Here's my take as a radiologist: this seems like a neat imaging tool that complements existing imaging tools (CT/MR) with new tradeoffs and questionable value. If whole-body ultrasound does provide value, it'll take quite a while (likely decades) for this to become a standard imaging tool offered by hospitals and physicians because the clinical trials to show any positive value take years, and then you have to convince insurance companies and Medicare to pay for it, and then you have to establish guidelines for physicians explaining when whole-body ultrasound may be appropriate to order.

Like the video says, this isn't a replacement for MRI or CT. Ultrasound has amazing superficial spatial resolution, but it falls off dramatically with depth, so the center of your body is essentially un-imageable. Ultrasound also struggles to penetrate air and bone. The video says having multiple probes around your entire body helps mitigate this, but I'm skeptical about how much that helps in practice. Your lungs take up the vast majority of your thoracic cavity, and your partially air-filled GI tract takes up a lot of your abdominopelvic cavity.

Based on how other preventative care and screening tools have panned out in recent years, I think this is going to yield pretty blurry images in relatively healthy patients that push them into getting more conventional imaging (e.g., MRI or CT). This in turn yields more false positives and biopsies with non-zero risk that likely outweighs any potential benefit of whole-body ultrasound. Counterintuitively, it's rare for proactive/preventative interventions in medicine to actually help people.

I feel that...if this only ever useful for limbs and not the head or torso.. it could STILL be a useful device given how cheap and useful it is.

We already routinely ultrasound limbs! This is primarily for muscle, tendon/ligament, and other superficial soft tissue injuries because ultrasound is very good at imaging these structures. Cancers and other subtle yet dangerous pathology disproportionately DO NOT occur in the limbs. So there's really no point in imaging the limbs of healthy people without a specific injury or pain.

> But are you all forgetting that they literally injected a homeopathic drug on the author?

I'm no fan of pseudoscience either, but this is where things get blurry. The placebo effect is real even if patients are aware of it. If you give a patient a homeopathic drug while informing them of potential side effects (if any), and then they feel better, have you hurt them? Or have you helped them?

I personally have no interest in trying homeopathic medicines, but the reality is that many patients do take these and are adamant they help. As long as any risks are communicated and there are no serious side effects, it's difficult to make an argument against their use in patients who report a subjective benefit.

This is relying on the patient being stupid. I would always prefer just an honest explanation of things rather than pseudo-science drugs. And if I do discover that it's a pseudo-science drug then I've lost all confidence in that doctor. Doctors should stop pretending that they have access to some divine knowledge and everyone else is stupid.

And this interpretation is charitable, assuming that they wanted the patient to feel better via placebo. A different (and more likely) interpretation being they just wanted to charge for something extra.

It does both: https://www.openevidence.com/user-guide/visits-overview

In certain circumstances, the answer is yes. If an airplane's pilots are incapacitated, do you simply give up and crash the plane because there are no other pilots on board? Or would you rather have someone on the ground try to coach a passenger into at least attempting to land the plane?

A passenger crashing the plane while trying to avoid a certain crash doesn’t make things any worse. An incompetent doctor trying to save you from certain death can make things so much worse. It’s all about weighing the best/worst outcome compared to where you are now.

I hate to break it to you but death is certain for everyone.

Properly emotionally processing this fact and your complete inability to do anything about it is called an "existential crisis" and if you haven't had one or several yet, you will.

I’m not sure what the “revelation” is? How is this related to what I said?

Putting that aside, your philosophy sounds shallow. Death is certain, but how long you have to live and the quality of that life are not predefined. An incompetent passenger-pilot trying to save you from a crash will at worst make no difference. But an incompetent doctor can teach you that death isn’t necessarily the worst outcome.

There are many healthy psychological ways to accept the certainty of eventual death. But the process is inevitably painful.

I think the different ways people accept death explains a lot of people's psychology, like how you can guess people's attachment styles or Freudian stage fixation. For instance, billionaires who pour all their money into anti-aging research clearly are not handling it well.

I thought LLMs are better than random weak sauce replies. Micro indeed.

That's an extreme edge case, which I don't think is in the context of the concerns in this thread.

The specific case doesn't matter--it's meant to make you think about the general question throughout this thread: when an expert isn't available, should non-experts use AI (or other tools) to help themselves? Sometimes the answer is yes because the potential benefits outweigh the potential harms (if any harms exist). But sometimes the answer is no because misleading/incorrect advice can cause a net harm.

But if the cases where AI use is a net positive are one in a million in medical situations? The argument is surely about the ratio, which many people here are arguing (from anecdote, would be interested to see a real study) is not in its favour, and the potential downsides - from both false positives and negatives - can be huge.

As long as that passenger didn’t have the fish.

Yes, I remember, I had lasagna.

You can choose a) a calm, level-headed passenger who knows they aren't a pilot, or b) a calm, level-headed passenger who almost has their pilots license but has a medical condition that prevents them from admitting when they lack certain knowledge.

Who do you choose to be coached by an expert on the ground?

No thank you, I will ask Claude and then ask ChatGPT to challenge me, and do a couple of rounds like that.

The first: Has no clue about anything and therefore no useful knowledge and cannot challenge me

The second one: Is proven to willfully give wrong information and will make me do mistakes for sure.

The LLMs will do their best, even if imperfect, since they summarizes what appeared in books.

I prefer to be grounded on what Airbus / Boeing manuals, or on what pilots training book said, than two far more unreliable sources.

I see your argument, but it's not exactly news that an expert found a flaw in a popular tool. You could say the same about Wikipedia--experts have tons of issues with it, but Wikipedia still provides value to non-experts. The most likely alternative to Wikipedia for non-experts is simply not trying to learn anything new.

Similarly with LLMs, you can't just write them off entirely because they sometimes provide misleading or incorrect advice. The positive utility maximizing view is to learn when you need to call in an expert. I recently moved in to a new house and have used Claude extensively to figure out basic things (e.g., adjusting the garage door height, how to mount a TV). However, when the HVAC suddenly stopped working, I gave Claude a shot for an hour and tried some non-destructive fixes, but then realized I had to call in an HVAC expert.

You 100% can write them off entirely and go about your business as you previously had done. Ignoring the errors, it is very debatable whether there are even productivity gains beyond: human programmer or whatever is excited and cranked up to unsustainable degrees of activity and thinking to 'keep up' with what he thinks is an AI doing the work.

I'm seeing this fairly often and when it isn't garbage it's a capable person who has gotten inspired by their 'collaboration' in which the busywork is being done by a machine, but they're doing so much directing and correcting that it's not unlike what would happen if they got heavy into meth and went on a tear.

You absolutely can write them off entirely and decide for yourself what your comfort level of human-killing speed-freakism you want to pursue in your productivity. There's a long history of humans managing astonishing levels of productivity through self-destructive means. This is not even cheaper, once the 'first one's free' wears off: it's just a novel method of getting humans to burn themselves harder in the belief that they have a magic feather.

The ones who're really throwing themselves into the situation are the ones who'll burn out, but who aren't setting themselves up for atrophy and learned helplessness. Anyone who believes the technology lets them be a lazy manager just getting paid, is in for an unpleasant discovery.

The free alternative to Wikipedia is the library, not “don’t learn anything new ever”.

I find Claude is surprisingly similar to a confident but incorrect coworker, with the benefit that Claude will reevaluate when I correct it.

I used the phrase "most likely alternative" intentionally. The library is where people should go to get answers in a world without Wikipedia, but the vast majority of people won't. So in practice, most non-experts either learn from Wikipedia or don't try to learn anything at all.

Sure, if we’re going to go that broad. People are already leaning heavily towards learning nothing instead of using Wikipedia.

I guess to me it has to be comparable to be an alternative.

Like, I don’t consider doomscrolling x an alternative to reading Wikipedia but I might consider it an alternative to CNN, even though they’re all technically and very broadly activities that I could use to inform myself.

In that same way I don’t consider the multitude of ways I could use my free will necessarily alternatives to each other even though they technically are. It kinda sucks but going that broad feels to me like it breaks the concept of alternative and makes it kind of meaningless.

I get what you're saying, but I'm not deciding what should and shouldn't count as an alternative to X. I'm trying to answer the counterfactual: how do people behave in an alternative world without Wikipedia but otherwise identical to our world?

I mean, technically… I’ve lived in that world. You just go back 25 years. We had the Dewey decimal system (card catalog) and the library, hard copy encyclopedias. You could also ask someone else.

Then we had computerized encyclopedias and search engines that searched the library.

I mean, you had to work for the knowledge. Sometimes you didn’t know something and no one else knew either, so you had to wait until you got a chance to find out, but you would think about it and sometimes you would be right when you found a reference source.

I’ll also note, Wikipedia is a secondary source. It is not a reliable source of truth. It is more like the ‘ask someone else’ alternative than anything else, it’s just ‘someone else’ is a person on the internet who writes Wikipedia articles.

Claude will do everything to retain you as a user, because that's one of their most important metrics.

Excellent point my colleague has the exact opposite incentive.

Slightly OT Nitpick: in regard to experts and Wikipedia, when doing a neuroscience-adjacent MSc, experts in the field actually directed me to Wikipedia as an excellent source for high-level neuroanatomy, including recent research, so I'm not sure your blanket description about experts and Wikipedia is correct.

I'm a radiologist but can't really weigh in without seeing the full 3D MRI dataset. Regarding this point:

> They performed shockwave therapy on my shoulder even though a recent clinical practice guideline says clinicians should not use or recommend shockwave therapy for rotator-cuff tendinopathy without calcification; I was told during ultrasound that there was no calcification.

Ultrasound isn't a great way to assess for calcification. It'll find large calcification but easily miss small ones. Plain radiograph would be more helpful, but the MRI may have revealed it as well. Either way, shockwave therapy isn't harmful in the absence of calcification--it's just not helpful.

Edit: when a radiology report says something isn't present, there's always an implicit caveat that the finding isn't present within the context of the modality and images obtained. So an ultrasound report can state there are no calcifications while a plain radiograph can report the presence of calcifications without being inconsistent. Obviously very confusing to patients and people unfamiliar with medical jargon, but clarifying this in reports would make them sound even more qualified, "hedgey", and annoying to read than they already are.

> So an ultrasound report can state there are no calcifications while a plain radiograph can report the presence of calcifications without being inconsistent. Obviously very confusing to patients and people unfamiliar with medical jargon

This is being overly nice, I think. Anyone who doesn't understand this is an idiot imo. You would have to assume that every type of diagnosis instrument has infinite clarity and is always correct to be confused in this case.

Reminds me of the Babbage quote where somebody asked him, if I put the wrong question into this computing device, will it still give me the right answer? His response, paraphrased "I can not fathom the logic of the minds which would come up with such a question".

> Anyone who doesn't understand this is an idiot imo

I don’t think that’s true. Avoiding this mistake requires knowing that an ultrasound may not detect calcification. For a patient reading their own report, I don’t think that’s intuitive. I would expect most people to read “no calcifications” and assume that their joint has no calcifications.

Most people should have learned at a young age that absence of evidence is not evidence of absence. My 8 year old understands this. After all, you can rarely ever prove something does not exist, only that it is unlikely to exist.

If a report states that X was not found, it does not mean X did not exist, it means it was not found.

What may be lost on the layperson is the nuance and understanding of how thorough or not a particular scan is and how much weight to give the findings and thus the odds that the report is correct.

This is - by far - the most stupid stuff I've read on the internet the past few days. They didnt find cancer either (as well as a plethora of diseases that could be related to the symptoms), and afaik its not in the report.

Yah you can argue that the tool is not ideal for that diagnostic, yadda yadda. I get it, and in the end I agree with the subtle difference you highlight, because it is something that makes sense to a certain kind of people. You know how many medics would read the report exactly like the author did? Too many.

How do I know? Im not in a wheelchair after being constantly misdiagnosed by using the wrong imagiology technique by (mostly) chance, and a good help from friends, including a surgeon. This seems to be a case where AI would be a valuable doctor tool for differential diagnosis; instead we have know-it-alls that can't bother to verify, and AI that often gets details wrong. That is the problem.

I think it’s the combined depth AND breadth of knowledge that can be captured by AI models that is going to make them way better than most humans at this kind of stuff.

It's like when finding out about the sex of your baby via ultrasound before they're born. If you're told it's a boy, you can be pretty certain you're getting a boy. If you're told it's a girl, you shouldn't get too attached to the idea. The ultrasound tech might just have missed the evidence your baby was a boy.

> Most people should have learned at a young age that absence of evidence is not evidence of absence.

I’m fairly sure that there are no lions in my house. Lions are quite large and I’m capable of detecting lion sized objects with my eyes.

To demonstrate that something is not present you first define the object, then come up with a test that will reliably detect the object. If the test comes back negative then the object is not there.

In a strict philosophical sense I cannot prove that there are no lions in my house, the external world might not exist! A hypothesis that no one has thought of might be correct and that hypothesis could show that there are invisible lions in my house!

However I intend to act with the certainty that there are no lions in my house. Because I have no evidence of lions in my house.

Absence of evidence is evidence of absence.

"Calcifications not found" is a different statement from "no calcifications".

Even then, the context that "ultrasound isn't a great way to assess for calcification" is important when reading either statement. Laypeople don't necessarily have that context.

But the problem was that the report is not saying "not found", it is saying "is not present" or "there is no X".

And I think we can easily have examples where we can reasonably trust this, and a spectrum of such.

E.g. there is a math solution and the report says "there is no errors in this solution", you would imagine that to be quite reliable, no?

> Most people should have learned at a young age that absence of evidence is not evidence of absence.

That might be true, but it is definitely not the world we live in.

Exactly. I was about to reply to the comment with “perfect example of not knowing what you don’t know” in terms of self-diagnosis.

My internal model is/was “if the scan wasn’t set up / can’t detect the thing, why would the statement be present at all?”.

That implicit assumption is really subtle.

It's a fatal flaw to think counter-intuitive == wrong.

It’s 2026 and my computer will happily give me the right answer even when i make typos. I love it.

Not really, it just requires to assume an ultrasound has infinite, perfect resolution when you are faced with a different imaging tech which reports things that didn't appear in the first one. That's just stupid.

> Anyone who doesn't understand this is an idiot imo

I disagree. A priori it's not obvious to a layperson whether or not a statement that uses unconditional phrasing is intended to be authoritative or conditional on something unspecified, like the resolution of the measuring device. This goes for any sufficiently technical field.

If you got the brakes checked on your car, and the mechanic did <something> and told you there are no issues with them, and you then took your car to a different mechanic who did <something else> and told you there is a problem, you would not be an idiot for thinking that these conclusions contradict one another.

> You would have to assume that every type of diagnosis instrument has infinite clarity and is always correct to be confused in this case.

There's a difference between 99.9% clarity and 50% clarity. Even if neither exactly equals 100%, it's understandable that a layperson would expect different language between them

This comment sounds like it's written by someone who doesn't interact with real people very often

I’ll bet they’ve got a debilitating case of engineer’s disease, too.

"On two occasions I have been asked [by members of Parliament], 'Pray, Mr. Babbage, if you put into the machine wrong figures, will the right answers come out?' I am not able rightly to apprehend the kind of confusion of ideas that could provoke such a question."

Off topic but I have always felt this seemed like his misunderstanding rather than theirs. It’s an odd question, but it’s a very sensible point to make if Babbage has just told you this will solve the problem of mistakes in calculations - humans being involved at the start means human error still plagues the output.

> I am not able rightly to apprehend the kind of confusion of ideas that could provoke such a question.

Well, he did diagnose the situation correctly. He couldn't comprehend the confusion of ideas that provoked the question.

I'm also not entirely sure it's an odd question to ask. To this day, users are surprised when their software produces garbage output instead of failing. Perhaps the members of parliament were expecting some form of input validation or sanity checking out output.

Looking into his biography, it seems that he was indeed pitching the engine not as a means of efficiency, but as a means of avoiding mistakes in mathematical tables. It would have done Babbage well to insist he couldn't possibly solve all classes of mistakes, but would have solved a great many of them! "Why yes Senator, you are quite intelligent and handsome and make a fair point, allow me to give you the finer picture..."

Would have also been a fair point if Babbage had channeled his inner techbro and insisted it would directly replace human calculators; simple machines like Babbage's will chug along blindly on obviously erroneous data, but humans for all their sloppiness can often backtrack on errors.

To quote the LLM-ism, they were making a sharp point. It doesn't matter how precise the calculations are if you're calculating the wrong thing.

I suspect their sarcasm might have escaped Babbage who seems to have been on what we now call "the spectrum."

Actually, I would be really pleased if a member of Parliament asked that. That shows a level of deeper consideration.

Isn’t there a saying about there being no stupid questions, only stupid answers or something?

I don’t think people are idiots if they don’t understand how a normally intelligent person might not intuit that. I do think they have a seriously underdeveloped theory of mind.

> idiots

> seriously underdeveloped

What's the difference?

Between being an idiot and having an underdeveloped theory of mind?

It’s funny that the answer to this has increasingly become “yes” over the last few decades.

> Anyone who doesn't understand this is an idiot imo

Even if this is true, so what?

Idiots get sick at least as often as others, and the medical system needs to work as well as it can for that population too.

As a rad tech, YOU TELL ‘EM DOC! I do like some uses of AI I’ve seen that help patients advocate for themselves or understand basic things like blood panel numbers, but it’s really bad at glazing people and leading them down medical rabbit holes kind of like the OP.

You would think that the AI would point out that calcium is best demonstrated on Radiographs/CT imaging vs Ultrasound or something to that effect.

Semi-related: my father has complications from a motorcycle accident ~25y ago that crushed arteries in his leg coupled with diabetes (insulin / kept sugar at ~100 and his A1C was kept under 6.7 for ~15y). 6w ago had to have his toes removed due to dry gangrene; they eventually (2.5w ago) had to remove his leg below the knee because of the severe blood flow issues below the knee.

Between the toes and the below the knee amputation, there were no less than 15 different doctors and PAs / related personnel who COULD NOT COME TO A CONSENSUS. They would just tell my mother and I (PoA) the details; they refused to come up with a singular plan of action moving forward, leaving it up to us to make 'an informed decision,' something that's IMPOSSIBLE when you have to take up to 15 different opinions into consideration.

What exactly are we supposed to do as patients/family members when medical personnel cannot give reasonable paths forward and instead just throw a bunch of shit over the fence at you and tell you, "you decide what to do from here," regardless of how many VERY DIRECT conversations I had w/the 'care team' on doing better to provide a limited array of options and reasons/likelihood of 'positive outcomes'.

I'm used to dealing with a wide variety of stakeholders/SMEs in decision-making; it's my job to apply my extensive industry experience to present our clients with their options, ranked and reasoned. Doctors, in my experience and most recently with my father, clearly do NOT do that (I assume due to liability; but, no real idea, honestly). So; when dealing with LIFE CHANGING circumstances, what are we supposed to do except rely on what might be able to offer more analysis and option narrowing w/AI?

I certainly don't want to make the job of medical staff more difficult by putting out crazy theories I found on the interwebbernets through my own research, etc; but, when we're having to deal with uncertainty and insanity, what else can we do?

This lines up with my experience with my mother, though it played out differently. In her case, she would switch doctors every ~5-10 years and each time they'd basically say everything the previous doctor said was wrong. First it was "you have Lupus", second it was "actually it's some other autoimmune disease", then it was "actually whatever you had has been in remission for some time now and you've been taking brain-numming medicine for no reason." Then it was "you have cancer", "it's a rare one", and "oh turns out the brain-numming meds have a correlation with rare cancers". The cancer part was handled well (albeit unsuccessful) though. After such a bad time with rheumatologists, I was shocked by how competent people were when it came to cancer.

All of the above was intertwined with brief stints with doctors that would just berate her for being a painkiller junkie, even though she hated the stuff and just wanted to find/fix the problem.

Kind of a rant, really. I'm not sure how to tie it back into AI. I do wish we had AI at the time so that we could at least cross-check, but I also understand that doctors are already sick of patients self-diagnosing on the web and that AI probably just makes that worse. At the same time, if our medical system could catch up a bit (more doctors? less corruption/paperwork? not sure what it needs) then maybe people would be less inclined to take matters into their own hands.

I recently discovered I am allergic to hydrocodone and codeine, and the effort I had to go through to get oxy instead was stressful and I felt I had to bring all of the extra pills with me everywhere to show I wasn't drug seeking or selling them. And I pointed out that inwaa shooting myself in the foot for all future desires by asserting I am allergic.

P. S. Opiates work, very well. If you tale one and it doesn't work, you might also be allergic. Hydro didnt really work, then itching and puking started after 2 days of untouched pain(essentially, a reduction of 2 points). Codeine nausea.

I wasn't aware of the possibility.

I'm sorry to hear that. The accusations of drug seeking are particularly galling.

AI is absolutely a god send for patients navigating the medical system.

I know the US system is horrible and I sympathize with doctors doing their best within it. But we must admit, they are also responsible for the countless stories just like yours, and have contributed to the public's deteriorating trust of medical institutions. It's not just the insurance companies and conglomerate CEOs.

Probably liability... on the amputations I indicated and contraindicated, it's increasingly difficult to navigate trough patient perceptions while not disclosing so much as to give them rope to hang us. Some decisions are a game of probability that often we don't have clear numbers. In trauma, I have both cases where I recommended an amputation and at last minute decided to see that happened and the patient is walking with their leg today; and cases where I didn't recommend and later had to amputate as the lesion evolved. With cancer it's more straightforward, the cancer is what dictates the surgery... some cancers have poor response to other treatments, so we amputate. Some cancers had invaded the neurovascular bundle, so curative options involve necessarily amputation to get good margins. In cancer there's less doubt in the prognosis, so less chance of legal ramifications.

Keep in mind I’m not a doctor, just the guy who takes your images, but I believe it’s all liability. I really wouldn’t want to be a doctor from all the crazy stories of liability stuff I hear everyday.

I empathize with you as my grandmother is also being what feels like gaslit by several doctors being told her symptoms are dementia and not from the chronic UTI’s she suffers from, but when the UTI’s clear all of a sudden no symptoms. Our medical system is very frustrating, between doctors who don’t have the time needed for complicated cases, or the threat of every patient suing them causing them to be overly cautious.

I think as long as you’re aware of the pitfalls of AI, as you seem to be, it’s a solid tool for helping to understand medical situations with the right amount of double checking.

I don’t think our system will improve until 1) We increase the amount of doctors in our country and tell Congress to quit limiting the amount we can train yearly, and 2) the system of liability for doctors is changed to be more like New Zealand’s where their liability insurance is nationalized and they’re not at constant threat of losing everything to a lawsuit over a patient who wouldn’t take their meds and got worse (the cases are generally much more complex than that, but the idea is it’s not always the doctors fault as media would have us believe).

Your see this in coding agents too. The only times so far I’ve really seen Opus tie itself into a knot is where I’ve asked it to fix something that I thought was broken but actually wasn’t in the way I had described. It will bias towards your description (I’m guessing because that’s the most recent context it has?).

i'm sorry, but AIs only "know" about stuff that they have been trained on.

If we would allow AIs to be trained on the petabytes of medical data hidden in hospital systems, they would most likely be much better at diagnosing illnesses and conditions than the average doctor.

(Justifiable) Privacy around medical records so far prevents this.

You think you're cheering for humans, but in fact you are gatekeeping healthcare.

I dunno... if we gave an AI all of these medical records as training data, wouldn't it be trained to give the same answers as the doctors already gave, without knowing whether those diagnoses were correct or not?

Except it would see all the times similar starting conditions led to different diagnosis and recognize those contradictions. Or all the different treatments and their outcomes. And it would never forget or have bias.

It would be like the sum of all medical professors in existence.

I feel like the promise of these models is to help people make more informed decisions. Improving the knowledge economy and general understanding.

The problem is these are just statistical models at the end of the day, so you need to know something to be able to identify the errors. You can’t let them really be autonomous and you also can’t really have people turn into glorified approvers. If the machine is correct 89% of the time, you cannot make people responsible for that 11%. It’ll just cause automation fatigue.

tl;dr: the actual use cases of these LLM (or generative AI in general) is rather limited, so it is offensive how much hay has been given to them eating the entire capitalist system. They are not fit for purpose.

Why should we not expect a computer vision model to outperform humans on reading medical images?

The human experts are literally just a trained biological neural network. In this domain they are not capable of anything a computer can't already do.

> Why should we not expect a computer vision model to outperform humans on reading medical images?

Humans can identify. A computer vision model can return a statistical value. Both can make errors, but these errors are orthogonal to how we work and what is being asked of them. I think a CV model can absolutely provide value as augmentation. Identifying possible misses or a different diagnosis worth considering, but that is not what is being asked of them here. The pitch by Altman and Amodei is not to say, “This tool that might cost $1,000/month can help increase the accuracy of your diagnoses by 10%,” instead it’s, “This tool can allow you to keep 10% of your workers to monitor it and you can fire the rest. Also, the workers carry all the liability.”

> The human experts are literally just a trained biological neural network. In this domain they are not capable of anything a computer can't already do.

People need to stop making this baseless claim. Human beings are not stochastic computing devices, we are not neural networks. We don’t fully understand human cognition and intelligence. I have the highest confidence we will figure it out one day, though.

Yes, neural networks were based on a superficial view of the human brain, that’s it. For instance, it is biological impossible for the human brain to do backpropagation, which is kind of important for a modern neural net.

This really rubs me the wrong way because it's objectively false, but people keep bring it up because I think people want it to be true rather than accepting generative AI for what it is: a tool with a bunch of caveats.

Whether brains do gradient descent is irrelevant to a CFO deciding whether to staff one radiologist or three. The market doesn't care if the model "identifies" versus "returns a statistical value", it cares what the error rate costs versus what the salary costs, and it prices liability into contracts either way, same as it already does with autopilot and compliance software.

Also disagreement among human radiologists has been documented for decades, so the clean expert baseline you're defending doesn't actually exist outside this argument.

When the identifiers pass human-detection-rate percentages, it will most likely be cheaper to hire a fall-guy for the liability with a much smaller salary, I think this will be a big market in fact.

Thank you. I think my comment was careful to specify "in this domain" and "computer vision model"; I didn't say anything about generative AI. The reference to neural networks was hopefully an obvious rhetorical flair, rather than a one-line assertion that computers and brains are actually equivalent.

I also didn't say anything about whatever Altman or any specific company is doing.

The simple fact is that we send humans to school for years to learn to read and classify these things. It's something computers will be able to do strictly better.

> It's something computers will be able to do strictly better.

I don’t think there’s any evidence that’s true.

Really? What about the use of computer vision for satellite imagery? Facial recognition?

The premise seems to be proven, just not extended to the medical domain yet.

I think you’re conflating detection with interpretation.

Radiologists like to distinguish between "perception" and "cognition", but the reality is that cognition is the same statistical process machines use, just without knowing the actual probability numbers.

Satellite image processing can certainly detect a hotspot then interpret it as either a small brushfire or a missile launch. Facial recognition detects my features then interprets who I am. It's all pattern matching just at different scales in different parameter spaces.

Agreed. Not a radiologist, but I do a fair bit of MRI research. Experts vs lay people probably have different success with getting the right diangosis out of a frontier model. Subtle changes in prompts can cause different diagnosis[1]

[1] https://www.nature.com/articles/s41591-026-04501-8

Radiologist who does read shoulder MRI would like to add that over half the annotations are wrong, glaring mistakes in anatomy and cardinal direction which begs the question of how is it making these findings without knowing what it’s looking at (here’s a hint, it’s hallucinated based on reports it sees).

What is "it"? Claude Opus 4.x? ChatGPT-5.x? GLM? DeepSeek? RadFM? Med-PaLM?

Claude, the model in the post.

Huh, I'm reading and looking up these words you guys are saying and it is starting to look exactly like the symptoms I have been having with my own right shoulder! I feel like a giant gaping rabbit hole just opened up next to my desk.

We're discussing calcific tendinitis (https://radiopaedia.org/articles/calcific-tendinitis?lang=us). If you think you have it, you can see a doctor and consider shoulder radiographs to start.

If you think you have it, then you don't. If you have it, you won't think, you'll know.

Spoiler: because it hurts like hell.

That doesn't make any sense, it would imply that anything that hurts would automatically be the same diagnosis.

Both inductive and abductive reasoning would say that just because something hurts that doesn't mean that everything that hurts is that thing.

Why isn’t diagnostic ultrasound used in orthopedics? They inspect fetus hearts and other organs everyday, why not shoulders? Seems much cheaper and faster.

They do. Ultrasound in orthopedics is a relatively newer field, and there aren't quite as many sonography techs and radiologists experienced in reading these studies, which is likely why you don't see it offered more widely.

Edit: I should mention that ultrasound is basically unusable for evaluating bones. Sound waves can't penetrate bone, and so you end up just seeing a huge black void. That's a huge orthopedics use case that ultrasound just can't benefit. However, ultrasound is fantastic for evaluating muscles, ligaments, tendons, and other superficial soft tissues.

Serious question: If the bones specifically show up as black on ultrasound but the surrounding (muscle, etc) don't, wouldn't that be an option that could be used to try to determine a broken/fractured bone without the radiation from an xray? Or are the gaps in those cases usually too small to pick up?

We order ultrasounds all the time for shoulders (for like soft tissue issues; for trauma, you'd start with an xray). For other joints, such as the knee, MRIs are a better choice (unless htere has been substantial trauma, in which case xray initially or further), though more expensive, unless you're excluding a Baker's cyst, in which case an ultrasound is fine.

Since MRIs are more expensive, private doctor's might order them instead of an ultrasounds.

(I'm a doctor)

Where are you? Pi and work comp attorney in medium US midwest metro. I've never seen one in 20y. Not from HCA ERs, medicaid er visits to univ affiliated er, nor prestige practices.

It's a manual, non-standardized process without a standardized output. Image quality depends both on user skills (how deeply they press the sensor on the skin) and the machine they have. Unlike CT/MRI the examination results cannot be easily shared and compared between patients for studies.

Ultrasound was overlooked by US medicine as a first line imaging tool for a long time because it takes real skill and experience to do it right. But it's making a comeback. We've had Chinese, Indian, Australian, and American doctors visit us for one to two month stints to build up their skills.

Given the skill involved, it's probably a liability concern they don't want the exposure over there.

They're used quite a bit for nerve entrapment—both in diagnosing and treating.

Can vouch for it. Ultrasound hasn't found calcification in my shoulder but MRI did. Exactly as you said, because it was very small.

You can create custom aliases on your own domain. I do this for every log in and am migrating old emails to my custom domain aliases.

Take a look at how things worked before (and still do): employers decide who get jobs based on a combination of personal biases, nepotism, and ulterior motives while applicants present distorted versions of themselves and network/pull strings to put the odds in their favor. That seems more problematic.

You would be surprised at the process in other industries. What you are describing is the tech job market specifically.

Other fields have their own problems, including credentialism and ballooning concomitant student loans, but do, by strict convention, not hire based on vibes or pulled strings. Often to their partial detriment, as the cure -- ie, strict oversight of hiring that also forces the hiring manager to ignore important implicit signals -- is alive and well in medicine, law, civil engineering, education, and the trades. Notable exceptions include entertainment, sales, real estate, and software engineering.

By optimizing for vibes, the tech industry gains "Spidey senses" in the hiring loop but pays for it in impartiality.

IMO this precipitated the DEI movement's advent, as it was seen as a way of remediating the drawbacks while preserving the information channel.

Without it, expect either homophily, and, eventually, a harsh and remedial credentialism.

I'm a physician and have recently been on both sides of the hiring process for new physicians and residents at a few different institutions. It's absolutely not meritocratic--you'd be shocked at how strong a role connections and pedigree play. The hard requirements are just table stakes, but the selection process from there is completely subjective and susceptible to all kinds of problematic biases. Generally people don't want to rock the boat and discuss this stuff openly, but it's absolutely a problem that needs to be pointed out.

Weird. I used to be an academic and hiring was wildly formal. Sorry to hear medicine fell to vibes.

Some of it is lack of imagination, but some of it is because many truly visionary examples would largely sound stupid to most of today's audience. Imagine it's 2007 and you're explaining how the smartphone will change society over the next 20 years:

- A photo sharing app will change restaurants, public spaces, and the entire travel industry across the world

- The smartphone will bring about regime change in Egypt, Tunisia, Lebanon, and other countries in ~4 years

- We'll replace taxis and hotels by getting rides and sharing homes with strangers

- Billions of people across the world will never need to own a desktop or laptop

- A short video sharing app will kill TV

- QR codes become relevant

Most of these would be a hard sell at the time.

None of these actually were hard to sell. In 2007 we had mobile phones, we had mp3 players (the iPod was actually very good), we had CouchSurfing, etc.

I think the smart phone revolution is actually pretty overstated. It basically only made computers cheaper and handier to carry (but also more walled gardens). There are a few capabilities of smart phones we do today which we didn’t with do with computers and mobile phones back in 2007, such as navigation (GPS were a thing but not used much by the general public).

Your case would be much stronger if you’d use the World Wide Web as your analogy, as in 1995 it would by hard to convince anybody how important it would be to maintain a web presence. And nobody would guess a social media like the irc would blow up into something other then a toy.

However I think the analogy with smartphones are actually more apt, this AI revolution has made statistical models more accessible, but we are only using them for things we were already capable of before, and unlike the web, and much like smartphones, I don’t think that will actually change. But unlike smartphones, it will always be cheaper and often even easier to use the alternatives.

Even the navigation part, I'm not so sure. I remember Dad would bring a laptop when we would drive new places and it would be running Microsoft Streets and Trips with a GPS dongle, and I think that have been late 90s or early 00s. I remember seeing other people do that and by the time I was driving a lot in 07 I remember having a dash mounted GPS, maybe a Magellan or Garmin, that didn't cost that much and again I remember a lot of people doing it. The smartphone definitely displaced it, but it wasn't a complete novelty even for the general public.

I think you lived in a strange bubble when you were a kid. When I was a teenager in the 90s, we'd have paper maps that we'd bring with us. We had no GPS. I don't think we knew what GPS was.

In the late 90s we'd print out directions from MapQuest. That was a game-changer. Still no GPS, though.

As an adult in the early 00s, I was still printing out MapQuest maps. In 2004 I got a car with a built-in navigation system! (Complete with a DVD drive in the trunk with a disc holding the maps.) It was still incredibly uncommon; I was one of the few people I knew who had one. I did know a few people who had Garmin GPS devices that they'd suction-cup to their windshield, but not many.

By 2007 most people were aware of GPS devices with little screens that you could bring into the car, though I'd guess maybe 25% of the drivers I knew then had one.

If your dad was bringing a laptop with a GPS dongle in the car in the 90s, I think you were very unusual. Hell, I didn't even have a laptop until 2004, and even then it was a hand-me-down from my dad's work. And I was in my 20s by then!

I remember GPS being something mountaineers had. People who would take their jeeps up to the glacier had them. Boats also had them. Coincidentally I was a fisherman back then and did observe my captain using a super fancy navigation device with an interactive map (and yes the map did come on a DVD); I also knew a couple of jeep men (or jeppakarlar as we call them in Icelandic) who had something similar (though more compact) in their jeeps; and to top it of, I would spend hours on google earth, just having fun looking at the map on my desktop.

I however did not see this technology coming to our phones, and becoming this commonplace.

It has been a day since I wrote the upthread post, and navigation is still the only novel capability of smartphones, which I think would have been a hard sell in 2007. I really can‘t think of another example.

> I however did not see this technology coming to our phones, and becoming this commonplace.

I didn't see a lot of things coming to phones. I never expected that I'd pay for things by hovering my phone over a payment terminal. Didn't think it would replace my iPod (or MP3 CD player, or Discman, or Walkman). Absolutely had no idea it would replace my camera.

And on the other side of the coin... my "phone" is barely a phone. The phone features are probably what I like least about it.

Air travel has changed a lot.

Booking, boarding, change/gate notifications, rebooking options, customs and immigration is done via phone.

Transit to/from the airport via Uber or a transit pass stored in your smartphone wallet.

Baggage tracking via airtags

Yeah, there's vague precedents for this stuff from the desktop computer era, but it only _really_ works when you've got an internet-connected device in your pocket.

Ahhh, payment via phones is also a new thing that I think very few people saw coming (including me). However it is also a very recent development and not really a part of the supposed smartphone revolution. In 2007 we did not have touchless payments (except in some public transit systems; gyms; etc. but it was limited to a special cards you couldn’t use for anything else) so this is definitely a new capability which was probably hard to sell in 2007.

The others you mentions, I would argue against. Yes it is convenient to order a taxi via an app on your phone, but in 2007 you could do so via SMS or a phone call, so not much has change really other then we now have one more interface to pick from.

I don’t see how smartphones have changed rebooking, nor customs, and especially not immigration which has become 100x more of a headache then it was in 2007. And finally, airtags are a separate technology from smartphones.

Hand-waving away ride-sharing as not much of a change makes me wonder what you would actually consider to be significant. It completely upended the taxi business.

2007: arrive in a new city, figure out who to call (or maybe text) for that particular city, wait, hope someone will pick you up and understand enough of your language and the local geography to get you where you want to go, possibly some unpleasant haggling over the fare

2026: arrive in a new city/country, open Uber, specify in the app precisely where you want to go, choose a vehicle, when to get picked up, etc, track vehicle progress in real-time, up-front pricing

And that's the consumer side. The provider side was even more radically changed.

If you don't see how smartphones changed the experience of flying... maybe you don't fly anywhere?

Airtags are entirely dependent on the ubiquity of smartphones.

I have already said navigation and tuchless payments are worthy examples of smartphones providing new and unpredictable innovations.

Your ride sharing experience sound more like you would expect from any consumer product gaining a global market share (or even monopoly). 1980 - Arrive in a new city and not knowing how to get a hamburger. 2000 - Arrive in a new city, find the nearest McDonalds and get your usual BigMac.

> arrive in a new city/country, open Uber, specify in the app precisely where you want to go, choose a vehicle, when to get picked up, etc, track vehicle progress in real-time, up-front pricing

This is actually something we should be a little uncomfortable about. It's a fine example of monopolists at work. The convenience does come with downsides.

I do like it, though, for exactly the reasons you state. If I end up in a country with cabbies who generally have good English skills and aren't out to rip me off, it's fine, and often easier to take a taxi. But you never know until you get there, and that can be stressful. The consistent Uber/Lyft experience is a breath of fresh air after a long flight when you just want to get to your lodging and pass out.

> If you don't see how smartphones changed the experience of flying... maybe you don't fly anywhere?

Eh, I'm not convinced. Sure, it's changed, but the general paradigm is the same. The main big change is the mobile boarding pass, seamlessly delivered after checking in on your phone, which is a genuine improvement. (But so many airlines still require you to check in with a human at the airport for international travel.) Print-at-home does come close enough, though, and still means you avoid lines at kiosks or (gasp) waiting for a real person to print you a boarding pass. Some airlines now charge you to print out your boarding pass (because of the availability of mobile passes), and that's disgusting. (I know people who still insist on printing at home, because they've had bad experiences around their boarding passes refusing to load, app crashing at exactly the wrong time, etc.)

Yes, all the airlines have apps, though after traveling a bit in Central America and in the Balkans recently, I've found that some airline apps are absolute trash, worse than having to wait in line for an hour to talk to a person. Most of my digital interaction with the airline is done on my laptop before the trip anyway. Notifications about gate information or delays are useful, but a push notification from an app is not markedly better than an SMS, and either way I always feel like I need to verify on a physical departures board, especially if connection timing is tight.

In instances where my flight has been delayed or cancelled, it's definitely an improvement to be able to rebook in the app, instead of waiting in line to talk to someone, or getting on the phone with the airline (or both, as I'd usually do, to find out which would resolve the problem faster).

I've never used airtags (don't have an iPhone anyway); I've checked bags at most twice in the past 20 years when I had no other choice (my mantra: checked luggage is lost luggage). But even considering that, I feel like all the fuss people make about airtagging their luggage is overblown.

Some airlines have eliminated seat-back entertainment and expect you to use your phone. That's crap.

Meanwhile, as GP has pointed out, security, customs, immigration have all gotten worse. Boarding processes have not improved, food hasn't gotten better, and airplane seat comfort has gone down. I say this not to blame smartphones, but to suggest that there are other, more important problems with air travel that have nothing to do with phones.

I agree, not every change is an unalloyed good.

Who stops and looks for a physical departures board in 2026? I already know the gate I'm going to because I've had ample time to check my smartphone while I'm waiting for all the carry-on maximalists to get their oversized roller AND stuffed "personal item" backpack from the overhead bins. ;)

I think you've understated/missed some of the aspects of flying itself, but probably not necessary to litigate it further. There's also all the stuff at the destination that the smartphone has enabled, eg - rental cars with carplay - walking directions on a paired smartwatch - transit pass via NFC (and transit-specific directions) - checking into accomodations (airbnb-type places especially) - authenticating Netflix, etc on tv at your airbnb/hotel - bike-sharing apps - activity passes in your digital wallet

Wardriving with a car + GPS and Atheros Wifi adapter and Pringles antenna, oh sweet 90s/00s.

I used to have PDAs with Windows Mobile, hmm even a BlackBerry. Oh gosh, navigation apps were absolutely crap back then, screens were crap, cameras were crap. Video calls via "3g", if any of your friends/family also had a 3g-capable phone, maybe it worked, experience you couldn't compare to FaceTime. iPhone/Android, really brought a new life into this ecosystem.

Camera phones were already very popular in 2007. The Flight of the Concords even made a joke out of it. But most people still owned a separate digital camera. It was not hard to predict that the cameras on your phone would get better and eventually replace your dedicated digital cameras. We all saw that coming.

Same with video calls, if anything that idea was oversold in 2007. Most people had Skype (or something similar) and would video call international calls (which were very expensive using the regular phone lines back then). If you were traveling internationally you would find an internet café log in to your Skype and make a call. Moving this capability to the smart phone was a no-brainier. Turns out that when we have it in our phones, video calls are still more popular on desktops (via zoom, etc.) in 2026.

- A nation-agnostic online currency (and its offshoots) would lead to a multi-polar world.

- Publicly waving your resume around will passively invite job interviews.

There's a new OpenClaw adaptation, Ottie, that I think could be a bank manager, bank teller, stockbroker, piggy bank, accountant, wallet, security guard and credit card provider all rolled into one. I just haven't used it yet. https://ottie.xyz/

So that would be:

- Digital sidekick weeds out parasitic relationships.

There has to be tremendous value in that.

When solutions are looking for problems, it means that things may seem oversold when in fact they are still undersold.

Instagram Arabian spring Uber Airbnb Cloud-ification/shift to web apps and mobile-first ....tiktok? Or is YouTube considered "short video sharing app"? Because I see no evidence tiktok in particular killing TV... To be fair, QR code did hit print magazines/newspapers in Germany (just as an example; English wiki was not elaborating on initial history of public use/perception) in late 2007, so that one wasn't nearly as far-fetched.

Not only is TV alive and well, we're even getting channels back with the content splintered across multiple streaming platforms.

KDE was far less mature than macOS and Windows 10 years ago. Of course it’s come a long way.