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There's a good zen koan waiting to be written with the CEO as the novice and the domain expert as the master. Ironically I tried to use Claude to write one and only got crap.

Writing a non-crappy koan will be my litmus test for LLMs from now on, thanks for the idea!

Care to elaborate?

The world doesn't owe you a business model. It's not work if someone doesn't value it, just like a street performer isn't working just because they're putting on a show.

If people can't make money without the government enforcing artificial scarcity of their output, they can always chose another business model.


People with a conscience and an ounce of empathy will always value creative work if they themselves intend to make a profit with it in someway. If you take someone's work, and use it to make money, you should pay them for that work. Its really not that hard of a concept.

>If you take someone's work, and use it to make money, you should pay them for that work. Its really not that hard of a concept.

How many paid products are using foss software without paying the developers. 99%? I do not consider that being evil.

If there are no IP laws nobody will have the expectation to have control over what other people do with their creative output. If you are unwilling to accept that you do not get to make art, the same is true now for art as well. If you do not want someone to make a parody of your art your only option is to never publish it.


> People with a conscience and an ounce of empathy will always value creative work if they themselves intend to make a profit with it in someway.

Is that empathy, or just self interest / good business? If I need a product I can't produce for my business to make a profit I'd better be giving my supplier a cut, lest they stop supplying me. With intangibles it's more fluid than with good bound by scarcity, but novel expressions of creativity become not-novel pretty quickly and, inevitably, you're going to need to go back to the well.


> If people can't make money without the government enforcing artificial scarcity of their output, they can always chose another business model.

Okay, but this literally goes for every single good ever. Case in point: theft. If theft wasn't "arbitrarily" made illegal, then there exists no business models for anything, ever. Because you could just steal it for free.

The idea behind IP is that IP is a good but an ephemeral one, one without a physical manifestation. So, we need to translate a type of theft that works for that.

Or, we could not. But keep in mind IP doesn't just mean music. It means, like... everything that isn't physical. Including my job, and probably your job too.


I think I've spend more on street music than any other music.

Imagine I put up a ghetto blaster and a hat. I play the finest music ever made. Would you put money in the hat? Would the idea to put money in the hat ever cross your mind? Would one even understand they want you to put money in the hat for playing the music?


Moreover, technological progress shouldn't be stifled by attempts to create artificial scarcity by technical means (read: DRM, war on general purpose computing, "The Right to Read", etc).

A lack of IP protection would incentivise even more extreme DRM. DRM exists because copyright law alone is considered insufficient protection by rights holders. A lack of such laws would not get rid of DRM, it would do the opposite.

FOH with that Calvinist nonsense

No, it's a horrible use, relying on something entirely unreliable to make medical diagnoses. All the AI safety people who pretend to worry about killer robots or whatever should actually be up in arms about these kind of uses, but you can see where actual priorities lie.

The best use of AI in medicine would be to automate away administrative bloat to let people get proper medical care.


What if it was really reliable? Would you still be against it?

The question doesn't make sense imo because it, meaning neural network or other ML computer vision classification, doesn't have a mechanism to be trustworthy. It's just looking for shortcuts with predictive power, it's not reasoning, doesn't have a world model, it's just an equation that mostly works, etc, all the stuff we know about ML. It's not just about validation set performance, you could change the lighting or some camera feature or something, have some unusual mole shape, and suddenly get completely different performance. It can't be "trusted" the way a person can, even if they are less accurate.

These limitations are often acceptable but I think as long as it works how it does, denying someone a person looking at them in favor of a statistical stereotype should be the last thing we do.

I can see if this was in a third world country and the alternative was nothing, but in the developed world the alternative is less profit or fewer administrators. We should strongly reject outsourcing the actual medical care part of healthcare to AI as an efficiency measure.


I understood that you don't believe it can be made reliable. But my question was: what if it were?

Let me put it differently. Suppose I don't tell you it's ML. It's a machine that you don't know how it works, but I let you do all the tests you want, and turns out they're great. Would you then still be against it?


If my grandmother was a tractor, would she have wheels?

How trustworthy really are humans?

   99% accuracy in diagnosing benign case
This is meaningless. The only thing that matters in this kind of application is false negative rate at some acceptable false positive rate.

I assume whoever is working on this knows that, so this is mostly a criticism of the article. That said, this is a horrible use of AI.


It’s really all about the protocol. AI tends to spot things that doctors don’t, and vice versa. Dermatology is also an area being pillaged by private equity and access is poor for many people.

I lost my wife to melanoma. She noticed a lesion within days of it appearing, and a doctor saw it within 48 hours and felt it was benign. My wife didn’t accept it and had a plastic surgeon remove it and biopsy, then had a margin removed by surgical oncologist, the standard of care at the time. It came back as a brain tumor 4 years later and she was gone in 6 months, even with the incredible advancements today.

So I’d hold the position strongly that anything that improves overall detection rates and access to care is incredibly important and will save lives. Weeks matter with melanoma. Today with immunotherapy Molly would be fine. But if she hadn’t advocated and gotten the original thing removed, it would have cost her 4 important years.


Similar story: mom had a melanoma removed from her foot. multiple lymph node biopsies and other tests said it had been successfully removed.

She went back once a year for checks for 4-5 years. It was only when she was called into see an oncologist and told an unrelated x-ray lead them to discover she had stage 4 metastatic melanoma (brain, liver, spine, femur, lungs and i’m sure i’m forgetting something) that we found out that they’d only been giving her visual checkups each year, no PET scans or anything else. The oncologist was shocked that the checks were so basic, mom didn’t know she was supposed to have anything else and she was dead in about 8 weeks.

We were told that the form of melanoma only came back like that in 1% of patients and usually simple visual checkups were enough. I have no idea how true that is.


My wife had a similar experience, except it was her shoulder. They took a margin, looked at lymph nodes, and did a nuclear test that traced something that I can’t recall.

Another lesson learned is that if at all possible, go to a national cancer center. Even if for a second opinion analysis. The level of care is different and better than what you find in community oncology or hospital practices.


So sorry, brother.

I've been told the only way to be sure if skin cancer or not , is a biopsy. I also have been told ... not skin cancer... but Dr decided to send me to a dermatologist. Is thing he said when say it .. is looks like skin cancer ... lets take a biopsy now ... to check . It was skin cancer ... a BCC

Dude that sucks mate. I had a melanoma taken off last year. It was dormant (stage 0) but had been there for 10ish years. But reading shit like this reminds me that even though I'm probably fine, all I can do is just live my best life. Hang out with my family. Enjoy the things I enjoy and not think about it too much. (and get my skin checks every 6 months :D)

Are your skin checks just visual checks? If so, read my other comment in this thread. It was in UK fyi.

> The only thing that matters in this kind of application is false negative rate at some acceptable false positive rate.

It sounds like they are inverting the scenario here. The question is not "do you have skin cancer?", it's "can you safely go home without seeing a doctor?".

For this new question, we set the acceptable false positive rate to zero (we never want to send a real cancer case home), and determine the false negative rate (we accept that some benign cases will be seen by a doctor).

The reason for the interest in identifying benign cases, rather than trying to identify the positive cases, is that it improves the situation for everybody: benign cases identified by AI are sent home almost immediately, everyone else has a shorter waiting time, so benign false negatives can be assessed more quickly by the doctor and given the all clear, and more time is now available for spending with the real cancer cases.

The numbers they're citing are 7000 cases with 5% real, so 350 real cancer, 6650 benign. If we can accurately say that 6500 of those benign cases are benign without wasting the doctors' time, then we're down to only 500 people needing to see a doctor, which is a huge improvement for everyone.


I went searching for more. The tool is called DERM by Skin Analytics. They have more info on stats:

https://skin-analytics.com/ai-pathways/derm-performance/

A few peer reviewed pubs down the bottom of the page


It's trendy to say "it's horrible to use AI for this" without giving specific reasons. Some reasons it could be good to use AI here:

- this can prioritize urgent patients for the severely overworked doctors

- medical error is a leading cause of death, this serves as a second-opinion (97% true-positive rate and 79% true-negative rate)

- it can be used as evidence by a nurse or physician advocating for a patient's treatment


What do you mean by this being a "horrible" use of AI? (Although as another commenter has mentioned, this should more properly be called ML).

It's quite easy to correctly classify 100% of benign cases as benign.

If it's so easy, then why do people die from having lesions misdiagnosed as benign?

Even if the success rate of the human eye was in the 99.5%+ range, why not have an extra sanity check from an AI model?


> If it's so easy, then why do people die from having lesions misdiagnosed as benign?

You're confusing False Negatives with True Negatives. For Non-Benign (Positive) vs. Benign (Negative) classification:

* True Positive Rate (TPR): non-benign classified as non-benign.

* False Positive Rate (FPR): benign misclassified as non-benign.

* True Negative Rate (TNR): benign classified as benign.

* False Negative Rate (FNR): non-benign misclassified as benign.

> It's quite easy to correctly classify 100% of benign cases as benign.

You can engineer a 100% TNR if you just classify everything as the "benign" negative class. The FNR is going to be 100% too, but that doesn't matter -- you correctly classified 100% of benign cases as benign.

> why do people die from having lesions misdiagnosed as benign?

Because the FNR is not 0%. FNR is important. You probably want a decent TPR in there as well. And FPR can be very important too, depending on how life-changing/painful/invasive the treatment for a positive case is!


Because this non-AI function 'correctly diagnoses 100% benign cases as benign':

    def is_benign(mole: Image) -> bool:
        return True
...but also misdiagnoses 100% malignant cases.

To contextualize, I think the tool in this article correctly diagnoses 97% benign cases as benign but misdiagnosis 22% of malignant cases.

I don't think its a horrible use of AI at all, in fact it seems like a fairly good use case.

It's a tool that can be used in amongst the current methods to help detect skin cancer, it shouldn't be used at the only method.


Not really. It allows you to order your cases from most-likely to least-likely, and get human eyeballs on the most-likely cases first.

This is how most ML in healthcare is used. It's a fantasy to think we can give all patients equal attention, so it often makes sense to prioritize those most at risk. Of course no model is perfect, but ML can be very beneficial when used in the right context (i.e. not like United Healthcare).

Yup. The word I should have used is "triage".

On 2, it appears to be open source so you could look and see if/what it logs.

I seems to send all urls you visit to Microsoft, Symantec, Emisoft, Webshield, Norton, Gdata Security, and/or BitDefender, depending on your settings. And of course, those URLs can be changed on the next update.

This is true, and they do. I'm replacing Comodo's Valkyrie API with Symantec's Browser Protection API for performance reasons. But, no data is logged, and only the minimum amount of data is sent to each provider.

Yeah this is just a minor example of enshittification, there's no more to it than that. Netflix and other modern software like it aren't written for customer they are written to extract maximum "value" from "users". They want to push the kids account thing because they think it will make them money. Ux is only important to the extend it's so bad it creates churn, it's not something they care about optimizing.

Is there an example of how these could be used in LLM prompting?

Pretty sure 404 media is automatically killed, possibly because it doesn't have a paywall bypass. Same as if you post a link to "the information" - it's something nobody can read so not worth linking.

That's odd, because this other link I wanted to post from 404 (someone beat me to it) wasn't killed: https://news.ycombinator.com/item?id=43646920

(Unless it was vouched back to life.)


That article isn't registerwalled, it's also a good quality article, not sensationalistic, not breathless, not about sex.

I assume "not sensationalistic, not breathless, not about sex" is not something an automated HN filter can flag. Or paywalls, for that matter.

20 years ago it was science fiction, with BERT models and LSTM it is easy. The hard part is getting a collection of 5000 articles that are "sensationalistic/breathless/about sex" and another 5000 that aren't. You could beat 90% on that one easily, probably 95%. Or you could just block 404media and have accuracy about that good.

It was posted [dead] and vouched.

Interesting, I've seen lots of 404 submission [dead] and assumed that was why. I notice that the link you posted above is not paywalled but the dead one is, though I'd be surprised if that's actually detected somehow.

We did a similar (less rigorous) evaluation internally last year, and one of the big things we identified was "purple prose":

  In literary criticism, purple prose is overly ornate prose text that may disrupt a narrative flow by drawing undesirable attention to its own extravagant style of writing, thereby diminishing the appreciation of the prose overall.[1] Purple prose is characterized by the excessive use of adjectives, adverbs, and metaphors. When it is limited to certain passages, they may be termed purple patches or purple passages, standing out from the rest of the work. (Wikipedia)
The Slop Score they have gets at this which is good, but I wonder how completely it captures it.

Also curious about how realistic this benchmark is against real "creative writing" tools. The more the writing is left up to the LLM the better the benchmark likely reflects real performance. For tools that have a human in the loop or a more structured approach it's hard to know how well the benchmarks match real output, beyond just knowing that better models will do better, e.g Claude 3.7 would beat Llama 2.


One person's purple prose is often another's style. It's not really a measure of something, and more an assertion of taste. You see a similar thing when someone says a writer uses "too much description and not enough action!" without realizing that, sometimes, the action is in the description. It's a style of writing with a different reader in mind, a different understanding of how word choice and prose functions.

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