AlphaAndOmega

Karma: 937

AlphaAndOmega 9 Oct 2025 23:12 UTC
23 points
0
on: Hospitalization: A Review
>So I looked it up and apparently the guideline is actually a 2 hours fast for clear liquids! 2 hours![7] The hospital staff, however, hardened their hearts. Nurses said to ask the surgeons. The surgeons said to ask the anestheologists. It wasn’t until 7am that the anestheologists said, yep, you can drink a (small) glass of water.
Ah, this takes me back to my medical officer days. No junior doctor ever got into trouble for telling a patient to fast a bit too long, and many do for having a heart and letting them cut it short. It is also likely the least consequential thing we can bother the anesthetists about, and it’s not going to kill anyone to wait longer (usually).
Knowing the local demographic and behavioral tendencies on LW, I think it might worth noting that ozempic/semaglutide and other GLP drugs can cause delayed gastric emptying. As a consequence, even the standard fasting duration might not be adequate to fully empty your stomach. If you’re scared of getting aspiration pneumonia, it’s worth mentioning this to your surgeon or the anesthetist. The knowledge hasn’t quite percolated all the way up the chain, so you can’t just assume they’re aware.
What links here?
- Hospitalization: A Review by Logan Riggs (9 Oct 2025 14:36 UTC; 269 points)

AlphaAndOmega 7 Oct 2025 14:31 UTC
18 points
7
on: The Origami Men
Here’s how I parsed this:
1. We’re in a future not particularly long after a hard takeoff Singularity (changes to the environment described as quite sudden rather than gradual).
2. This is a multipolar AI scenario, given that the Origami Men claim to have purchased these humans from another entity that owned them.
3. The Origami Men (or the entity operating them) is severely misaligned but not to an omnicidal degree. It appears to value (bad) proxies for human wellbeing, such as ensuring that they have jobs, pets, residences and food. They either do not understand or do not care that their implementation is… subpar. We might as well call it the Uncanny Valley of Care.
4. They seem to have some more subtle store of value, in the sense that they desire to only rear humans who do not actively breach containment, or who do not spread memes about breaking out (“contagion”). The general impetus behind the cull or reclamation is not clear to me, do they initially just pick people at random? Or does the narrator finding something “beautiful” in the people chose correlate to an unknown preference? They will take you if you get too close to the border of the dome, but general discontent is not policed. Nor is attempts at violence against the Origami Men, though that appears entirely futile.
5. “Provenance”? Do they only value pre-Singularity specimens? That would explain lack of any evidence of artificially boosting human numbers or encouraging reproduction.

AlphaAndOmega 2 Oct 2025 15:40 UTC
4 points
0
on: Some Biology Related Things I Found Interesting
>I was surprised to find out that I could not find a single neurotransmitter that is not shared between humans and mice (let me know if you can find one, though).
As far as I can tell, this is true. The closest I could find is a single subtype of receptor that a frameshift mutation in a primate ancestor made nonfunctional.
https://www.sciencedirect.com/science/article/pii/S0021925818352189
I suspect you’d have to go even further back in terms of divergent ancestry to find actual differences in the neurotransmitter substances themselves. There are definitely differences in receptors and affinities, but the actual chemicals? From a quick search, you’d have to go all the way to ctenophores, which are so different that some have posited they evolved nervous systems independently.

AlphaAndOmega 2 Oct 2025 15:34 UTC
1 point
0
in reply to: Richard_Kennaway’s comment on: Some Biology Related Things I Found Interesting
I presume it would be an overview of histone molecule. DNA is often kept compacted by wrapping around one, like a rope coiled around a baseball.
https://youtu.be/gbSIBhFwQ4s

AlphaAndOmega 16 Sep 2025 19:33 UTC
1 point
0
in reply to: dr_s’s comment on: The Culture Novels as a Dystopia
I find it very hard to believe that a civilization with as much utter dominion over physics, chemistry and biology as the Culture would find this a particularly difficult challenge.
The crudest option would be something like wiping memories, or synthesizing drugs that re-induce a sense of wonder or curiosity about the world (similar to MDMA). The Culture is practically obsessed with psychoactive substances, most citizens have internal drug glands.
At the very least, people should be strongly encouraged to have a mind upload put into cold storage, pending ascendance to the Sublime. That has no downsides I can see, since a brain emulation that isn’t actively running is no subjectively different from death. It should be standard practice, not a rarity.
Even if treated purely as a speculation about the “human” psyche, the Culture almost certainly has all the tools required to address the issue, if they even consider it an issue. That is the crux of my dissatisfaction, it’s as insane as a post-scarcity civilization deciding not to treat heart disease or cancer.

AlphaAndOmega 14 Sep 2025 15:44 UTC
10 points
1
in reply to: Adam Newgas’s comment on: The Culture Novels as a Dystopia
Even if such ennui is “natural” (and I don’t see how a phenomenon that only shows up after 5-6x standard lifespan, assuming parity with baseline humans can ever be considered natural), it should still be considered a problem in need of solving. And the Culture can solve just about every plausibly solvable problem in the universe!
Think of it this way, if a mid-life crisis reliably convinced a >10% fraction of the population to kill themselves at the age of 40, with the rest living happily to 80+, we’d be throwing tens of billions at a pharmacological cure. It’s even worse, relatively and absolutely, for the Culture, as their humans can easily live nigh-indefinitely.
Even if you are highly committed to some kind of worship of minimalism or parsimony, despite infinite resources, or believe that people have the right to self-termination, then at least try and convince them to make mind backups that can be put into long-term storage. That is subjectively equivalent to death without the same… finality.
This doesn’t have to be coercive, but the Culture demonstrates the ability to produce incredibly amounts of propaganda on demand. As far as I’m concerned, if the majority of the population is killing itself after a mere ~0.000..% of their theoretical life expectancy, my civilization is suffering from a condition that ours standard depression or cancer to shame. And they can trivially solve it, they have incredibly powerful tools that can edit brains/minds to arbitrary precision. They just… don’t.

AlphaAndOmega 14 Sep 2025 14:59 UTC
33 points
22
on: The Culture Novels as a Dystopia
While the Culture is, on pretty much any axis, strictly superior to modern civilization, what personally appalls me is their sheer deathism.
If memory serves, the average human lives for around 500 years before opting for euthanasia, mostly citing some kind of ennui. What the hell? 500 years is nothing in the grand scheme of things.
Banks is careful to note that this isn’t, strictly speaking, forced onto them, and exceptions exist, be it people who opt for mind uploads or some form of cryogenic storage till more “interesting” times. But in my opinion, it’s a civilization-wide failure of imagination, a toxic meme ossified beyond help (Culture humans also face immense cultural pressure to commit suicide at the an appropriate age).
Would I live in such a civilization? Absolutely, but only because I retain decent confidence in my ability to resist memetic conditioning or peer pressure. After all, I’ve already spent much of my life hoping for immortality in a civilization where it’s either derided as an impossible pipe-dream or bad for you in {hand-wavy ways}.
Another issue I’ve noted is that even though this is a strictly post-scarcity universe in the strong sense, with matter and energy freely available from the Grid, nobody expands. Even if you want to keep natural bodies like galaxies ‘wild’ for new species to arise, what’s stopping you from making superclusters of artificial matter in the enormous void of interstellar space, let alone when the extragalactic supermajority of the universe lies empty? The Culture is myopic, they, and the wider milieu of civilizations, seem unwilling to remotely optimize even when there’s no risk or harm of becoming hegemonizing swarms.
(Now that you’ve got me started, I’m half tempted to flesh this out into a much longer essay.)

AlphaAndOmega 7 Sep 2025 22:47 UTC
13 points
2
on: OffVermilion
Strong upvote. When I began reading, I slightly scoffed at the idea of “musician’s dystonia”. Never heard of it, didn’t sound plausible to me, despite being a doctor and psych trainee. I thought it was a nice hypothetical to shore up the story’s central conceit.
And then I actually Googled it, and found a wiki article. Oh dear.

AlphaAndOmega 5 Sep 2025 1:13 UTC
11 points
3
in reply to: Viliam’s comment on: Viliam’s Shortform
There is an important distinction to be made between base models, which are next token predictors (and write in a very human like manner) and the chatbots people normally use, despite both being called “LLMs”. Those involve taking a base model and then subjecting it to further instruction tuning and Reinforcement Learning from Human Feedback.
My understanding is that a lot of the stylistic quirks of the latter arise from the fact that OpenAI (and other companies) either personally or through outsourcing hired Third World contractors. They were cheap and reasonably fluent in English. However, a large number were Nigerian, and this resulted in a model slightly biased towards Nigerian English. They’re far more fond of “delve” than Western English speakers, but most people wouldn’t know that, because how often were they reading Nigerian literature or media? It’s particularly rampant in their business or corporate comms.
Then you have other issues stemming from RLHF. Certain aspects of the general chatbot persona were overly engrained, as preference feedback biased towards verbosity and enthusiasm. And now that the output of ChatGPT 3.5 and onwards is all over the wider internet, to an extent, new base models expect that that’s how a chatbot talks. This likely bleeds into the chatbots that are built on the contaminated base model, since they have very strong priors that they’re a chatbot in the first place.
That doesn’t mean that there isn’t significant variance in how current models speak. Claude has a rather distinct personality and innate voice, even within the various GPT models, o3 was highly terse and fond of dense jargon. With the availability of custom instructions, you can easily get them to talk you in just about any style you prefer.

AlphaAndOmega 13 Aug 2025 15:58 UTC
2 points
0
on: GPT-5s Are Alive: Synthesis
I was a big fan of Horizon Alpha, a stealth model available on OpenRouter, later revealed to be an early checkpoint/variant of GPT-5. Unfortunately, the release candidate isn’t quite as good at my usual vibes benchmark when it comes to creative writing, be it 5 or 5-Thinking.
(4.1 was really good at the same task, and surprisingly so, for a model marketed for coding. I missed it when it was gone, and I’m glad to have it back)
I was initially quite negative about GPT-5T, but I’ve warmed to it. It seems as smart or smarter than o3, and is a well-rounded and capable model. The claims of a drastically reduced hallucination rate seems borne out in extensive use.

AlphaAndOmega 11 Aug 2025 18:02 UTC
16 points
15
in reply to: Kaj_Sotala’s comment on: Kaj’s shortform feed
I don’t think 4o is that harmful in objective terms, but Altman made a big fuss about reducing sycophancy in GPT-5 and then immediately caved and restored 4o. It’s a bad look as far as I’m concerned.
More concerningly, if people can get this attached to an LLM as mediocre as 4o, we’re in for a great time when actually intelligent and manipulative ASI gets here.

AlphaAndOmega 6 Aug 2025 17:16 UTC
1 point
0
in reply to: Nina Panickssery’s comment on: Do Not Render Your Counterfactuals
You’re correct. When GPT’s native image gen came out, it absolutely refused to touch kids. I didn’t realize that they’d changed it (at least because I never had the reason to try) till I attempted this ill-fated experiment.

AlphaAndOmega 4 Aug 2025 16:25 UTC
1 point
0
in reply to: cousin_it’s comment on: [Linkpost] Avatar’s Dirty Secret: Nature Is Just Fancy Infrastructure
An interesting idea, but I genuinely don’t see how that’s supported by the movies? Ignore this if you were just joking!

AlphaAndOmega 2 Aug 2025 20:48 UTC
3 points
0
in reply to: CronoDAS’s comment on: Do Not Render Your Counterfactuals
I’m sorry. I can only hope you’ve found peace, and I’d be the last to judge if you were to indulge in AI generated dreams of a better world.

AlphaAndOmega 1 Aug 2025 15:53 UTC
4 points
2
in reply to: uugr’s comment on: Do Not Render Your Counterfactuals
Thank you.
The issue, as I see it, isn’t just the ability to do so. Theoretically, I could have taken the picture of the two of us, gone to a human artist and gotten a portrait with kids commissioned. I would have been exceedingly unlikely to go down that route, or even explore alternatives like using old fashioned Photoshop for that purpose. The option of just uploading a single image and a short prompt, and it taking a mere few seconds to conjure exactly what I’d envisioned? That temptation was too alluring to resist.
Ease of access makes all the difference, a quantitative change can become qualitative. Honey was a delicacy to be savored, but now, we can get something as sweet or sweeter in minutes, delivered to the comfort of our homes.
I try not to make sweeping declarations here, I’m a technophile, and I think that the ability to conjure arbitrary, high quality images is amazing. A small subset of that capability can cause immense pain, or at least did to me. The rest of the time, I’m still marveling at my ability to illustrate ideas I’d never have hoped to see with my own two eyes. Even as painful as this way, a small part of me appreciates the ability to have seen how things might have gone differently.

AlphaAndOmega 1 Aug 2025 14:43 UTC
3 points
−3
in reply to: avturchin’s comment on: Do Not Render Your Counterfactuals
In my defense, I did put up CW tags. I don’t use those very often, but I felt they were appropriate here.

AlphaAndOmega 1 Aug 2025 6:02 UTC
12 points
6
in reply to: Shankar Sivarajan’s comment on: Do Not Render Your Counterfactuals
To the credit of ChatGPT, or an any multimodal LLM, they’re much more versatile than the Mirror. The Mirror does one thing very well, showing you your heart’s true desire. Optionally, two, if you want to use it as a storage vault of questionable security!

AlphaAndOmega 26 Jul 2025 19:51 UTC
7 points
2
on: a 9-week trip on retatrutide
I admit I am confused. If someone seeks more “energy and focus”, I’d expect that the first port of call would be prescription stimulants, not indirectly via GLP-1 drugs. Did you try those and find them lacking? I struggle to think of a jurisdiction where it’s easier for the average person to get retratrutide than an Adderall prescription.
I will extend an n=1 anecdote here, which is heavily confounded to boot. I have a diagnosis of ADHD and benefit greatly from dextroamphetamine, less so from methylphenidate. I’ve also been on oral semaglutide at 7mg for over a month now, primarily for the purpose of weight loss. It made no difference to my general willpower or executive function, but it definitely made me less hungry, and I’ve lost quite a bit of weight.

AlphaAndOmega 25 Jul 2025 15:07 UTC
4 points
0
in reply to: anaguma’s comment on: Taking Abundance Seriously
Aria is strictly better off than Maria. She has parents who care, and where they can’t, the resources to seek better. Just having the money for better treatment makes a difference, and hopefully we’ll have the technology to match soon! At the very least, I don’t see any fundamental barriers in the way.

AlphaAndOmega 24 Jul 2025 12:11 UTC
32 points
12
on: Taking Abundance Seriously
This is a thoughtful and well-written essay, but I have my issues with it:
Aria is not unique. As a psychiatry resident, I am all too familiar with the fact that all too many human beings are broken, and the extent of dysfunction might not to be obvious to those who do not spend a lot of time around impoverished communities:
Let me tell you about a patient, or at least a synthesis of several patients. We’ll call her Maria.
Maria is the same age as Aria. Like Aria, she has problems with substance use. Like Aria, she has a complicated relationship with her mother. That is where the similarities end.
Maria’s mother isn’t flying in with designer drugs; she’s working a second shift cleaning offices and a third shift at a diner (optimistically, in the UK, she’s just as likely to not work at all and subsist off unemployment or disability allowances), and Maria hasn’t seen her awake in three days. Maria isn’t acting out to see if the boundaries will hold; she’s acting out because there are no boundaries. There is no one home to make any. The “friction” in her life is not a carefully calibrated challenge to build character. It is the constant, grinding abrasion of poverty, neglect, and trauma. She doesn’t have an emotional support animal; she has a barely legal descendant of an American bully chained up in the yard that her step-dad threatens to kill when he’s drunk.
When Maria skips class, it’s not to escape to a more exciting party; it’s because a boy from her neighborhood who thinks he owns her is waiting outside. When she uses drugs, it’s not a rebellious search for meaning in a meaningless world; it’s a desperate attempt to numb the relentless pain of a too-meaningful one, a world where every choice is freighted with the potential for immediate, catastrophic consequences.
And consequences? Maria craves a world without them. Her tragedy isn’t that an urn she pushes off the mantel fails to shatter. Her tragedy is that when her stepfather pushed her down the stairs, the bone shattered exactly as physics would predict, and the primary consequence was her mother telling her not to make a fuss.
Maria does drugs, just like her wealthier counterpart. She probably has access to coke and ket (the supply is cleaner in the UK, and probably cheaper), but in its absence, she’s drinking alcohol. A lot of alcohol.
Maria’s school lacks the cushy amenties Aria takes for granted. No personal therapist for her. Social workers who might be well-meaning, but are utterly burnt-out and unable to do very much about her issues. When I go visit the pubs around here and disclose that I’m a psychiatry trainee, it’s 50:50 if someone won’t immediately tell me about the problems they’re facing, kids going without a diagnosis of ADHD or autism for years or even decades from when it was flagged.
Someone like Maria, or even Aria, might eventually receive a diagnosis. You may take your pick of any of the following:
- Borderline Personality Disorder (BPD): This is a strong possibility. BPD is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and emotions, alongside marked impulsivity.
- Conduct Disorder (CD): This diagnosis is given to individuals under 18 who exhibit a persistent pattern of violating the rights of others and major societal norms. Aria displays some of these behaviors, such as theft (stealing ketamine) and serious rule violations (substance use on campus).
- Substance Use Disorder (SUD): This diagnosis is almost a certainty. She uses multiple substances (cocaine, alcohol, ketamine, Adderall) in a way that is clearly causing significant impairment in her life, leading to her eventual expulsion. Her mother’s role in supplying drugs indicates a severe and established pattern of use. For many adolescents, substance use is a way to cope with other underlying disorders like anxiety or depression.
- Oppositional Defiant Disorder (ODD): ODD involves a persistent pattern of angry/irritable mood and defiant behavior toward authority figures. Aria’s constant arguments with her parents and teachers, defiance of school rules, and deliberately annoying others fit this pattern. ODD can be a precursor to Conduct Disorder.
Now, outside of the obvious, I would wager that she might well have depression or ADHD. The pattern fits.
A rose by another name smells just as sweet, and has just as many thorns. Should Maria ever end up in front of a child or adolescent psychiatrist, a formal diagnosis is unlikely to do her any good.
She doesn’t have the luxury of having parents capable of shifting her to a different, more elite or more strict boarding school. She might drop out, her parents and social workers will likely be powerless to stop her. Her parents didn’t have the means to put her in a relatively safe environment, or at least one without boys/men ready and willing to take advantage of her. She’s probably going to be knocked up sooner or later. Later down the line, she might commit a crime, be it petty, drug-related or more serious, and begin a spiral that may or may end in a lengthy prison sentence.
It isn’t the presence or absence of money and luxury that usually causes such problems. Some people are simply broken, dealt a bad hand by genetics or environmental factors.
The prevalence of such conditions, however, does depend on socio-economic background. In their respective cohorts, there are far more Marias than there are Arias, and that’s adjusting for population size. There might be one Aria in her class. It is possible to have an entire class of Marias.
Wealth is a decent proxy for IQ, and IQ a decent proxy for mental health and well-being. The universe doesn’t care about human notions of fairness, the halo effect isn’t entirely unjustified: the rich are likely to be happier, healthier, smarter and better adjusted.
The kind of person who wins big at the lottery, isn’t the kind of person who might have earned the same amount of sum by labor or investment. Little surprise that they squander it. Similarly, it far less of a negative signal to be poor in a society where everyone is poor than it is to be in one where far more opportunities for socio-economic mobility exist.
(I would probably have to look up better citations, but I strongly expect that the Native American communities that make large amounts of money do better than those without that good fortune. They’re both still heavily dysfunctional. The money or not having to work for a living isn’t what’s causing it. I do not expect this trend to hold.)
I don’t expect a wealthier society to, by itself, change this. But the same factors that produce “abundance” hinge on technological advancement. Giving everyone UBI won’t solve Maria or Aria, but better medication, genetic or social engineering, those might.
I have had lifelong struggles with depression or ADHD, I found a workable solution to both, albeit with drawbacks. In a less enlightened time, I’d have just been screwed.
In the future, we will have the tools to solve ennui and such failures of the ancestral psyche, which hasn’t adjusted to motor vehicles or the absence of famine, let alone Fully Automated Luxury Space Communism (with optional homosexuality). Will we apply those tools? I hope so.
The worst part of depression is often the anhedonia. You cease to care, you lose the ability to enjoy things you once enjoyed. I am (mostly) an optimist about the future, which is an intellectual position hard to hold while feeling that life sucks and has sucked for ages. But I have given thought to what I’d do in a better future. Is it possible that humans will exhaust our entertainment options, that we won’t be able to expand Infinite Fun Space faster than we can plumb it? I think that’s very unlikely.
Yet, if we somehow manage to end up with nothing to do, and can’t make the universe more exciting, we can change ourselves. I see this as a last resort, but if I find myself as a mind in a Matrioshka Brain that finds the space of experience to be unavoidably ergodic, unable to find a new and exciting hobby to indulge, then I am willing to tamper with reward circuitry, to make myself with content merely with the space of what’s possible or already experienced.
UBI will be necessary, to ensure that biological humans survive in a future where their cognitive and physical labor don’t fetch a rate sufficient to justify a living wage. But I don’t think more money actually means more problems, and it is a solvable problem.