A worthwhile book to read on this topic is Outlive by Peter Attia (MD). The core premise is that American healthcare focuses far too much on treating problems after they’re extremely severe. It is would be cheaper and healthier to invest more into conservative & preventative care, trying to prevent or minimize problems early in life before they become incredibly dangerous and expensive/difficult/impossible to treat.

I have a close friend who works in conservative care, and it’s astonishing what they see. For example, someone went to a number of specialists and doctors about a throat condition where they really struggled swallowing. They even had to swallow a radioactive pill to do some kind of imaging. Unnecessary exposure, and an expensive process to go through, and ultimately went exactly nowhere.

Meanwhile, it was a simple musculoskeletal issue which my friend was able to resolve in a single visit with absolutely no risk to the patient.

Medical schools need to stop producing MDs who reach for pills as the first line of defense without trying to root cause issues. Do you really need addictive pain killers, or maybe some PT, exercise, massage, etc. to help resolve your pain.

It’s not medicine. It’s healthcare system. Doctor isn’t paid enough to go thoroughly through the complaint and dig deeper. In Germany you get 5 minutes diagnose and that’s all from health insurance. And this from the better doctor. For normal one diagnose comes from 2 minutes interaction. Believing that the diagnose is right is very naive.

This reminds me of another recent comment in some other post, about doctors not diagnosing "hard to diagnose" things.

There are probably ("good") reasons for this. But your own persistence, and today the help of AI, can potentially help you. The problem with it is the same problem as previously: "charlatans". Just that today the charlatan and the savior are both one and the same: The AI.

I do recognize that most people probably can't tell one from the other. In both cases ;)

You'll find this in my post history a few times now but essentially: I was lethargic all the time, got migraine type headaches "randomly" a lot. Having the feeling I'd need to puke. One time I had to stop driving as it just got so bad. I suddenly was no longer able to tolerate alcohol either.

I went to multiple doctors, was sent to specialists, who all told me that they could maaaaaybe do test XYX but essentially: It wasn't a thing, I was crazy.

Through a lot of online research I "figured out" (and that's an over-statement) that it was something about the gut microbiome. Something to do with histamine. I tried a bunch of things, like I suspected it might be DAO (Di-Amino-Oxidase) insufficiency. I tried a bunch of probiotics, both the "heals all your stuff" and "you need to take a single strain or it won't work" type stuff. Including "just take Actimel". Actimel gave me headaches! Turns out one of the (prominent) strains in there makes histamine. Guess what, Alcohol, especially some, has histamines and your "hangover" is also essentially histamines (made worse by the dehydration). And guess what else, some foods, especially some I love, contain or break down into histamines.

So I figured that somehow it's all about histamines and how my current gut microbiome does not deal well with excess histamines (through whichever source). None of the doctors I went to believed this to be a "thing" nor did they want to do anything about it. Then I found a pro-biotic that actually helped. If you really want to check what I am taking, check the history. I'm not a marketing machine. What I do believe is that one particular bacterium helped, because it's the one thing that wasn't in any of the other ones I took: Bacillus subtilis.

A soil based bacterium, which in the olden times, you'd have gotten from slightly not well enough cleaned cabbage or whatever vegetable du jour you were eating. Essentially: if your toddler stuffs his face with a handful of dirt, that's one thing they'd be getting and it's for the better! I'm saying this, because the rest of the formulation was essentially the same as the others I tried.

I took three pills per day, breakfast, lunch and dinner. I felt like shit for two weeks, even getting headaches again. I stuck with it. After about two weeks I started feeling better. I think that's when my gut microbiome got "turned around". I was no longer lethargic and I could eat blue cheese and lasagna three days in a row with two glasses of red wine and not get a headache any longer! Those are all foods that contain or make lots of histamine. I still take one per day and I have no more issues.

But you gotta get to this, somehow, through all of the bullshit people that try to sell you their "miracle cure" stuff. And it's just as hard as trying to suss out where the AI is bullshitting you.

There was exactly a single doctor in my life, who I would consider good in that regard. I had already figured the above one out by that time but I was doing keto and it got all of my blood markers, except for cholesterol into normal again. She literally "googled" with me about keto a few times, did a blood test to confirm that I was in ketosis and in general was just awesome about this. She was notoriously difficult to book and later than any doctor for schedules appointments, but she took her time and even that would not really ever have been enough to suss out the stuff that I figured out through research myself if you ask me. While doctors are the "half gods in white", I think there's just way too much stuff and way too little time for them. It's like: All the bugs at your place of work. Now imagine you had exactly one doctor across a multitude of companies. Of course they only figure out the "common" ones ...

At least in Poland, I can almost always see my results before my doctor does - I get a notification that the labwork is ready and I can view results online.

Also, the regular bloodwork is around $50-$100 (for noninsured or without a prescription), so many people just do this out of pocket once in a while and only bring to doctor if anything looks suspicious.

Finally, there is EU regulation about data that applies to medical field as well - you always have the right to view all the data that any company has stored about you. Gatekeeping is forbidden by law.

You don't need a doctor to order bloodwork. I get a full panel done yearly, just to establish a baseline and trend. I try not to overanalyze it, and just keep it around for a professional in case some real issue arises in the future.

It's amazing this still needs to be said, especially here

You are _absolutely_ going to die in the next 30 minutes.

When it doesn't happen will you still be happy?

Part of the issue is taking it's output as conclusion rather than as a signal / lead.

I would never let an LLM make an amputate or not decision, but it could convince me to go talk with an expert who sees me in person and takes a holistic view.

The trick with the vo2 max measurement on the apple watch though is that the person can not waste any time during their outdoor walk and needs to maintain a brisk pace.

Then there's confounders like altitude, elevation gain that can sully the numbers.

It can be pretty great, but it needs a bit of control in order to get a proper reading.

The paper itself: https://www.apple.com/healthcare/docs/site/Using_Apple_Watch...

Seems like Apple's 95% accuracy estimate for VO2 max holds up.

  Thirty participants wore an Apple Watch for 5-10 days to generate a VO2 max estimate. Subsequently, they underwent a maximal exercise treadmill test in accordance with the modified Åstrand protocol. The agreement between measurements from Apple Watch and indirect calorimetry was assessed using Bland-Altman analysis, mean absolute percentage error (MAPE), and mean absolute error (MAE).

  Overall, Apple Watch underestimated VO2 max, with a mean difference of 6.07 mL/kg/min (95% CI 3.77–8.38). Limits of agreement indicated variability between measurement methods (lower -6.11 mL/kg/min; upper 18.26 mL/kg/min). MAPE was calculated as 13.31% (95% CI 10.01–16.61), and MAE was 6.92 mL/kg/min (95% CI 4.89–8.94).

  These findings indicate that Apple Watch VO2 max estimates require further refinement prior to clinical implementation. However, further consideration of Apple Watch as an alternative to conventional VO2 max prediction from submaximal exercise is warranted, given its practical utility.

The lack of self-consistency does seem like a sign of a deeper issue with reliability. In most fields of machine learning robustness to noise is something you need to "bake in" (often through data augmentation using knowledge of the domain) rather than get for free in training.

I don't see how they are considered a health fad, they're extremely useful and accurate enough. There are plenty of studies and real world data showing Garmin VO2Max readings being accurate to 1-2 points different to a real world test.

There is this constant debate about how accurately VO2max is measured and its highly dependent on actually doing exercise to determine your VO2max using your watch. But yes if you want a lab/medically precise measure you need to do it a test that measures your actual oxygen uptake.

Why do you have those expectations?

Oh I have a plan for this.

Allow it to answer general questions about health, medicine and science.

It can’t practice medicine, it can only be a talking encyclopedia that tells you how the heart works and how certain biomarkers are used. Analyzing your specific case or data is off limits.

And then when the author asks his question, it says it’s not designed to do that.

Why are you assuming that the general public ought to have access to imperfect tools?

I live in a place where getting a blood test requires a referral from a doctor, who is also required to discuss the results with you.

> "ChatGPT is AI and can make mistakes. Check important info."

Is the same thing that can be said about any human

> "Doctor is human and can make mistakes"

Therefore it's really not sufficient to make it clear that it is wrong in different ways and worse than human.

> Popups/agreement after every question "I understand this might be BS"?

Considering the number of people who take LLM responses as authoritative Truth, that wouldn't be the worst thing in the world.

> the onus is on them to make it reliable.

That is not a plausible outcome given the current technology or of any of OpenAI's demonstrated capabilities.

"If Bob's Hacksaw Surgery Center wants to stay in business they have to stop killing patients!"

Perhaps we should just stop him before it goes too far?

You only need this if you are a researcher. Undergraduate knowledge of Calculus and Linear Algebra is more than enough to have quite a good understanding of ML in general, and LLMs in particular.

Maybe a very small bit of Information Theory (a couple of Shannon's papers are enough) and some classical books on Natural Language Processing from the late 90s and early 2000 so you have an idea of what Language Models are outside the modern Deep Learning driven approach.

How so?