatric Times article about the clozapine REMS (Risk Evaluation and Mitigation Strategies) program. I found a couple of articles on the web about the difficulties helping patients with treatment resistant schizophrenia which I think give a little more texture to the issue:
Farooq S, Choudry A, Cohen D, Naeem F, Ayub M. Barriers to using clozapine in treatment-resistant schizophrenia: systematic review. BJPsych Bull. 2019 Feb;43(1):8-16. doi: 10.1192/bjb.2018.67. Epub 2018 Sep 28. PMID: 30261942; PMCID: PMC6327301.
Haidary HA, Padhy RK. Clozapine. [Updated 2023 Nov 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535399/
The paper on the barrier to using clozapine by Farooq et al is very interesting and the summary of the barriers begins in the section “Barriers to the use of clozapine in TRS (treatment resistant schizophrenia). I think it gives a much-needed perspective on the complexity involved in managing the disorder.
The Psychiatric Times published an article about the large majority of FDA committee members recently voting to dismiss the Risk Evaluation and Mitigation Strategy (REMS) for clozapine.
That reminded me of my short post about Cobenfy, a new drug for schizophrenia. It has side effects but none of which necessitate the need for a REMS program. If you do a web search for information on Cobenfy and REMS, you can ignore the Artificial Intelligence (AI) Gemini notification at the top of the Google Chrome search page saying that “Cobenfy…is subject to a REMS (Risk Evaluation and Mitigation Strategy) due to potential side effects like urinary retention.” That’s not true.
It was yet another AI hallucination triggered by my internet search. I didn’t ask Gemini to stick its nose in my search, but it did anyway. Apparently, I don’t have a choice in the matter.
Anyway, the FDA vote to get rid of REMS for clozapine also rang a bell for me of the incredibly difficult and tedious process that the clozapine REMS registration process caused in 2015 when it was first initiated. I spent lot of time on hold with the REMS center (I think it was in Arizona) trying to get registered. A few people in my department seemed to have little problem with it, but it was an ongoing headache for many of us.
Then after getting registered, I started getting notified of outpatients on clozapine getting added to my own REMS registry list. The problem is that I was a general hospital consultation-liaison psychiatrist only—I didn’t have time see outpatients.
I think I called REMS on more than one occasion to have outpatients removed from my REMS list. I suspect they were added because their psychiatrists in the community were not registering with REMS. And then in 2021, the FDA required everyone to register again. By then, I was already retired.
Other challenges were occasional misunderstandings between the psychiatric consultant and med-surg doctors about how to manage medically hospitalized patients who were taking clozapine, or brainstorming about how to fix medical problems caused by clozapine itself. Sometimes it was connected to things like lab monitoring for absolute neutrophil counts or restarting clozapine in a timely fashion after admission or following surgeries, or trying to discharge them to facilities which lacked the resources for adequate monitoring of clozapine.
Arguably, these are probably not absolute reasons for shutting down the REMS registry. They’re more like problems with how the program is run, such as “with a punitive and technocratic approach” as expressed by one FDA committee member.
Committee members also thought psychiatrists should be allowed to be doctors, managing both the medical and psychiatric aspects of patient care.
On the other hand, some might argue that those are reasons why consultation-liaison psychiatry and medical-psychiatry training programs exist.
I’m not sure whether the clozapine registry will go away. I hope that it can be streamlined and made less “punitive and technocratic.”
I just sat through the two and a half hour long House Committee Oversight and Accountability hearing dramatically entitled: “Unidentified Anomalous Phenomena: Exposing the Truth.” The impression I got is that somebody still thinks we can’t handle the truth.
This is the second congressional hearing on UAPs I’ve seen. I have to admit, I thought of Agent K’s line to a low ranking MIB agent in the movie Men in Black 3. It’s in the scene in front of what’s obviously a flying saucer as Agent J is administering a neuralyzer blast to the unlucky human witnesses, who will of course forget what they just saw:
“Check the composition of the fuel units and run a scan on the surface deposits. I want to know who was driving that thing.” Me too.
I don’t think this meeting was much different than the one last July. There were 4 witnesses, one of whom was Luis Elizondo (“I believe what I believe in.”). There were quite a few “I don’t know” and “I’d be happy to answer that question in a closed session” type of answers.
Dr. Gold was the scientist who seemed to play a role similar to retired Commander David Fravor played last year, with an engaging, good humored, “stick to the facts” demeanor.
Nobody talked much about the closed session meetings the previous group had after last year’s meeting, except to point out that the “overclassification” of information about UAPs continues and we still don’t know “…who was driving that thing.”
Yesterday, Sena and I talked about a recent news article indicating that a federal judge ordered the Environmental Protection Agency (EPA) to review the allowed level of fluoride in community water supplies. The acceptable level may not be low enough, in the opinion of the advocacy groups who discussed the issue with the judge, according to the author of the article.
A few other news items accented the role of politicians on this issue. This seems to come up every few years. One thing leads to another and I noticed a few other web stories about the divided opinions about fluoride in “your precious bodily fluids.” One of them is a comprehensive review published in 2015 outlining the complicated path of scientific research about this topic. There are passionate advocates on both sides of whether or not to allow fluoride in city water. The title of the paper is, “Debating Water Fluoridation Before Dr. Strangelove” (Carstairs C. Debating Water Fluoridation Before Dr. Strangelove. Am J Public Health. 2015 Aug;105(8):1559-69. doi: 10.2105/AJPH.2015.302660. Epub 2015 Jun 11. PMID: 26066938; PMCID: PMC4504307.)
This of course led to our realizing that we’ve never seen the film “Dr. Strangelove Or: How I Learned to Stop Worrying And Love the Bomb,” a satire on the Cold War. We watched the entire movie on the Internet Archive yesterday afternoon. The clip below shows one of the funniest scenes, a dialogue between General Jack Ripper and RAF officer Lionel Mandrake about water and fluoridation.
During my web search on the fluoridation topic, one thing I noticed about the Artificial Intelligence (AI) entry on the web was the first line of its summary of the film’s plot: “In the movie Dr. Strangelove, the character Dr. Cox suggests adding fluoride to drinking water to improve oral health.” Funny, I don’t remember a character named Dr. Cox in the film nor the recommendation about adding fluoride to drinking water to improve oral health. Peter Sellers played 3 characters, none of them named Cox.
I guess you can’t believe everything AI says, can you? That’s called “hallucinating” when it comes to debating the trustworthiness of AI. I’m not sure what you call it when politicians say things you can’t immediately check the veracity of.
Anyway, one Iowa expert who regularly gets tapped by reporters about it is Dr. Steven Levy, a professor of preventive and community dentistry at the University of Iowa. He’s the leader of the Iowa Fluoride Study, which has been going on over the last several years. In short, Dr. Levy says fluoride in water supplies is safe and effective for preventing tooth decay in as long as the level is adjusted within safe margins.
On the other hand, others say fluoride can be hazardous and could cause neurodevelopmental disorders.
I learned that, even in Iowa there’s disagreement about the health merits vs risks of fluoridated water. Decisions about whether or not city water supplies are fluoridated are generally left to the local communities. Hawaii is the only state in the union which mandates a statewide ban on fluoride. About 90 per cent of Iowa’s cities fluoridate the water. Tama, Iowa stopped fluoridating the water in 2021. Then after a brief period of public education about it, Tama restarted fluoridating its water only six months later.
We use a fluoridated dentifrice and oral rinse every day. We drink fluoridated water, which we offer to the extraterrestrials who occasionally abduct us, but they politely decline because of concern about their precious bodily fluids.
Go Retire Psychiatrist 