> I live in a place where getting a blood test requires a referral from a doctor,
To me, this is horrific. I am the advocate for my own health. I trust my doctor - he's a great guy. I have spoken to him extensively around a variety of health matters and I greatly trust his opinion.
But I also recognize that he has many other patients and by necessity has to work within the general lines of probability. There is no way for him to know every confounding and contributing factor of my health, no matter how diligent I am in filling out my chart.
I get my own bloodwork done regularly. This has let me make significant changes in my life to improve health markers. I can also get a much broader spectrum of tests done than the standard panel. This has directly lead to productive conversations with my doctor!
And from a more philosophical standpoint, this is about understanding my own body. The source of the data is me. Why should this be gatekept behind a physician referral? I find it insane to think that I could be in a position where I am not allowed to find out the cholesterol serum levels in my blood unless a doctor OKs it! What the fuck?
I've not seen evidence that creatine actually has significant impact on eGFR. Anecdotally, mine does not budge even on 5g a day. Meta-analysis show minimal impact, e.g. https://pmc.ncbi.nlm.nih.gov/articles/PMC12590749/
Muscle mass obviously does, though. cystatin c is a better market if your body composition differs from the "average"
I did end up taking a cystatin c test privately to be able to prove to my GP that the results he freaked out over were nonsense. I'm in the UK, and for whatever reason the NHS just doesn't typically do them for basic kidney function - presumably cost, but they were dirt cheap to do privately so...
NICE guidelines.
"Evidence on the specific eGFR equations or ethnicity adjustments seen by the committee was not from UK studies so may not be applicable to UK black, Asian and minority ethnic groups. None of the studies included children and young people. The committee was also concerned about the value of P30 as a measure of accuracy (P30 is the probability that the measured value is within 30% of the true value), the broad range of P30 values found across equations and the relative value or accuracy of ethnicity adjustments to eGFR equations in different ethnic groups. The committee agreed that adding an ethnicity adjustment to eGFR equations for different ethnicities may not be valid or accurate...."
My creatinine levels are high because my body mass - including muscle mass - is well above average. On the basic kidney tests my GP did, my numbers indicated kidney disease. Doing a Cystatin C test showed very clearly that my numbers were firmly in the normal range.
The page does go on to point out the muscle mass issue:
> The committee highlighted the 2008 recommendation, which states that caution should be used when interpreting eGFR and in adults with extremes of muscle mass and on those who consume protein supplements (this was added to recommendation 1.1.1).
Further down they do mention Cystatin C, and seem to have basically decided that a risk of false positives is acceptable because of a lower risk of false negatives. That part is interesting, and it may well be the right decision at a population level.
But if your muscle mass is sufficiently above average, the regular kidney tests done will flag up possible kidney disease every single damn time you do one, and my experience is that UK doctors are totally oblivious to the fact that this is not necessarily cause for concern for a given patient and will often just assume a problem and it will be up to the patient to educate them.
EDIT: What's worse, actually, is the number of times I've had doctors or nurses try to help me to "game" this test by telling me to e.g. drink more before the test next time, seemingly oblivious that irrespective of precision, making changes to conditions that also invalidates it as a way to track changes in eGFR is not helpful.
I'm not sure what point you're trying to make here. Have I missed somewhere in the discussion where eGFR equation adjustment based on ethnicity has been discussed?
Creatinine is the standard marker used for eGFR. It is also a byproduct of muscle metabolism. People who regularly lift weights or have lifestyles that otherwise result in a higher-than-normal muscularity will almost universally have higher creatinine levels than those who don't, assuming similar baseline kidney function. It's also problematic for people with extremely low muscle mass, for the opposite reason.
It's one of the reasons enhanced bodybuilders can get bit with failing kidney function - they know that their eGFR is going to look worse and worse based on creatinine formulas so they ignore it, when the elevated blood pressure from all the dbol they're popping is killing their kidneys.
Cystatin C is the better option for people with too much (or too little) muscle for creatinine to be accurate.
I'll preface this with I generally trust doctors. I think on the whole they are well positioned to provide massive benefit to their patients.
I will also preface this with saying I do not think any LLM is better than the average doctor and that you are far better served going to your doctor than asking ChatGPT what your health is like on any factor.
But I'll also say that the quality of doctors varies massively, and that a good amount of doctors learn what they learn in school and do not keep up with the latest advances in research, particularly those that have broad spectrums such as GPs. LLMs that search scientific literature, etc., might point you in the direction of this research that the doctors are not aware of. Or hallucinate you into having some random disease that impacts 3 out of every million people and send you down a rabbithole for months.
Unfortunately, it's difficult to resolve this without extremely good insurance or money to burn. The depth you get and the level of information that a good preventative care cardiologist has is just miles ahead of where your average family medicine practitioner is at. Statins are an excellent example - new prescriptions are for atorvastatin are still insanely high despite it being a fairly poor choice in comparison to rosuvastatin or pitavastatin for a good chunk of the people on it. They often are behind on the latest recommendations from the NLA and AHA, etc.
There's a world where LLMs or similar can empower everyday people to talk to their doctor about their options and where they stand on health, where they don't have to hope their doc is familiar with where the science has shifted over the past 5-10 years, or cough up the money for someone who specializes in it. But that's not the world of today.
In the mean time, I do think people should be comfortable being their own advocates with their doctors. I'm lucky enough that my primary care doc is open to reading the studies I send over to him on things and work with me. Or at least patient enough to humor me. But it's let me get on medications that treat my symptoms without side effects and improved my quality of life (and hopefully life/healthspan). There's also been things I've misinterpreted - I don't pick a fight with him if we come to opposite conclusions. He's shown good faith in agreeing with me where it makes sense to me, and pushed back where it hasn't, and I acknowledge he's the expert.
I interviewed for Ada, whose ML diagnostic tool had shown itself more accurate at diagnosis than a panel of doctors. It was specifically trained on case data, IIRC, and doctors were paid to help improve the results.
I wonder what it’s like now. Any time I use it for a diagnosis I get outlandish results, and then I’ll head to my GP and turns out it was something rather simple.
I think the fairest test is: what is the best and fastest way to reduce medical uncertainty? For rare ailments with a single cause and exclusive symptoms, that can be accurately described with simple language (no medical jargon), its possible that an LLM is better than a doctor.
For more ambiguous situations where you need actual tests, I am skeptical of using LLMs.
You're right that this is a concern but this and the followup are also totally unhelpful.
Even if you don't want to do any additional work explaining it or finding a source, all you have to do to change this message from being dickish to being helpful would be to phrase it more like "I think there are some serious risks with this approach from a prompt injection standpoint. I would recommend doing some research on the risks for AI agents with unfettered access to the internet and prompt injection."
And if spending a few more seconds typing that out is still too much of a waste of time for you to do, I might question if you have time to waste commenting on HN at all when you can't uphold basic social contracts with the time you do have.
The person who starts shooting him has full visibility of the gun the entire time.
Even if he doesn't realize it is a misfire, why would he believe that it was Pretti who shot? How can you reasonably believe a dude that is dogpiled with a gun not in his control is the shooter?
Again, the officer that begins the shooting can literally see Pretti is disarmed. He has no gun. He watches the other agent take his gun off of him.
A more reasonable take in that situation would be thinking that some other protestor has decided to start shooting at them, not that the guy dogpiled by a half dozen agents and visibly fuckin' disarmed is the one doing it.
I am not a gun control person. I think we'll never realistically get guns away from criminals, and as long as that's the case, law-abiding citizens should be allowed to have firearms to be on even footing. Full stop.
But if we can't hold out law enforcement agencies, however nominal in nature they are, to high enough standards that they don't create the entire situation that causes them to kill someone who was never a threat to them, then they shouldn't be armed. Because we can't trust them not to slaughter US citizens.
> Again, the officer that begins the shooting can literally see Pretti is disarmed. He has no gun. He watches the other agent take his gun off of him.
How do you know what the officer saw? They’re tackling an armed man who attacked them. It’s very possible they might not be noticing every detail of what their colleagues are doing.
There are not non-citizens on voter rolls. They want the rolls to get data on voters.
When you ask yourself why the ultra-politicized DOJ (which isn't even the DHS...) from an administration that has explicitly called liberals the enemy is asking for voter rolls, it becomes pretty understandable why people might come to the conclusion that it is to suppress the people that have already explicitly been identified as targets.
> Presumably, it's because a lot of them are getting Medicaid despite not being eligible to
Why are you presuming this? There is no evidence this is happening in any widespread fashion.
> Isn't the point of every audit, investigation, etc. to find things that aren't being done correctly?
If it is being honest about it's intention, yes. I think we have seen an absolute mountain of evidence that this administration does "audits" as massive data collection waves to suit any and every purpose they want, though.
If this was about fixing things being done incorrectly, DHHS should be doing the audit, not DHS. Perhaps the latter doesn't understand the difference between the two, though, not noticing they're missing an H in their abbreviation.
> There is no evidence this is happening in any widespread fashion.
Isn't the point of this data so that they can uncover exactly that? It'd be silly to say you're not allowed to look for evidence of anything unless you already have evidence of it. Also, the qualifier "in any widespread fashion" is weasel words. It makes me think you already know it is happening, and the only remaining question is to what scale.
How exactly would non-citizens, who do not have social security numbers or other valid identifying documents, receive medicaid? It's difficult enough for qualified people to get it. It would seem fairly difficult to pass the registration process without having a valid SSN. Furthermore, if someone was able to fraudulently sign up - say by using a stolen identity, then wouldn't the data in the system look valid and therefore not really show up on an audit?
And as the GP pointed out, it makes no sense to put the president's paramilitary agency¹ in charge of such an audit, rather than qualified auditors, perhaps from the HHS² OIG³.
Yet law enforcement officers are some of the most resistant to the idea, and Trump and DHS are extremely resistant to the idea of utilizing them for ICE and CBP, and have even cut funding for it.
When we know that the body cams are frequently used in a way that benefits the people wearing them, I find it quite telling when those people are railing against the idea and those in power actively work to block it.
Trying to map the current Republican party, despite calling themselves conservatives, to anything that Freeden would recognize in 98 does not seem to be particularly productive.
They are not where I would hold them to if they were truly a principled organization and not largely a political tool for the far-right on any and every talking point, but we got far more out of them than we usually do.
They publicly called out a Trump appointee for saying you're not allowed to bring a gun to a protest, and have urged that there be an investigation in to what occurred.
They also then blamed it on the MN government, because for some reason CBP (250 miles from a border, and thus 150 miles away from their remit...) pretending to be police officers when they also lack a remit to do that and them then fucking things up and murdering people because of the lack of remit, lack of training, lack of screening on the hiring... is because of Walz and co.
So... better than I expected, but still pretty dogshit.
To me, this is horrific. I am the advocate for my own health. I trust my doctor - he's a great guy. I have spoken to him extensively around a variety of health matters and I greatly trust his opinion.
But I also recognize that he has many other patients and by necessity has to work within the general lines of probability. There is no way for him to know every confounding and contributing factor of my health, no matter how diligent I am in filling out my chart.
I get my own bloodwork done regularly. This has let me make significant changes in my life to improve health markers. I can also get a much broader spectrum of tests done than the standard panel. This has directly lead to productive conversations with my doctor!
And from a more philosophical standpoint, this is about understanding my own body. The source of the data is me. Why should this be gatekept behind a physician referral? I find it insane to think that I could be in a position where I am not allowed to find out the cholesterol serum levels in my blood unless a doctor OKs it! What the fuck?
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