Comment by 3rodents | Hacker News Reader

Comment by 3rodents | Hacker News Reader

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I agree that absolute deference to doctors is a mistake and that individuals should be encouraged to advocate for themselves (and doctors should be receptive to it) but I'm not so convinced in this specific case. Why do high blood sugar levels matter? Are there side effects associated with the alternative treatment? Has ChatGPT actually helped you in a meaningful way, or has the doctor's eventual relenting made you feel like progress has been made, even if that change is not meaningful?

In this context, I think of ChatGPT as a many-headed Redditor (after all, reddit is what ChatGPT is trained on) and think about the information as if it was a well upvoted comment on Reddit. If you had come across a thread on Reddit with the same information, would you have made the same push for a change?

There are quite a few subreddits for specific medical conditions that provide really good advice, and there are others where the users are losing their minds egging each other on in weird and whacky beliefs. Doctors are far from perfect, doctors are often wrong, but ChatGPT's sycophancy and a desperate patient's willingness to treat cancer with fruit feel like a bad mix. How do we avoid being egged on by ChatGPT into forcing doctors to provide bad care? That's not a rhetorical question, curious about your thoughts as an advocate for ChatGPT.

I know what you mean and I would certainly not want to blindly "trust" AI chatbots with any kind of medical plan. But they are very helpful at giving you some threads to pull on for researching. I do think they tend a little toward giving you potentially catastrophic, worst-case possibilities, but that's a known effect from when people were using Google and WebMD as well.

> Why do high blood sugar levels matter?

Are you asking why a side effect that is actually an entire health problem on its own, is a problem? Especially when there is a replacement that doesn’t cause it?

Side effects do not exist in isolation. High blood sugar is not a problem if it is solving a much bigger health issue, or is a lesser side effect than something more serious. If medication A causes high blood sugar but medication B has a chance of causing blood clots, medication A is an obvious choice. If a patient gets it in their head that their high blood sugar is a problem to solve, ChatGPT is going to reinforce that, whereas a doctor will have a much better understanding of the tradeoffs for that patient. The doctor version of the x/y problem.

Look, anyone can argue hypotheticals. But if one reads the comment being discussed, it can be deduced that your proposed hypotheses are not applicable, and that the doctor actually acknowledged the side effect and changed medications leading to relief. Now, if the new medication has a more serious side effect, the doctor (or ChatGPT) should mention and/or monitor for it, but the parent has not stated that is the case (yet). As such, we do not need to invent any scenarios.

The comment being discussed advocates for people to use ChatGPT and push their doctor to follow its recommendations. Even if we assume the OP is an average representation of people in their life, that means half of the people they are recommending ChatGPT to for medical advice are not going to be interrogating the information it provides.

A lazy doctor combined with a patient that lacks a clear understanding of how ChatGPT works and how to use it effectively could have disastrous results. A lazy doctor following the established advice for a condition by prescribing a medication that causes high blood sugar is orders of magnitude less dangerous than a lazy doctor who gives in to a crackpot medical plan that the patient has come up with using ChatGPT without the rigour described by the comment we are discussing.

Spend any amount of time around people with chronic health conditions (online or offline) and you'll realise just how much damage could be done by encouraging them to use ChatGPT. Not because they are idiots but because they are desperate.

As a physician, I can give further insight. The blood pressure medication the commenter is referring to is almost certainly a beta blocker. The effect on blood sugar levels is generally modest [1]. (It is rare to advise someone with diabetes to stop taking beta blockers, as opposed to say emphysema, where it is common)

They can be used for isolated, treatment of high blood pressure, but they are also used for dual treatment of blood pressure and various heart issues (heart failure, stable angina, arrhythmias). If you have heart failure, beta blockers can reduce your relative annual mortality risk by about 25%.

I would not trust an LLM to weigh the pros and cons appropriately knowing their syncophantic tendencies. I suspect they are going to be biased toward agreeing with whatever concerns the user initially expresses to them.

[1]

No, it was hydrochlorothiazide.

I replaced it with Lisinopril with no side effects.

I have type 2 diabetes. Blood sugar levels are a concern for me. I switched medications to one that was equally benign and got my blood sugar levels decreased along with my blood pressure. I don’t know why you assume that the medication I switched to might have higher or worse side effects. That wasn’t a choice I had to make given the options I was presented with.

> Why do high blood sugar levels matter?

I have type 2 diabetes.

> How do we avoid being egged on by ChatGPT into forcing doctors to provide bad care?

I don’t ask it leading questions. I ask “These are my symptoms, give me some guidance.” Instead of “these are my symptoms, I think I have cancer. Could I be right?” If I don’t ask leading questions it keeps the response more pure.

Yeah, and "I found one paper that says X" is very weak evidence even if you're correctly interpreting X and the specific context in which the paper says it.

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