China is also giving them dump trucks full of cash though. Plus you have to content with the nationalism reason (unfortunately this has died off in America for too many). The idea of building your country is valued for most Chinese I have met. Plus China is incredibly nice to live in, especially if you have lots of money and/or connections. So you can work in China, get paid lots of money, feel like you are doing good. Or In America you can get paid lots of money, and get yelled at by people online because the Government wants to use your model.
China city life is amazingly convenient. Trains and subways are just such an enormous quality of life boost. Add to that the relative cleanliness of having nearly zero homelessness and you’ve got something very compelling.
I will say we are winning in accessibility. China doesn’t have much of a ramp game
I wonder if you max out your options in China. It seems the Party is suspicious of ambition and high profile winners. I'm sure you can live comfortably, but there's a ceiling.
That’s not relevant to normal people. If you’re a billionaire with aspirations of power then it’s probably good there’s a ceiling. Sure beats having Elon randomly firing your public servants while high on ketamine.
Star athletes really hate being told they can't score more than 10 goals in a season because it's unfair to the other weaker players. The players will either leave to go play somewhere else, or they become weaker players themselves.
Why would a country want to welcome a psychopath whose goal is to make lots of money and wield political power that results from the money. I'm sure they would be happier with just as psychopathic people who make a bit less money but don't have aspirations of running the country from their secret bunker.
I got an offer out of the blue for a consulting gig in ML, offering USD 400/hr in China. Assuming this was legit (the offeror seemed legit), it looks like China is also throwing a lot of Benjamins around...
I would imagine if it isn't illegal its a very bad idea not to. But regardless, I would bet large amounts of money that you would never get any flack for doing anything for the government. If I went on X, Threads, Bluesky, TikTok and said "Hey I am a software engineer selling awesome new technology to the government and military!" I am going to get Americans attacking me for supporting Trump / ICE / FBI whatever the current issue of the day is. If I did the same on Douyin or Weibo the response would be able making China strong, and there would be no criticism of that choice.
Sure, but the difference is that while the Chinese state is measurably awful on all sorts of human rights things within their own borders... they're not currently dropping bombs on foreign cities, starving a neighbour of critical petroleum shipments, or heavily funding an ally to slowly exterminate a population.
My point is as a non-American I feel no allegiance to either state, and current events don't make me sympathetic to the geo-political aims of the USA. So I don't see a strong moral case for this tech being an especial purvey of either party.
If you'd asked me two years ago my answer might have been different.
And to the original point, yeah, I would feel entirely justified in the critique of engineers in providing tools to the US defense apparatus at this point.
At least the Chinese shops are giving their weights away for free, and not demanding that any government ban the rest.
Why did Meta release theirs? The better question is, why not? If you aren't at the cutting edge and don't have a moat then releasing them is pure reputational upside with zero downside.
Do you have a legit source for this? When I search for information, I only found this case, “Luo Changqing, a 70-year-old Hong Kong cleaner, died from head injuries sustained after he was hit by a brick thrown by a Hong Kong protester during a violent confrontation between two groups in Sheung Shui, Hong Kong on 13 November 2019.”
None of the other legit sources claim the police killed any of the rioters.
> I have no fear of calling the US President a pedo or saying Fuck the Police on my Twitter.
Does that matter? In China people don't judge the state of their civilization by how easily you can insult the police but whether you need to be afraid to meet them on the street. "I can insult my pedophile president" (who doesn't care if you do) isn't exactly a flex.
It does tell us something though that the evaluation of American life now consists of parasocial interactions with the president on social media. I'm starting to belief Bruno Maçães, ex Portuguese secretary of state, was prescient with his diagnosis that American material society has rotted to the point where life is now entirely defined by virtual interactions. That's the difference between China and the US today.
The president's a pedophile, a criminal, undeterred by democracy, economy or social disorder but you can freely yell into the void. Have you considered that in the US one can freely say all these things precisely because that's irrelevant?
> The president's a pedophile, a criminal, undeterred by democracy, economy or social disorder but you can freely yell into the void. Have you considered that in the US one can freely say all these things precisely because that's irrelevant?
Americans will vote for their Congress representatives in November. They will have a chance to decide how they want their government to be run. The US President was already shot-down once by the Supreme Court (tariffs). The system is working. Let the voters decide, and then let it work.
Oh, China absolutely does not tolerate _public_ dissent very much including highly visible social media posts. Everybody there knows that.
But this:
> According to the social credit system, Chinese citizens are punishable if they indulge in buying too many video games, buying too much junk food, having a friend online who has a low credit score, visiting unauthorized websites, posting “fake news” online, and more.
...is just pure bullshit. There were _ideas_ about including these kinds of stuff into the score, but they have never been implemented. At this point, the social credit score is only used to find people who dodge court decisions.
Please ignore the gun pointed at your head / social credit score / masked goons roving about Minnesota / flock cameras / etc as it hasn't been used against you at this point.
It seems to me your argument is in bad faith because (taking the parents analysis at face value) you created a straw man "social credit score" that doesn't exist. But there ARE masked goons roving Minnesota.
I did no such thing - you are the one creating a straw man. The comment chain I responded to has several different parties making various claims about the social credit score. My comments are consistent with those I responded to.
If you wish to dispute the veracity of one or more comments in the thread, by all means do so. But please make a substantive argument and (given the nature of the topic) cite sources.
Constant military drills around Taiwan isn't peaceful or responsible.
China is bullying lots of countries in the SCS (ramming Philippine coast guard ships, building military installations in the SCS, ...). Not peaceful or responsible.
AKA defending itself against separatists and sovereignty intrusions from much less powerful aggressors with unreasonable amount of restraint. One would argue overly peaceful, and irresponsible to the point of detrimental peace disease. BTW PRC settled most border disputes in recorded history with most concessions, majority over 50%, that objectively makes PRC the most peaceful rising power in recent history. Even in SCS PRC was second last to militarize, the other disputees started land reclamations and militarization first (apart from Brunei), aka a fucked around and find out situation. Even then all PRC did was build a bigger island, instead of glassing theirs, PRC coast guard last to weaponize as well.
I'm sure it's a very nice place to live if you're content to just stay quiet in society and never put a political sign in your yard or even just talk about the wrong thing with your friend in a WeChat.
> never put a political sign in your yard or even just talk about the wrong thing with your friend in a WeChat.
Practically, how many care about that? Consider that in other part of the world they also cancel folks based on social media opinion...
and that Benjamin Franklin's opinion on security and freedom? Thats terminally online phenomenon only. I once tried to bring that without specifically mentioned that it came from ol Ben himself to folks IRL. Many thought it was some anarchist blabbers.
This is an exaggeration. Nobody in China cares about what you speak with each other privately, and people talk about stupid policies all the time. The government cares about _public_ actions.
In practical terms, if you're not kind of person who would want to run for an office in the US, China is incredibly comfortable. Cities are safe, with barely any violent crime. Public drug use is nonexistent. And with the US-level AI researcher income, you'd be in the top 0.1% earners.
> nobody in China cares about what you speak with each other privately, and people talk about stupid policies all the time. The government cares about _public_ actions.
My comment and the linked video says otherwise. The guy was in a private group chat and said some nasty things about the police for confiscating his motorcycle. Now he's arrested and in the Tiger Chair.
Group with 75 people. That's a crowd, doesn't matter if gated behind QR code invites. Shit talk cops and gov with the bois is fine. Shit talk / soapbox in a crowd (virtual or real) and get caught or reported = drink tea on the menu.
Sigh. Let's not invent things? You can protest anything in the US just fine, with generally no consequences. Heck, our local _high_ _school_ students go out and protest everything to weasel out of classes.
Let's just clarify that visitors don't have the same rights as citizens. Whether or not you agree with the current administration's policies hopefully we can agree that it is entirely reasonable for them to deport foreign political dissidents more or less at their discretion.
If you want to put this to the test try crossing the Canadian border and when they ask you the purpose of your visit respond that it's to attend a protest.
> Let's just clarify that visitors don't have the same rights as citizens.
Yunseo Chung was not a visitor. She came to the United States from South Korea at age 7. She was arrested last year for peacefully protesting. Charges against her were dropped but the govt. canceled her green card.
The govt. has been trying to deport her since then, but the courts keep blocking it.
While the legality of these actions are being debated in courts, I think most of us can agree that this is reprehensible behavior on part of the Trump admin.
I never claimed to condone the actions of the current admin. The examples of people being deported for protesting that I am familiar with are student visa holders. While I don't personally support the examples that I am aware of, I also recognize that in those specific cases the executive branch appears to be within the bounds of the law. I don't even object to the executive branch having the power to cancel the visas of political dissidents in the general case, merely to how they are choosing to apply it.
It's surprising to me to learn that a green card could be revoked for protected speech. That ought to fall well outside the bounds of the law IMO. Green cards and visas are entirely different things.
>While I don't personally support the examples that I am aware of, I also recognize that in those specific cases the executive branch appears to be within the bounds of the law. I don't even object to the executive branch having the power to cancel the visas of political dissidents
It's my understanding that the 1st amendment applies to everyone, not just citizens. So if that's true (not 100% sure about that), how can political speech (protesting) be a valid reason to remove someone from the US?
> Trump admin did put people in prison and then deported them, for doing nothing more than protesting.
Link? I’m guessing we’re going to see that this definition of “protesting” involves being aggressive and directly in the face of law enforcement officers, not merely holding a sign at a distance.
> Link? I’m guessing we’re going to see that this definition of “protesting” involves being aggressive and directly in the face of law enforcement officers, not merely holding a sign at a distance.
Please read up on this one example of a US permanent resident. And then justify the actions of the govt against Yunseo Chung.
It just looks a bit ridiculous when students walk out in protest against things that are far outside the influence of their school, city, or even state.
> get yelled at by people online because the Government wants to use your model
Well duh, as recently demonstrated, an US model used by the US gov will 100% end up murdering actual children sooner than later, in this case less than a calendar year in some far flung war that many Americans do not support. Alternatively PRC model used by CCP might kill in some hypothetical future but for national reunification/rejuvenation that many Chinese support. At the end of the day, researchers and population on one side sleeps more soundly.
Chinese people are very racist towards non-Chinese. It might seem like a happy utopia, but if you aren't Chinese, then you may not really enjoy your time there. It may not be quite as bad as being black in rural US south, but being black (or anything non-Chinese) in China is still not going to be a good time.
Have you experienced racism? In Japan atleast, it was evenly applied. That company won't rent to foreigners but this one will. That company won't hire foreigners but this one will. Police will bother you if you ride a bike, but they will be polite while they waste 10 minutes of your time asking for your gaijin card for biking while foreign.
In the US people try to hide it and are far more sinister about it, since there are a lot of laws against obvious racism. The cops are also happy in the US to just kill you.
The racism in the US comes out of hate where as what I experienced abroad was more, we don't think you'll fit in and follow the rules and you have to constantly prove that you can.
I didn't spend too much time in China so maybe it is a racist hell hole.
But my experience in Japan was that white immigrants were way more inclined to make a huge deal about the lighter racism they experienced because they had never been somewhere where their skin color was a disadvantage.
"we don't think you'll fit in and follow the rules and you have to constantly prove that you can"
I speculate that if you were a permanent minority instead of a visiting inconvenience, then that 'nice' racism you describe would metastasize into the type of racism you see in the USA. It's more friction from time and exposure added on. And, you know, slavery.
The dream I think has always been heterogeneous computing. The closest here I think is probably apple with their multi-core cpus with different cores, and a gpu with unified memory. (someone with more knowledge of computer architecture could probably correct me here).
Have a CPU, GPU, FPGA, and other specific chips like Neural chips. All there with unified memory and somehow pipelining specific work loads to each chip optimally to be optimal.
I wasn't really aware people thought we would be running websites on GPUs.
No, you just dont want people that will start interrupting work, causing a ruckus, starts signing open letters, or randomly quits based on whatever blue sky post they read last.
There is a major gap in this analysis by not controlling for industry or companies. Engineering Manager is a very generic title, so this is going to get Start Ups, Big Tech, Little Tech, Enterprise, Contract Shops, etc. Staff Engineer is very uncommon in Enterprise or Contract shops, there you typically see SWE 1/2/3 -> Tech Lead -> Architect. Most Tech companies I think have more of a SWE 1/2/3 -> Staff Engineer -> Principal.
The other part is that Engineering Manager is a terminal position, I've known a few people who were manager for 20 years without ever going to Director / Exec whatever, its just a competitive jump and mathematically most will never go up. This is ALSO true for Senior -> Staff and Principle though. But Engineering Manager positions often have more of an upside with bonuses / incentives than Engineers get.
Finally it is ultimately a career change, and that should be the primary factor to consider.
> Engineering Manager positions often have more of an upside with bonuses / incentives than Engineers get
Not really.
Staff Eng and above will end up making similar to an EM including bonuses and has much more job mobility. You have to remember that most EM roles only open up once you hit Staff, so you are basically taking much more responsibility and longer hours for a marginal salary impact.
Engineering Manager jobs are hard to come by and your job security is actually less than an individual contributor, because even if an initiative was delivered late due to no fault of your own, if sales is braying for blood in order to protect themselves after failing to meet quota, it's the EM's head that is offered on a silver platter.
Above Staff and Staff+ companies are usually looking for expertise in domain, in addition to cross org leadership. Unless you want to get hired with Sr title.
Management is different though, you have highly transferrable skillset, managing people, up and down.
> Management is different though, you have highly transferrable skillset, managing people, up and down
Most tech companies are not hiring an EM without relevant domain experience. "People Management" is a table stakes skill in 2026 and Staff/Principal Engineers and Product Managers largely offer that as well as technical or product insight.
Additionally, it's something that can be cultivated in-house and is why internal promotions to EM tend to be preferred unless a director, principal engineer, or PM is getting their friend a job (which happens fairly often).
I wonder how long we have until we start solving some truly hard problems with AI. How long until we throw AI at "connect general relativity and quantum physics", give the AI 6 months and a few data centers, and have it pop out a solution?
I think a very long time because part of our limit is experiment.
We need enough experimental results to explain to solve these theoretical mismatches and we don't and at present can't explore that frontier.
Once we have more results at that frontier we'd build a theory out from there that has two nearly independent limits for QFT and GR.
What we'd be asking if the AI is something that we can't expect a human to solve even with a lifetime of effort today.
It'll take something in par with Newton realising that the heavens and apples are under the same rules to do it. But at least Newton got to hold the apple and only had to imagine he could a star.
> I think a very long time because part of our limit is experiment.
Yes, maybe. But if you are smarter, you can think up better experiments that you can actually do. Or re-use data from earlier experiments in novel and clever ways.
What prevents us from giving this system access to other real systems that live in physical labs? I don't see much difference between parameterizing and executing a particle accelerator run and invoking some SQL against a provider. It's just JSON on the wire at some level.
In 1900 Henri Poincaré wrote that radiation (light) has an effective mass given by E/c^2.
So it really isn't far fetched. What intrigues me more is if it was capable of it would our Victorian conservative minded scientists have RLHF it out of that kind of thing?
Hold your horses, that’s a long way off. The best math AI tool we currently have, Aletheia, was only able to solve 13 out of 700 attempted open Erdos problems, only 4 of which were solved autonomously: https://arxiv.org/html/2601.22401v3
Clearly, these models still struggle with novel problems.
If AGI will ever come, then. Currently, AI is only a statistical machines, and solutions like this are purely based on distribution and no logic/actual intelligence.
I swear that AI could independently develop a cure for cancer and people would still say that it's not actually intelligent, just matrix multiplications giving a statistically probable answer!
LLMs are at least designed to be intelligent. Our monkey brains have much less reason to be intelligent, since we only evolved to survive nature, not to understand it.
We are at this moment extremely deep into what most people would have been considered to be actual artificial intelligence a mere 15 years ago. We're not quite at human levels of intelligence, but it's close.
All the answers for all your questions is contained in randomness. If you have a random sentence generator, there is a chance that it will output the answer to this question every time it is invoked.
But that does not actually make it intelligent, does it?
You are arguing a point no-one is making. LLMs are not random sentence generators. Its probability distributions are anything but random. You could make an actual random sentence generator, but no-one would argue about its intelligence.
This is exactly how problem solving works, regardless of the substrate of cognition.
Start with "all your questions contained in randomness" -> the unconstrained solution space.
The game is whether or not you can inject enough constraints to collapse the solution space to one that can be solved before your TTL expires. In software, that's generally handled by writing efficient algorithms. With LLMs, apparently the SOTA for this is just "more data centers, 6 months, keep pulling the handle until the right tokens fall out".
Intelligence is just knowing which constraints to apply and in what order such that the search space is effectively partitioned, same thing the "reasoning" traces do. Same thing thermostats, bacteria, sorting algorithms and rivers do, given enough timescale. You can do the same thing with effective prompting.
The LLM has no grounding, no experience and no context other than which is provided to it. You either need to build that or be that in order for the LLM to work effectively. Yes, the answers for all your questions are contained. No, it's not randomness. It's probability and that can be navigated if you know how
You can constrain the solution space all you want, but if you don't have a method to come up with possible solutions that might match the constraints, you ll be just sitting there all day long for the machine to produce some results. So intelligence is not "just knowing which constraints to apply". It is also the ability to come up with solutions within the constraints without going through a lot of trial and error...
But hey, if LLMs can go through a lot of trial and error, it might produce useful results, but that is not intelligence. It is just a highly constrained random solution generator..
I believe that's I and the paper are both saying as well. The LLM is pure routing, the constraints currently are located elsewhere in the system. In this case, both the constraints and the motivation to perform the work are located in Knuth and his assistant.
Routing is important, it's why we keep building systems that do it faster and over more degrees of freedom. LLMs aren't intelligent on their own, but it's not because they don't have enough parameters
Last week I put "was val kilmer in heat" into the search box on my browser. The AI answer came back with "No, Val Kilmer was not in heat. Val Kilmer played Chris Shiherlis in the movie Heat but the film did not indicate that he was pregnant or in heat. His performance was nuanced and skilled and represents a high point of the film." I was not curious about whether he was pregnant.
We are not only not close to human level of intelligence, we are not even at dog, cat, or mouse levels of intelligence. We are not actually at any level of intelligence. Devices that produce text, images, or code do not demonstrate intelligence any more than a printer producing pages of beautiful art demonstrate intelligence.
Honestly, when I read your first sentence, given the lack of a capital H, my brain initially went the same direction the AI did. Then I realized what you meant but since I already went there, I might have made a similar response as a joke. For the sake of my ego I'm forced to reject your claim that this is evidence of stupidity.
On Google, just clicking "AI Mode" gives you a substantially smarter model, and it's still pretty weak. But I assume the OP wasn't talking about Google because it doesn't seem to make this mistake even in a search.
It was bing as that is the default for Edge as supplied on my work laptop. It doesn't do this now, but it does do something else quite weird:
search: was val kilmer pregnant or in heat
answer:
Not pregnant
Val Kilmer was not pregnant or in heat during the events of "Heat." His character, Chris Shiherlis, is involved in a shootout and is shot, which indicates he is not in a reproductive or mating state at that time.
And then cites wikipedia as the source of information.
In terms of cognition the answer is meaningless. Nothing in the question implies or suggests that the question has to do with a movie. Additionally, "involved in a shootout and is shot, which indicates he is not in a reproductive or mating state" makes no sense at all.
If you asked a three-year-old a question that they proceeded to completely flub, would you then assume that all humans are incapable of answering questions correctly?
Nobody is arguing for the quality of the search overviews. The models that impress us are several orders of magnitude larger in scale, and are capable of doing things like assisting preeminent computer scientists (the topic of discussion) and mathematicians (https://github.com/teorth/erdosproblems/wiki/AI-contribution...).
Microsoft is bad at AI and this is a great example. I'm wondering if someone saw your post on HN and tried to hardcode a rule here, because I agree, it's nonsense. None of the actual AI companies are emitting nonsense like this.
It's clearly just a hallucination. Everyone knows there was never a movie called Heat, Val Kilmer did not play Chris Shiherlis in it, and he has always been pregnant.
It only took 4 years, but it appears that this view is finally dying out on HN. I would advise everyone who found this viewpoint compelling to think about how those same blinders might be affecting how you are imagining the future to look like.
The issue to my mind is a lack of data at the meeting of QFT/GR.
Afterall few humans historically have been capable of the initial true leap between ontologies. But humans are pretty smart so we can't say that is a requirement for AGI.
“The laws of nature should be expressed in beautiful equations.”
- Paul Dirac
“It is, indeed, an incredible fact that what the human mind, at its deepest and most profound, perceives as beautiful finds its realisation in external nature. What is intelligible is also beautiful. We may well ask: how does it happen that beauty in the exact sciences becomes recognizable even before it is understood in detail and before it can be rationally demonstrated? In what does this power of illumination consist?”
- Subrahmanyan Chandrasekhar
“I often follow Plato’s strategy, proposing objects of mathematical beauty as models for Nature.”
“It was beauty and symmetry that guided Maxwell and his followers.”
- Frank Wilczek
“Beauty, is bound up with symmetry.”
- Herman Weyl
"Still twice in the history of exact natural science has this shining-up of the great interconnection become the decisive signal for significant progress. I am thinking here of two events in the physics of our century: the rise of the theory of relativity and that of the quantum theory. In both cases, after yearlong unsuccessful striving for understanding, a bewildering abundance of details was almost suddenly ordered. This took place when an interconnection emerged which, thought largely unvisualizable, was finally simple in its substance. It convinced through its compactness and abstract beauty – it convinced all those who can understand and speak such an abstract language."
- Werner Heisenberg
Maybe (just maybe) these things (whatever you want to call them) will (somehow) gain access to some "compact", beautiful, "largely unvisualizable" "interconnection" which will be the self-evident solution. And if they do, many will be sure to label it a statistical accident from a stochastic parrot. And they'll right, for some definitions of "statistical", "accident", "stochastic", and "parrot".
Donald Knuth is an extremal outlier human and the problem is squarely in his field of expertise.
Claude, guided by Filip Stappers, a friend of Knuth, solved a problem that Knuth and Stappers had been working on for several weeks. Unfortunately, it doesn't seem (from my quick scan) to have been stated how long (or how many tokens or $) it took for Claude + Stappers to complete the proof.
In response, Knuth said: "It seems that I’ll have to revise my opinions about “generative AI” one of these days."
Seems like good advice. From reading elsewhere in this comment section, the goalposts seem to be approaching the infrared and will soon disappear from the extreme redshift due to rate at which they are receding with each new achievement.
What goalposts do you think are being moved? I constantly see AI enthusiasts use this phrase, but it’s not clear what goalposts they have in mind. Specifically, what is it that you want opponents to recognize that you believe they aren’t currently?
We now have a tool that can be useful in some narrow domains in some narrow cases. It’s pretty neat that our tools have new capabilities, but it’s also pretty far from AGI.
Imagine hearing pre-attention-is-all-you-need that "AI" could do something that Donald Knuth could not (quickly solve the stated problem in collaboration with his friend).
The idea that this (Putnam perfect, IMO gold, etc) is all just "statistical parrot" stuff is wearing a little thin.
Connecting them is easy, one is the math of the exchange and one of the state machine.
A better question might be why no one is paying more attention to Barandes at Harvard. He's been publishing the answer to that question for a while, if you stop trying to smuggle a Markovian embedding in a non-Markovian process you stop getting weird things like infinities at boundaries that can't be worked out from current position alone.
But you could just dump a prompt into an LLM and pull the handle a few dozen times and see what pops out too. Maybe whip up a Claw skill or two
Unconstrained solution space exploration is surely the way to solve the hard problems
Ask those Millenium Prize guys how well that's working out :)
Constraint engineering is all software development has ever been, or did we forget how entropy works? Someone should remind the folk chasing P=NP that the observer might need a pen to write down his answers, or are we smuggling more things for free that change the entire game? As soon as the locations of the witness cost, our poor little guy can't keep walking that hypercube forever. Can he?
Maybe 6 months and a few data centers will do it ;)
I think the largest issue with health care right now is that the US is artificially shrinking the supply of Doctors. This is due to:
1. Size of medical school classes not increasing with population
2. US has an artificially small amount of residency slots.
These are largely due to AMA lobbying afaik and bad bills. But if we allowed every qualified medical student to enroll, and gave a residency slot to every graduate. In a decade we would have really shrunk the gap.
Does that matter though? My impression is that most people don't see doctors anymore. Every urgent care visit I've had in the past few years has been with a physicians assistant or nurse. Same for our pediatrician, I can't remember the last time we saw her instead of one of the nurses.
I actually have a routine visit with a specialist at one of the top hospital systems in the country in 2 days, and I see in the portal I'm seeing a "CRNP, MSN", not a doctor.
This affect is because of the doctor shortage though.
I am in the process of trying to find a primary care provider, and I cant find anyone accepting new patients.
Bigger places you basically see the doctor for 2 minutes when you actually need one. I went to a ortho surgeon and they had a dozen patients “seeing them” at the same time. As he just went between rooms and nurses prepped everything.
I went down a Reddit rabbit hole, a sub called /r/noctor. Basically people, mostly doctors, complaining about the prevalence of nurse practitioners, PAs practicing independently/outside of their scope, etc. The general consensus I see there is that the only people benefiting from this are private equity firms trying to squeeze more profit since they bill the same based on whether you see a doctor or an NP. This in turn has an affect where it doesn’t make sense financially to go through so much school and take on so much debt.
The primary utility of most medical professionals is to act as a gatekeeper to distinguish me from a drug-seeker. They are glorified security guards around medication. Fortunately, I always get what I want.
As an internist (not in the US), I would like to put in my two cents to say this is just wrong.
The primary utility of most medical professionals is to diagnose and treat a condition correctly. In the ER and elsewhere, the correct diagnosis is indeed often "drug seeking behaviour". And this is also a major aspect of medicine that many relatively healthy people interface with and remember. They are in pain for whatever reason, they desire to be relieved of said pain, and that desire puts them into contact with the skepticism and hesitancy around opiods that physicians have built up out of unfortunate necessity. It's often a hurtful and protracted experience, and so they remember it and form opinions like yours.
But this area of contact with medicine is a tiny, very visible tip of a much larger iceberg. Your description of "security guard around medication" is not strictly wrong for my field, seeing as internal medicine is largely about administering the right drug at the right time, but the 99% of the drugs we guard are not desirable at all for any drug-seeker. They are potent, full of side effects, are sometimes potentially deadly. But they do work. And you do not see any of this until you get properly sick, which to most people does not happen very often often (at least until they approach 70). And when it does happen, most people tend to focus on the one little side of the ice berg they come into contact with. But it is there, and it is about much more than distinguishing you from a drug seeker.
No professional has ever taken kindly to being told their primary function. The notion of greater grandeur infects everyone from janitor to president. I'm not foolish enough to tell doctors these things. If I did, I doubt I'd get what I want.
There are limits, naturally. I don't really expect to fit the percutaneous pins into my hand myself, even if I had third hand capable of equal dexterity. But if I have to sing a song you can be sure the song is sung. It's no different from selling B2B SaaS. You just need to make the sale.
I'm sure that's at least somewhat correct, but if I'd offer a similar reply, I could say that amateurs rarely takes kindly to being told that they do not understand what they are talking about. Dunning Kruger is endemic, and especially prevalent in populations making reductive comments about a group of professionals they maintain an adverserial relationship with.
My point was not about the emotional experience of being presented with a certain viewpoint of the function of physicians. My point was simply that if you look at the details of what physicians actually do, the stated viewpoint is wrong.
Of course, "primary function" is a somewhat subjective concept that you could define however you'd like, so it is more or less unfalsifiable as a standpoint.
What exactly is the problem with giving drugs to someone who might be a drug seeker? Is it worth letting someone sit in pain on the chance you might allow an addict to get high?
Harm reduction by just giving drugs to addicts in an organized fashion is honestly a strategy that might work fine on a societal level, and I'm not against it (although I am unsure about the details of implementations). However when your society does not practice it, and the ER/family med practioner becomes the one point of contact for potentially cheap drugs, you run into some practical problems over time. Essentially you can't have an open "drug seekers in line B" policy due to legal issues, so drug seekers will have to lie about being in pain and figure out a convincing lie.
Let us say they try to simulate an acute ruptured appendicitis. If they do this convincingly, they will get an acute CT with contrast. In my hospital system these machines and interpretation of resulting images is expensive and resource constrained, especially during evening and night time, meaning that the prioritisation of one patient will generally mean that another, let us say a patient in the process of having a very real stroke, might get delayed if traffic is high.
This is beyond the fact that roughly 30-120 minutes of the physicians time in the ER will be wasted in examining the patient, ordering blood work, the imagery, writing notes, and so on, which means that another patients time, who is often literally waiting in line for your time, is being wasted. Furthermore this kind of clientele have an unfortunate tendency to become unpleasant when you tell them that you can't find any reason for their pain or giving opioids, which is an extremely unpleasant and frankly often traumatic experience for green eyed doctors that enlisted in this career with the goal of aiding the sick. You can only get threatened, spat upon or assaulted so many times and maintain your professional enthusiasm. Many quit for this reason. And for the ones that don't, the experience of being forced to take on the role of distinguish between drug seekers and non drug seekers will generally turn you into a more unpleasant human being.
In summary, mostly due to unfortunate societal circumstances, you really, really, really do not want to encourage drug seekers to try their luck. It is an expensive waste of everyone's time, in circumstances where both money and time is tight.
Conversely, you really cannot predict in advance which ones of your opioid-naive patients will become addicts because the opioids that you gave them, which effectively means that you've fucked their life forever. Opioids are really, really dangerous. Sometimes people are obviously in pain and you open the tap quickly. But there's a name for the historical consequence of playing fast and loose with pain relief, it's called the opioid epidemic.
the largest issue in American health care is private equity and middle men raising the cost of everything.
edit if doctor scarcity were the issue then doctors would have a lot more leverage in salary negotiations than they do, which is to say they don't have much. because the hiring practices are limited by what they can bill, which they have no power over.
Private Equity is the effect not the cause. We need them to create efficiency because of the shenanigans that the AMA guild did in limiting doctor supply. Just allow people to take an exam to get credentialed, we'd have foreign doctors flown in by the hundreds of thousands and care would be as cheap as it is in India.
private equity doesn't create efficiencies. The real world is not some MicroEcon 101 class.
> “As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures. Take private equity firm Leonard Green and hospital operator Prospect Medical Holdings: documents we obtained show they spent board meetings discussing profit maximization tactics—cost cutting, increasing patient volume, and managing labor expenses—with little to no discussion of patient outcomes or quality of care at their hospitals. And while Prospect Medical Holdings paid out $645 million in dividends and preferred stock redemption to its investors—$424 million of which went to Leonard Green shareholders—it took out hundreds of millions in loans that it eventually defaulted on. Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.”
Private Equity does not create efficiency and we do not need them. What they do is to take debt to buy healthy companies, transfer debt onto them and then kill them.
None of that is efficiency in any reasonable sense.
Ugh I wish this braindead populist 'private equity boogieman' meme that's taken ahold of reddit-types would die.
No, private equity is not the reason healthcare costs in the US are out of control, you can even ask chatgpt.
PE is a 3rd tier mild symptom in certain niche health markets that sits downstream of all the structural root issues created due to the twisted public/private incentive misalignment nightmare of US healthcare.
People would have an opportunity to change their stance if you explain why they should hold a different one with evidence and persuasion. Berating them and then saying they are wrong without explaining why is not going to change anyone's mind.
Its interesting that elementary kids have this kind of evergreen introduction to Pokemon. There is always a new set of games coming out, cards to buy, toys, anime. So kids see older kids with it, they want to get it, then they get introduced. So this "fad" has gone on for 30 years.
However, even as someone who plays JRPGs. I can't for the life of me understand how adults are playing the games. The pokemon games are painful games to play, full of grinding, massive amounts of rng and just boring turn based combat (compared to other rpgs that exist). Why as an adult you would play Pokemon over SMT is something I can't get. Every time Ive tried ive bounced off newer games hard.
Oh, I don't want to play Pokémon games, but every few hours, I am given the controller and told to beat the boss with a team composed of 6 low-level Pikachus and zero healing items.
Newer Pokémon games have way more quality-of-life such as EXP share and way faster animations so it's not a slog anymore. Recently finished Scarlet and enjoyed it very much. Currently replaying SoulSilver and I couldn't play it without cheats that make the game a bit faster (cutting repetitive animations, making the game run at 60 FPS, etc.) since everything is so slow.
I'm nearing 30 and have played a lot of JRPGs in my life.
I completely agree with this. I'm playing through Leaf Green, and I'm around 8 hours in with just a single badge. I don't think I'd get through it without the boost of nostalgia for the GBC/GBA games. The newest games are nothing like the slog we went through as kids.
i play both! there is a sort of comfort in pokemon, like watching your favorite movie or eating junkfood, but i also love me a gourmet meal too. room for both! who doesnt wanna play a game with their favorite little doods, getting see what others can become favorites and then ya know everyone else playing so its a fun community thing. i also do love the grinding especially in the older games, and the RNG is fun to me. love when that 1% encounter rate hits after 30 mins of searching.
> The pokemon games are painful games to play, full of grinding, massive amounts of rng and just boring turn based combat (compared to other rpgs that exist).
As someone who was played every entry since the 90s I can't even imagine how you could come away as Pokemon games being "grindy", assuming you're talking about just playing through the story. EXP share has been a standard mechanic for the past few generations that have effectively eliminated any grinding.
I'm also not really sure where you're getting "massive amounts" of RNG from either. Sure, moves can miss but it's never consequential enough that it could ruin a run or something. At most you lose a few minutes having to run back somewhere.
As far as I can tell, my kids and their friends never actually play the game either, they just collect the cards. I don't think they even know the rules.
The grinding is less of an issue than being too easy. You can play through a number of the games with just your starter pokemon, playing with close to no strategy at all.
"You're playing it wrong" - Pokemon can be played with a min/max grinding attitude, or it can be played as digital cockfights that you futz around with from time to time.
Some people really like relatively "mindless" entertainment that they can do while doing other things. Hell, that describes the vast majority of mobile games.
> Why as an adult you would play Pokemon over SMT is something I can't get
bro are you serious? smt is the definition of painful in terms of time sunk and the newer pokemon games have so many guard rails; i can mindlessly blast through the whole story and craft a quick crew to beat down my wife and friends and just be done ;p
now granted, would I rather play (and 100 percent complete) any SMT game? yes. how do adults do it? i watched my friend who's an RN on hospital hours + has three kids blast through cyberpunk and the answer is pretty simple: sleep is for the weak.
I think Celeste was popular enough in the indie space to get "big developer". To put some words in OP's mouth, its not "Big Developer" as in a large studio. But "Big Developer" as in well known and acclaimed.
For me when there is a library or framework or "engine". You are often having to learn the specifics of how this thing works, and ALSO map your mind to the way it works. When you write things yourself you are only in your own mindset. So you can write your 90% self implementation in less time than learning this new mindset. Then you can build everything together without special ways of piping things together. Adding more frameworks or libraries is an exponential explosion in complexity, and more and more of your time is spent with glue code. When you write everything yourself, you are in one design space and things flow more naturally.
Vim/Emacs/Sublime (And now things like VSC/Helix) are more than sufficient for coding without an IDE. Autocomplete scripts, the terminal, build scripts, etc work great. Now with LSP you can turn any editor into an IDE pretty trivially.
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