Comment by csnover
2 days ago
> I think the ethics of allowing people to suffer due to economics while ignoring a technology that can help them is worse, no? Telling them to seek a health professional when none are available is worse ?
Not necessarily. Half-measures—especially those that try to offer technological solutions to social problems—allow the actual root problems to remain unaddressed, fester, and grow. The ACA was a hack for a failing system, and then when that quit working, more hacks were added on top, and on and on. LLMs are just another hack that let the can get kicked down the road once more.
If and until actual meaningful health care system reforms happen, the rich will continue getting their $63,000 14-day concierge service from Mass General Brigham whenever they feel blue, and the rest of us will end up getting Doctor Amazon telling us to practice deep breathing and buy some supplements.
I can’t argue this, but I can build an LLM based care provider today with likely decent results in patient outcomes for those adapted to it and good cost dynamics, and across a variety of critical use cases in the care vertical from providers to end delivery. I can not however change American society, our economic structure, or political dysfunction single handedly, can you? Should I not do the former and let people suffer in protest because the latter is not possible, and hold my breath hoping it’ll change? How many lives must be destroyed in protest hoping everything changes first?
Fine, let’s have socialized delivery of mental health care. Let’s go back in time 20 years and establish a pipeline of capable providers that doesn’t exist. Let’s do those things if we can. But I don’t see it happening in my life time.
I do however see an opportunity to take the technologies presented to use in the immediate present and providing a mechanism to bring help to people who need it today with good efficacy where it’s appropriate. Is it OpenAI that brings that? I doubt it - they’re selling shovels, not digging for gold. Is it a general model that provides direct care? Doubtful IMO. Is it a chatbot interface ? I doubt that too. But I think if we are creative and thoughtful we can use these technologies to address huge swaths of the care providing problem, which is more than talk therapy. And we can do it today, and don’t have to wait for MAGA/MAHA to accept reality on realities terms.
> I can not however change American society, our economic structure, or political dysfunction single handedly, can you?
Luckily this is only about fixing health care, so much easier. ;-) And, no, neither of us can single-handedly fix the more proximal causes of the problem, but you and me and around 268 of our best friends could.
I have no crystal ball and I am no genius. All I know is that an LLM will not make the inpatient beds come back once a hospital has been gutted by PE. It will not make the drugs suddenly affordable for the patient who needs them. It will not fix the terror and suffering caused by the system. It will not offer a genuine human connection. But it might give ammunition to the next guy who wants to “save money” by defunding 988, or discourage the next generation of mental health providers from choosing this as a discipline at all.
Obviously something must be done. But could the effort you spend on developing another hack atop the broken system instead be spent on getting the right people into the right places to fix the right problems? At the least, I’d ask “what would cause me to change my mind about this?”, and then work to make sure that there’s no way that thing could be true.
Thank you for the conversation, I appreciate it.