Saturday, April 20, 2024

AI Humor

 

https://www.theatlantic.com/sponsored/google-2023/a-bot-walks-into-a-bar/3874/

When Ken Jennings lost to IBM’s Watson on Jeopardy! in 2011, below his Final Jeopardy answer, he scrawled, “I, for one, welcome our new computer overlords.” By doing that, he easily beat Watson in the humor category, just by using a well-known meme formula signaling submission to a perceived all-powerful force to which resistance is futile.

Formulaic humor would seem precisely what an AI like Watson might have used to banter with Jennings. Yet Watson’s AI of 2011 could no more come up with a snappy comeback than its humanity-humbling predecessor Deep Blue when it took the crown from chess king Garry Kasparov in 1997.

I noted Deep Blue’s supposedly watershed victory in this New Yorker cartoon of mine, which foresaw a time when it might be my turn to say, “I, for one, welcome our new cartoon overlords.”

If that comes to pass, I might have had a hand or two in my own humbling. I’m the president of CartoonStock, the world’s largest database of single-panel cartoons like the one above. While I don’t know if any AI system has used it yet, by making thousands upon thousands of cartoons publicly available and easily scraped, I essentially created a gold mine for them.

The New Yorker Caption Contest is also my brainchild. Since 2005, The New Yorker has published a cartoon without a caption every week and asked readers to compete to write the winning caption. In 2016, the magazine began relying on an algorithm to sort the 5,000 to 10,000 caption entries per cartoon by funniness, aggregating voters’ opinions to present ranked lists. The combination of the prestige of the New Yorker cartoons and the unique quality of this dataset present the opportunity to give computers what they have always lacked: some humor.

The root of humans’ sense of humor has nothing to do with being able to “get” a joke or make one. Rather, it’s the answer to life’s existential problems that have no solutions, the blessing we receive in exchange for the curse of mortality. As Mark Twain said, “The secret source of humor is not joy but sorrow. There is no humor in Heaven.” AI has no sorrow and thus no need for humor, and creating that need would be cruel. We would have to give a machine sentience enough to suffer and vulnerability enough to die.

And yet, step by step, AI is getting closer to understanding what makes something funny. Perhaps unsurprisingly, considering the rapid advancement of large language models, it’s starting with captions. In 2016, I got an email from Vincent Vanhoucke, then Google DeepMind’s principal data scientist, now the senior director of robotics. “I believe that the success of artificial intelligence will ultimately not be measured in how well it can do at games like Go or whether it can respond to your emails,” he wrote, “but rather whether an artificial mind can one day get its cartoon caption published in The New Yorker.”

I wasn’t surprised that someone as high up the AI food chain as Vanhoucke was interested in the contest. It had been on the radar of the AI community for years, cited in a wide range of academic papers. But I was taken aback by the ultimate ambition, which appeared to be nothing less than creating—gasp—a Bot Mankoff. Winning the caption contest seemed to be merely one small step for machine kind.

At the time, even DeepMind’s whole bag of AI tricks couldn’t make a bot funny: Its combination of computer vision, convolutional neural networks, semantic vectors, and the oxymoronic Long Term Short-Term Memory wasn’t up to the task of even entering the contest. To be honest, I doubted that AI ever would be. I knew the technology was advancing at a mind-blowingly fast rate, but even if the machine-learning magic were up to snuff, I couldn’t see how all the data and equations in the world could replace the fundamentally human heart of humor that Twain described.

New Yorker cartoons can be zany or intellectual, or philosophical or spot-on observational, but they all share an understanding of what it means to be a certain type of person. In my own work, my objective is not to punch up or down, but to elbow to the side: to make fun of myself and others like me. The best cartoons cause us to laugh with them as well as at them. Even the best AI doesn’t have human peers with whom it shares interests and pet peeves. How could it beat us at making fun of ourselves?

Vanhoucke wasn’t a fan of this line of thinking. He was convinced it was only a matter of time before AI began competing seriously in the caption contest. And I’ve started to conclude he’s probably right. Last year, six years after our initial conversation, he sent me another email. “While we may still be a long way away from AI producing humor,” he wrote, “our latest models have become surprisingly adept at understanding why something is funny.” AI wasn’t writing jokes yet, but it seemed to be grasping the concept of what made a particular joke work.

The model Vanhoucke was describing was PaLM, a version of which now powers Google’s Bard. Here’s how it describes my 1997 cartoon about the chess-playing microwave:

The joke is that the microwave is so advanced that it can play chess. The man is frustrated that the microwave is so advanced that it can play chess, but it can’t reheat lasagna. The joke is funny because it is absurd. The joke is also funny because it is a commentary on the fact that technology is advancing so quickly that it is outpacing our ability to use it.

I’d rate this a solid B- explanation. Soon, PaLM will probably be able to earn an A. On one hand, so what? There will never be a coffee-table anthology of New Yorker cartoon explanations.

But the ability to understand humor is a key stepping stone toward the ability to create it. In a paper last year, a group of researchers led by Jack Hessel of the Allen Institute of AI, with some curation assistance from me, challenged AI models with three tasks: 1) matching a caption to a cartoon, 2) identifying a winning caption, and 3) explaining why a winning caption is funny. In all three categories, humans remained superior to even the most advanced models. The AI’s best performance came when describing the humor behind each cartoon, just as Vanhoucke found. For the Hessel paper, AI wrote 653 explanations for caption contest winners, creating its own database of what makes captions funny. Now someone could simply plop a bunch of the descriptions from the paper into Bard, ask for more, and rinse and repeat until the model has mastered every possible joke formulation.

Next, Hessel attempted a more sophisticated spin on things. The AI model developed 50 ideas for cartoons, each with five caption possibilities. From those 250 combinations, I picked the four I liked best, and cartoonist Shannon Wheeler drew them. Here are the results:

Shannon wasn’t impressed with the output. “Weird cartoon ideas. They lack the implied narrative that’s a solid New Yorker cartoon,” he summarized.

I agree with him, but that doesn’t diminish the scale of the accomplishment here. First of all, the training set of caption-contest cartoons that we fed into the AI model was intentionally bizarre. “A giant fish is seated at the bar with six empty shot glasses in front of it, gesturing to a bartender to bring another round,” one description read. “Museum workers looking at two dinosaur skeletons in a dancing pose like old-time vaudevillians with top hats and canes at a museum exhibit,” said another. Weirdness in, weirdness out.

And even without the narrative power of a New Yorker cartoon, the immersive museum gag and Brunhild on the subway evoked a smile from me. That means AI created at least serviceable cartoons out of nothing: Neither the captions nor images were in its training set, and to my knowledge, they did not previously exist anywhere else either. And for the sake of a clean experiment, we played it completely straight, not altering either the caption or the image description at all. We could have achieved much better results if AI-human collaboration had been permitted.

This points the way toward the most likely role for AI in cartooning: not a replacement but a brainstorming tool, helping creatively blocked cartoonists come up with ideas that the human can then improve upon. My captions will always feel more human than a machine’s because they arise from life in the real world—my own emotions, annoyances, and grievances. But just as some digital native cartoonists prefer iPads and e-ink to pen and paper, some also may like to use AI to reach greater creative heights.

I have no wish to welcome our cartoon overlords. But there’s also no need for me to shun AI models as potential collaborators, creative assistants, or inspirers. Cartoonists have shown that they are alchemists extraordinaire. I’m convinced they will be able to use this tool to augment their alchemy. I’m just as sure there will never be a day when robot cartoonists are creating robot cartoons for robot readers of The New Yorker to laugh at.

AI discusses PDF of Anne Lindbergh, Wave of the Future

Back up AI essays for main blog on Anne Morrow Lindbergh

Google word cloud for book, WAVE:


User

Write a summary of this PDF, thank you.

ChatGPT

Summary of "The Wave of the Future: A Confession of Faith" by Anne Morrow Lindbergh

In her controversial booklet "The Wave of the Future," Anne Morrow Lindbergh delves into the political and social upheavals of the early 20th century, particularly the rise of totalitarian regimes such as Nazism, Fascism, and Communism. She presents these movements not as anomalies but as inevitable developments in a historical process, a perspective that led to widespread debate upon the booklet's publication in 1940.

Lindbergh begins by expressing a sense of personal crisis, reflecting on the dramatic changes in the world around her, and her struggle to reconcile these changes with her moral and philosophical beliefs. She describes her work as a confession rather than a definitive argument, aiming to articulate her conflicted feelings and thoughts about the global situation.

Central to Lindbergh's thesis is the idea that the authoritarian shifts in Europe are part of a larger "wave of the future," a necessary, though often violent, evolution of societal structures. She argues that resistance to these changes might be as futile as resisting the forces of nature, suggesting that adaptation and understanding are preferable to conflict.

Throughout the booklet, Lindbergh criticizes the traditionalist and interventionist responses to the threats posed by these regimes, questioning the effectiveness of opposition through war. Instead, she proposes a more introspective approach, encouraging readers to consider the internal reforms needed within societies, including the United States, to address the underlying issues that give rise to totalitarianism.

"The Wave of the Future" concludes on a note of cautious optimism. Lindbergh calls for a renewal of the American spirit of reform and innovation, urging a forward-looking approach that embraces change rather than fighting it. Her work challenges readers to think critically about the direction of global progress and the moral choices that define humanity's response to its challenges.

This summary captures the essence of Lindbergh's arguments and the historical context in which they were made, highlighting why the booklet was both influential and highly contentious at the time of its publication.

User

What does she say about the Maginot line?

ChatGPT

In "The Wave of the Future," Anne Morrow Lindbergh refers to the Maginot Line to illustrate the limitations of relying solely on material defenses in the face of broader, more dynamic societal changes. She discusses how Germany's success in the early stages of World War II was not solely due to its military equipment but also because of the national spirit that had been incited among its people. She argues that an impregnable line of defense like the Maginot Line, while seemingly a formidable barrier, proved inadequate because it did not account for the deeper, more potent forces at play, such as national morale and the strategic agility of the German military.

Lindbergh's mention of the Maginot Line serves as a metaphor for broader arguments against purely defensive strategies in both military and social policy. She suggests that understanding and adapting to the underlying forces shaping the world are more crucial than attempting to fortify against them with static defenses. Her perspective reflects a broader critique of isolationist and purely defensive postures, advocating instead for a more dynamic and proactive approach to the challenges of the era.

 

Review of "The Wave of the Future: A Confession of Faith" by Anne Morrow Lindbergh

Anne Morrow Lindbergh's 1940 publication, "The Wave of the Future: A Confession of Faith," stands as a contentious historical artifact that sheds light on a tumultuous era in global politics. At its core, the booklet is an attempt to rationalize and understand the sweeping changes reshaping the political landscape of the early 20th century, particularly the rise of totalitarian regimes.

Lindbergh's work is framed as a personal reflection, one not aimed at providing definitive solutions but rather at exploring the philosophical and moral dilemmas presented by the era's seismic shifts. She posits that the rise of fascism, communism, and other authoritarian ideologies are not merely aberrations but perhaps inevitable outcomes of deep-seated historical forces. Her analysis suggests that these movements, while often manifesting in deplorable actions, might nonetheless be part of a broader, necessary evolution in societal structures.

Critically, the book's reception was sharply divided. Supporters found value in Lindbergh's introspective and broad-minded approach to the pressing issues of her time. Detractors, however, criticized her for what they perceived as a defeatist and overly sympathetic view towards fascism, particularly given the context of escalating global conflict and the horrors being perpetrated by regimes like Nazi Germany.

"The Wave of the Future" does not advocate directly for any specific political ideology but rather reflects a deep ambivalence about the ongoing conflict between traditional democratic values and emerging authoritarian models. Lindbergh's narrative is imbued with a sense of inevitability regarding these shifts, which she suggests might be as unstoppable as natural forces, a perspective that sparked considerable controversy for appearing to undermine the fight against totalitarianism.

Ultimately, the booklet serves as a historical lens through which to view the complexities and challenges of interpreting and responding to global crises. Its legacy is a testament to the fraught and often contentious process of intellectual engagement with world-altering events. Lindbergh's reflections provoke critical thought about the nature of progress, the inevitability of change, and the ethical considerations that must guide our responses to the forces shaping our world.

##

A new book that reviews the 1939-1941 period is Lynne Olson, Angry Days: Roosevelt, Lindbergh, America's Fight over WW2, 1939-1941.

A contemporary book, 1935, is Albert Jay Nock's "Our Enemy, the State."  Lindbergh felt the tidal wave was authoritarianism, or fascism, and we should concede to it and things may work out.   Nock felt the tidal way was big government (whether FDR, Stalin, or Hitler) and it would ruin all of us with little we could do.   People forget what it meant to say, "Democracy wasn't working."  WW1 and the Depression would have been considered two failures of democracy.   Parliamentary democracy could degenerate into 10 small parties, unable to form a government and small extremist parties being part of the mix.  Several years of parlimatentary maneuvering, appointments, and public elections only led to Hitler as chancellor (prime minister) in Germany.  Our democracy could be subject to dominance and vote-buying (e.g. Tammany Hall) that lasts for generations, while Nock felt the 1932 election and 1934 elections were deplorable vote-buying and power-grabbing exercises.   (He has a frontispiece quote that politics means one group being taxed while another benefits).  These were some of the contemporary context for Nock's, and later Lindbergh's, positions.

##
https://www.theatlantic.com/magazine/archive/1941/01/we-build-the-future/653482/

TEXT - The ATLANTIC

We Build the Future

By Carl Joachim Friedrich

JANUARY 1941 ISSUE

All of us who have followed the career of Mrs. Anne Morrow Lindbergh respect her literary accomplishments, her bravery and intelligence. Yet, because of her success in giving literary form to romantic adventure, her latest book, The Wave of the Future, is perhaps being questioned less seriously than it deserves. The author disarms criticism by urging the reader not to regard her as ‘a specialist in history, economics or foreign affairs.’

Is the future a wave, as Mrs. Lindbergh describes it in her ‘Confession of Faith’? Is it something outside of us which will sweep over us? Is there ‘no fighting it’? Are we ‘just children who could not fight against the gigantic roller that loomed up ahead suddenly’? The helpless determinism imposed by the use of these word pictures strikes at the root of Christian ethics. Our civilization has been built upon the conviction that the future is what we, each one of us, make it. The future of humanity is built out of many creative acts; we all participate in the shaping of it.

The bewilderment Mrs. Lindbergh seems to feel in the face of the future which she cannot comprehend results in her passive acceptance of all change. ‘There is no sin,’ she tells us, ‘punished more implacably by nature than the sin of resistance to change. …  To resist change is to sin against life itself.’ In comparison with this sin, persecution, aggression, rape, and war sink into insignificance. They are sins too, to be sure, but they merely constitute the ‘scum of the wave.’

 But is not much of life resistance to change? Surely it depends upon the direction of the change whether it is a ‘sin’ to resist it. To have resisted the change which was threatened in the assault of the Turks upon Vienna was surely no ‘sin,’ or the change which was resisted by the heroes of Thermopylae. On the other hand, Pilate’s rejection of Christ was a sin, if we accept the Christian view. This ‘if’ is all-important. It shows that sin has meaning only in relation to the ideas we value. The mere fact that the Nazis represent change tells us nothing about whether or not we ought to oppose them.

Are Hitler & Co. — that is to say, Hitler and all those marching under his banner, from Stalin to the men of Vichy and the Bund in the bargain — simply the scum of the wave? Are they but the ‘evil associates’ of ‘great ideas,’ as Mrs. Lindbergh would have us believe? What are these great ideas? Unfortunately she never gives us even an inkling of what they may be. Presumably she herself is not sure. She feels a wave coming and she is frightened. No one can blame her for that; the spectacle of a world dominated by Hitler is terrifying. But that does not mean that we have to accept the changes which the dictators seek to bring about. For they are clearly the most extensive reactionary movement known to us in history. Far from supporting Mrs. Lindbergh’s notion, the facts show us that the dictators would throw mankind back into feudalism. Tyranny is nothing new. The Führer principle is an attempt to disguise the reintroduction of the feudal system in which serfs were bound to their lord by unquestioning loyalty. Is it not characteristic that this neofeudalism is strongest in those lands which still contain many feudal remnants — Germany, Italy, Spain, Russia, and Japan?

Mrs. Lindbergh would label the dictators ‘part of a vast revolution,’ but was not Napoleon also ‘part of a vast revolution’? Were the British wrong in resisting him? Or were they right in asking the vital question: ‘Is this still the revolution? Or have ideas been turned into tools of oppression and force? Is this still a forward march, or is it terrified reaction?’ Not to make this vital distinction is romantic vagueness, the emotionalism of Weltschmerz. It is a very common confusion of historical perspective, and one assiduously promoted by the dictators, to term their movements an ‘inevitable revolution.’ But these historical analogies are not well worked out; for, if there is any comparison between the French Revolution and our own time, the Dantons and the Robespierres find their counterpart in the Trotskys, the Liebknechts, and the Lenins, and just as the reaction triumphed over them in the person of Napoleon Bonaparte, so reaction has triumphed over revolutionary socialism in the persons of Stalin, Mussolini, and Hitler. This may be the analogy; we cannot be sure about it.

We cannot be sure, because it is not yet clear what the direction of revolutionary socialism has been. That our industrial society is increasingly socialized, only a blind man could deny. Was revolutionary socialism, such as developed in Russia and Germany after the war, a part of that development? Very probably. But was it a change in the right direction? Who could be sure? Historical analogies are very dangerous, particularly when drawn with contemporary events in mind. The world around us is a world hard to see in perspective.

Both the French and the Russian revolutionaries saw themselves as fighting for democracy. They did not know how to achieve their ends, and hence were overtaken by a bloody reaction, followed by imperial aggression. Mrs. Lindbergh, not recognizing the present as a reactionary phase, would like to clinch her argument by juxtaposing ‘the old world of England, France and the United States to the new world of fascist Europe.’ By putting it that way, she neglects the powerful forces working in the right direction here. She forgets that the only places where a man today can say and discuss freely what he thinks Marx, Lenin, Mussolini, and Hitler mean are England and the United States. What, then, about the new world of the United States? How can we build it, as she herself wishes us to do, if we accept her counsel of not resisting the fascist reaction and its corruption of the future?

We like Mrs. Lindbergh’s frank avowal that if we do not better our civilization — our way of life and our democracy — there will be no use in trying to save it by fighting. But, while elder conservatives may think that we can save it merely by fighting, we of the younger generation have no such illusions. We ask another question: How can we better our civilization while the gang of dictators are at work? Look at America today as contrasted with only a few years ago. The resources urgently needed for social improvement have now to be expended for a colossal armament to break that very wave which Mrs. Lindbergh would have us ride.

What is even worse, many people are getting so agitated about certain groups in our midst that they advocate ‘abandoning democracy temporarily in order to save it.’ And what about the increasing tendency to call one’s political opponent a dictator and a fifth-columnist? This all constitutes the impact of totalitarianism upon us. Surely we are entitled to ask: How can we build our future, as long as this reaction confronts us?

This does not mean that we think the job is done when Hitler has been defeated. Far from it. Thoughtful people will never pretend that ‘civilization can be “saved” by simply going to war.’ It is certainly true that the most gigantic problems will face the world after it has emerged from the present reactionary phase. The collapse of the dictators will be followed by large-scale unemployment and economic dislocation. For, since they ‘created’ employment by preparing for war, bold thought will be required to project a reconstruction as vast as was the preparation for war and the destruction it brought.

No one recognizes that more clearly than the British. Indeed, unless all signs are deceiving, a great change is taking place in Britain. The common man is emerging. Democracy is on the march. We all realize — most of all the British themselves — that much was wrong with the British Empire and its social system. But this does not alter the fact that the British are now defending the future of freedom. They are defending the right of people to decide for themselves the direction in which they wish to go in the future, not as the defenseless victims of an inexorable fate, but as the responsible participants in a great task.

We wonder whether Mrs. Lindbergh would not, on further reflection, accept this interpretation herself. She finds eloquent words for a tribute to the gallantry of the British. But the British are not alone. There are millions among the various peoples that have fallen under the conqueror’s heel who are sacrificing life and all to carry on the struggle. Mrs. Lindbergh evidently does not recognize their struggle as meaningful. In speaking of those who ‘defend the good, the Christian, the democratic, the capitalistic world’ she asserts: ‘They are right, but only right relative to that small stage at which they are looking.’ But why call the stage small upon which the drama of the Christian and humanist revolution has already been playing for two thousand years — and with the end not yet in sight? There seems to be little justification for lumping together the capitalist and the Christian world, for surely the ethical principles of Christianity as exemplified in democracy far transcend capitalism, both in time and in space.

We cannot believe that Mrs. Lindbergh will not come to a sounder view of the present struggle. In her efforts to ‘find a deeper and truer answer’ she ventures the guess that the terrible upheavals of our time are due to ‘some new and perhaps even ultimately good conception of humanity trying to come to birth.’ True enough, but the dictators are seeking to prevent it. Ruthlessly suppressing the creative impulses in man, they are trying to turn the clock back. Against a progressive Germany, a liberal Italy, they marshaled the forces of a decaying feudalism, the frenzy of an obsolete nationalism. Mrs. Lindbergh’s concluding paragraph shows her to be on the other side, our side. Reform, she writes, should be a reaffirmation of our beliefs.

It should be a reaffirmation of them, an extension of them to wider fields and deeper recesses. It need not mean abandoning our fundamental principles, but rather a reëxamination of them to determine whether we are following the dead letter or the living spirit which they embody. It should not mean forsaking the beacons which have led us in the past, but a rekindling of them. It should be essentially a life-giving process. In other words, it seems to me that a creative act is demanded of us. And like all acts of creation it will take labor, patience, pain — and an infinite faith in the future.

This is grand. It is the democratic view. It is the future.

And therefore, when Mrs. Lindbergh says that in this war the ‘Forces of the Past’ are fighting the ‘Forces of the Future,’ she is utterly wrong as she means it. For the dictators certainly stand for the past. In the light of her own conclusion, Democracy, the social democracy of continuous reform, embodies the Forces of the Future — the Future we build.


####

The Anne Morrow Lindbergh Play, AI auto-translaton into German.

You are an excellent translator from English into German.   Please translate the whole summary of the play as you presented it early (in 4 acts etc).    If you need me to cut  paste for you, just tell me.

ChatGPT

Here's the translation of the play summary into German:

Titel: 

Echoes of the Future

Schauplatz: Das Wohnzimmer der Lindberghs zu Beginn der 1940er Jahre. Der Raum ist geschmackvoll mit einer Mischung aus Komfort und Eleganz eingerichtet, zeigt Gegenstände aus ihren Reisen. Große Fenster blicken auf eine friedliche Landschaft, im Kontrast zum Sturm der Kontroverse, der sich um die Familie zusammenbraut.

Charaktere:

Anne Morrow Lindbergh - Die Autorin, gefangen zwischen ihren intellektuellen Überzeugungen und der öffentlichen Empörung.

Charles Lindbergh - Ihr Ehemann, unterstützt sie zwar, ringt aber auch mit den Implikationen ihrer gemeinsamen Ansichten.

David Reynolds - Ein Familienfreund und begeisterter Unterstützer von "The Wave of the Future."

Eleanor Shaw - Eine kritische alte Bekannte, die die Ansichten des Buches entschieden ablehnt.

Journalist (nur Stimme) - Stellt die Medien und öffentliche Meinung dar, nur als Voiceover während der Szenenübergänge zu hören.

Gliederung:

Akt 1: Die Bühne wird bereitet

Szene 1: Charles und Anne diskutieren über den sofortigen Erfolg und die Kontroverse um "The Wave of the Future." Sie äußern gemischte Gefühle über die Rezeption und teilen ihre persönlichen Zweifel und Bestätigungen bezüglich der Botschaft des Buches.

Szene 2: Ankunft von David Reynolds, der das Buch enthusiastisch lobt und seine Weitsicht und Notwendigkeit in der aktuellen Zeit hervorhebt. Sein Lob bringt vorübergehend Erleichterung für Anne, steigert jedoch Charles' Besorgnis.

Akt 2: Konfrontation und Konflikt

Szene 3: Eleanor Shaw kommt unerwartet, was Spannung erzeugt. Sie konfrontiert Anne mit den Implikationen des Buches, kritisiert dessen besiegte Haltung und scheinbare Sympathie gegenüber totalitären Regimen. Anne verteidigt ihre Intentionen, zeigt jedoch Anzeichen von Zweifel.

Szene 4: Eine hitzige Debatte entfacht zwischen den vier Charakteren, wobei Charles und David das Buch gegen Eleanors Vorwürfe verteidigen. Die Diskussion berührt Themen wie Freiheit, die Rolle Amerikas in der Welt und die moralischen Verantwortlichkeiten öffentlicher Figuren.

Akt 3: Selbstreflexion und öffentliche Abrechnung

Szene 5: Nach dem Streit reflektieren Charles und Anne über ihre Positionen. Anne drückt tiefere Zweifel aus, angeregt durch Eleanors Worte. Charles bleibt zwiespältig, aber unterstützend.

Szene 6: Eine Radioübertragung (Voiceover) diskutiert die weit verbreitete Kritik am Buch, erwähnt spezifische Denunziationen durch prominente Figuren und den breiteren gesellschaftlichen Einfluss. Das Paar hört zu, nachdenklich und reflektierend.

Akt 4: Auflösung und zukünftige Wege

Szene 7: Eine abschließende Diskussion zwischen Anne und Charles, in der sie die Konsequenzen ihrer Handlungen und die Zukunft ihres öffentlichen Lebens erwägen. Anne entscheidet sich, ihren Fokus von politischen Schriften auf persönlichere und introspektivere Werke zu verlagern.

Szene 8: Eleanor und David kehren kurz zurück; Eleanor bietet eine versöhnliche Geste an, deutet darauf hin, dass sie die Courage Annes respektiert, auch wenn sie anderer Meinung ist. David bleibt unterstützend, deutet aber seine eigenen Zweifel an.

Epilog:

Ein Monolog von Anne, direkt an das Publikum gerichtet, teilt ihre gelernten Lektionen über die Macht der Worte und die Verantwortung von Schriftstellern. Sie drückt die Hoffnung auf Erlösung durch zukünftige Werke und persönliches Wachstum aus.

Themen: Intellektuelle Integrität, öffentliche Verantwortlichkeit, persönliche versus öffentliche Moral, der Einfluss von Ideologie auf Beziehungen und die Evolution von Überzeugungen unter öffentlichem Druck.


Dieses Stück würde die intensiven persönlichen und öffentlichen Dynamiken erforschen, die Anne Morrow Lindberghs Leben und Werke während einer tumultartigen Periode beeinflussten, und die emotionalen und ethischen Kämpfe beleuchten, denen Personen in der Öffentlichkeit gegenüberstehen.


Thursday, April 18, 2024

Discussing CMS NCD Key Questions and Gaps

 Can you read the text in the image and write it out for me

ChatGPT

Sure, here's the text from the image:


vbnet

Copy code

B. Discussion of Evidence


1. Evidence Question(s)


Question 1: Is the evidence sufficient to determine that a blood-based biomarker screening test (at the time of this review Epi proColon® is the only FDA approved commercially available blood-based biomarker screening test) is a suitable colorectal cancer screening test for prevention or early detection in Medicare beneficiaries?


Question 2: Is the evidence sufficient to determine that colorectal cancer screening using a blood-based biomarker screening test is appropriate for Medicare beneficiaries?


2. External Technology Assessments..


###

User

I'm flummoxed.   CMS offered two key questions for evidence review of colorectal cancer screening tests, in a 2001 tech assessment.   One question asks if the tests are "suitable".  The other, if they are "appropriate."  Is this crazy?    How can a test be highly suitable for Medicare patients, but not appropriate.  Or highly appropriate, but not suitable.  It makes my eyes cross!   here are the full questions, am I crazy, or do they virtually overlap and in a vague way.  ###


Question 1:     Is the evidence sufficient to determine that a blood-based biomarker screening test (at the time of this review Epi proColon® is the only FDA approved commercially available blood-based biomarker screening test) is a suitable colorectal cancer screening test for prevention or early detection in Medicare beneficiaries?

Question 2:     Is the evidence sufficient to determine that colorectal cancer screening using a blood-based biomarker screening test is appropriate for Medicare beneficiaries?

ChatGPT

Your confusion is completely understandable; the language in the two questions is quite similar, and it can certainly seem like they're asking the same thing. However, there is a subtle distinction that might be implied by the choice of words "suitable" and "appropriate," which can be nuanced in the context of medical screening and policy.


"Suitable" often refers to the effectiveness and accuracy of the test itself—its sensitivity, specificity, and predictive value in the detection or prevention of disease in a general sense. It's about the fit of the tool for the task, considering the characteristics of the test in the context of a medical condition.


"Appropriate," on the other hand, might refer to the broader context of using the test in a specific population—Medicare beneficiaries, in this case. This includes considerations such as cost-effectiveness, the potential for harm versus benefit, the availability of resources to act on the results, and the likelihood that the use of the test will improve outcomes in this particular group. "Appropriate" carries with it a sense of suitability but adds a layer of ethical, economic, and practical considerations.


For example, a test could be highly suitable in that it is effective at detecting colorectal cancer, but not appropriate for Medicare beneficiaries if it's prohibitively expensive or if positive results would lead to interventions that are not safe or effective in an older population.


Alternatively, a test might be appropriate because it's cost-effective and has minimal side effects, but not suitable if it isn't sensitive enough to detect early-stage cancers, which is essential for a screening test where early detection is the goal.


It's important to look at both the clinical performance of a test and the implications of its use in a specific patient population. These two questions likely aim to address both the clinical efficacy and the broader implications of implementing such a test for Medicare beneficiaries. So no, you're not crazy—the overlap is there, but the emphasis is just slightly different in a way that's meaningful for policy and healthcare decision-making.


User

But it seems to fail their purported standard of writing for the public and at more or less the senior high school level.    Most people would be stumped by the closely parsed difference visible to experts.

ChatGPT

You’re absolutely right. Clarity and accessibility are crucial when it comes to public-facing documents, especially those related to healthcare. The subtleties between “suitable” and “appropriate” could easily be lost on a general audience, and even professionals might find the distinction to be needlessly opaque without further explanation.


When creating these documents, the aim should be to communicate effectively with the intended audience, which often includes patients, their families, and non-specialist healthcare providers. Using language that requires interpretation or a deep understanding of policy nuances can create barriers to understanding and can detract from the document’s usefulness.


The use of plain language is encouraged in public communication to ensure that the information is accessible to readers with varying levels of education and expertise. In the case you presented, it would be more effective if the document not only used clearer language but also provided context for why different aspects of screening tests are being evaluated, and how these evaluations impact the care and options available to Medicare beneficiaries.


Addressing this issue might involve restating these questions in simpler terms or providing a brief explanation of what is meant by "suitable" and "appropriate" in this context. It’s about striking a balance between precision and accessibility, ensuring that the important distinctions are communicated in a way that is understandable to all readers.


User

                  HEre is how CMS approached answers to #1 is it suitable and #2 is it appropriate.   Do these answers jive with your best guesses, above, at the difference in the two questions.   (They may or may not support your conjectures, be objective).   ##### CMS defines suitable in its answer to Q1  (is it SUITABLE):


No, the evidence (direct or indirect) does not demonstrate that screening in Medicare beneficiaries using the Epi proColon® test is SUITABLE for prevention or early detection of colorectal cancer.  The published evidence does not show that the available blood-based biomarker CRC screening test improves health outcomes for Medicare beneficiaries.  The indirect evidence (comparing a blood-based screening test to another test that has been shown to improve mortality such as screening fecal immunochemical test) does not show that blood-based screening test is equivalent in the detection of large adenomas or early stage cancer.  The test performance of the Epi proColon® test does not meet sensitivity and specificity levels established by prior evidence at which the benefits of using the screening test outweigh harms to Medicare patients.


And for Q2 (is it APPROPRIATE).


No, the published evidence does not demonstrate that the available blood-based biomarker screening test will prevent progression of advanced adenomas to cancer or improve health outcomes for patients found to have colorectal cancer.  To provide clarity to innovators and to reduce burden of a reconsideration of this NCD, we provide a direct pathway for coverage of appropriate blood-based biomarker CRC screening tests when the criteria are met.


Among the cited studies, the study populations had a mean age between 55 and 71 years, and for persons at least age 60 years old, the percent ranged from 35.8% to 76%.  Both genders were adequately represented in the evidence base.  Even though the study populations were relatively balanced, some were slightly in favor of women (Church, 2014; Ørntoft, 2015; Sun, 2019).  Epi pro Colon® instructions for use state that “The rate of false positive Epi proColon® results increases with age. Test results should be interpreted with caution in elderly patients. See Performance Characteristics in Section 13.” (Epigenomics AG, Instructions for Use [IFU] Epi proColon®. March 26, 2014.)   While some of the clinical research studies were conducted in the United States (4 studies), many studies were completed in Europe (4), China (8), and Russia (1).

ChatGPT

In the response to Question 1 regarding whether the Epi proColon® test is "suitable," CMS's answer focuses on the test’s clinical efficacy—its sensitivity and specificity. This is consistent with the idea that "suitable" refers to the technical performance of the test and its ability to detect the condition it’s being used to screen for. They state that the test does not meet the established thresholds at which the benefits outweigh the harms, which is a judgment based on clinical effectiveness.


In the response to Question 2 regarding whether the test is "appropriate," CMS seems to expand the scope of their assessment. They mention the impact on health outcomes and progression of disease, which involves considering the broader implications of using the test in the Medicare population. They talk about providing a "direct pathway for coverage" if certain criteria are met, which suggests they are considering factors beyond just the test’s performance—like how it would be implemented and utilized within the healthcare system.


This does support the earlier conjecture to an extent. The answer to Question 1 is focused on the clinical validity and utility of the test, while the answer to Question 2 involves additional considerations like the demographic suitability, the implications of false positives in an older population, and the relevance of the studies to the U.S. Medicare population.


In essence, the CMS answers differentiate between a test being clinically valid ("suitable") and its implications for care within the specific context of the Medicare population ("appropriate"), which includes practical, ethical, and policy considerations. This does align with the nuanced difference between the terms that we discussed, indicating that the use of the terms was intentional and meant to convey these different aspects of evaluation.


User

It's interesting that CMS answers include study of the international population used, FDA warning remarks about the eldelry, etc, and adenomas.    But, the final decision is that CMS will cover any LBX test that is 74% sensitive and 90% specific (period).    So all the diverse  ying and yang and pros and cons that are debated, are absent from the final decision which predicates coverage solely and immediately on thost two statistics 74% and 90%.

ChatGPT

It seems that in the end, CMS has decided to set specific quantitative benchmarks for test performance as the criteria for coverage. This decision to use sensitivity and specificity thresholds might simplify the coverage criteria and provide a clear, measurable standard for future tests to meet in order to be covered.


The consideration of factors such as the demographics of the study populations, FDA warnings, and the performance of the test in detecting adenomas are important parts of the evidence review. They provide context and justification for why certain benchmarks are set. However, when it comes to making a coverage decision, having clear, objective criteria like sensitivity and specificity percentages can make the policy more straightforward to apply and enforce.


The decision to focus on these two statistics for coverage does not negate the importance of the broader considerations discussed in the evidence review; rather, it distills the decision down to quantifiable metrics. This could be intended to create a transparent and standardized baseline for all manufacturers to meet, which can encourage the development of tests that are not only clinically valid but also practically applicable to the Medicare population.


Furthermore, this approach could also be a reflection of the need to balance detailed scientific review with the operational simplicity of the healthcare system. By having clear numerical targets, CMS provides a direct pathway for coverage that can be understood and met by innovators, potentially reducing the burden of lengthy coverage determinations while still upholding a standard that ensures a reasonable level of efficacy for the tests.


User

I think the analysis could be framed a little less charitably (but fairly and perhaps insightfully) that they have 40 pages of review of diverse factors like racial inclusion, age includion, whether international studies are in the data, and so on, yet on the 40th page at the end they just predicate all future decisions for new products on the 74/90 rule alone.    So I think it's fair to ask, what use were all the discussions.  It's like, by analogy, you require 20 kinds of info about presidential candidates, but rule 21, is that you vote based on eye color alone.   So what was the use of the other 20 factors.   

ChatGPT

Your analogy certainly drives the point home about the disparity between the complexity of the review and the simplicity of the final criteria. If a review process takes into account a myriad of factors but then the final decision rests on just one or two metrics, it’s natural to question the value and purpose of the comprehensive review. The situation you're describing with CMS could raise questions about the transparency and consistency of the decision-making process.


One possible explanation is that the thorough review process is intended to be comprehensive to ensure all relevant factors are considered before setting the benchmarks. The discussions could serve to justify why those particular benchmarks—74% sensitivity and 90% specificity—are chosen as the cut-off points for coverage. This approach might be aimed at ensuring due diligence has been performed and all angles considered before landing on the most crucial, decisive factors.


However, it could also be argued, as you suggest, that if only a select few criteria are ultimately used for the decision, it might indicate a disconnect between the evidence review process and the policy-making process. This can lead to frustration and confusion among stakeholders who expect that the breadth of factors discussed in the review will directly inform the final coverage decision.


Such a decision-making process might suggest the need for a more integrated approach where the variety of factors that are evaluated in the evidence review have a clearer impact on the final coverage decision. Transparency in how each aspect of the review influences the decision-making could help address concerns about the relevance of the extensive discussions that appear to precede a seemingly oversimplified conclusion.


CMS Lab Expert Panel as German Fairy Tale

 

https://www.discoveriesinhealthpolicy.com/2024/04/brief-blog-cms-posts-info-for-summer.html

Es war einmal, in einem von Weisen und Gerechten regierten Reich, eine ehrwürdige Versammlung bekannt als das Beratungsgremium für klinische diagnostische Labortests von Medicare. Dieses illustre Gremium, berufen vom Sekretär des Gesundheitsministeriums, war eine Zusammenkunft der gelehrtesten und klügsten Köpfe des Königreichs, jeder ein Meister in der geheimen Kunst der Labormedizin und Gesundheitsökonomie.

Im Herzen eines prächtigen Saals, unter dem leuchtenden Schein von Kronleuchtern, die mit dem Licht tanzten, trat das Gremium bei jeder Umrundung der Sonne zweimal zusammen. Ihnen war eine Aufgabe von großer Bedeutung auferlegt: über die mystischen Codes neuer und überarbeiteter klinischer diagnostischer Labortests zu beraten und zu entscheiden, wie Gold – die Münze des Reiches – für deren Nutzung aufgeteilt werden sollte.

Das Gremium, bestehend aus molekularen Pathologen, erfahrenen Forschern und Weisen mit tiefem Wissen über Laborarbeiten, bediente sich alter Methoden, bekannt als "Crosswalking" und "Gap Filling", um ihre Entscheidungen zu fällen. Crosswalking war eine Methode, bei der der Wert eines neuen Tests gegen den Wert alter Tests gemessen wurde, sie verbanden sie wie die Steine einer Burgmauer. Gap Filling hingegen glich dem Erkunden unbekannter Gebiete, wobei Werte an Orten gesetzt wurden, wo zuvor keine Pfade existierten.

Jedes Treffen war ein Schauspiel aus Debatte und Diskussion, wobei die Worte der Gremiumsmitglieder durch die Luft woben wie Zauber, die die Zukunft der Medizin formten. Viele schauten zu, aus der Nähe und der Ferne, durch magische Spiegel und Geräte, die ihr Ebenbild und ihre Stimmen einfangen konnten, und verbreiteten ihre Beratungen im ganzen Königreich im Augenblick.

Die Empfehlungen des Gremiums waren wie goldene Schlüssel, die den Schatz von Medicare öffneten und sicherstellten, dass die Alchemisten und Heiler im Lande ihre edle Arbeit fortsetzen konnten, ausgerüstet mit den besten Werkzeugen und Kenntnissen. Ihre Entscheidungen wurden in großen Büchern festgehalten und auf den Marktplätzen und durch Boten auf schnellen Pferden verkündet, sodass alle von den weisen Festlegungen innerhalb des großen Saals erfahren konnten.

So gedieh das Reich, geleitet von der Weisheit des Gremiums, das die Gesundheit seiner Menschen schützte. Und so wurde die Geschichte des Beratungsgremiums für klinische diagnostische Labortests von Medicare in das Gewebe der Geschichte des Königreichs eingewoben, eine Erzählung von Weisheit und Verantwortung, immer wieder erzählt, wo immer Gelehrte unter den Sternen zusammenkamen.



Tuesday, April 9, 2024

German Dx Industry: View of 2023, 2024.

On April 5, 2024, 360Dx publishes an article by Justin Petrone on the annual review from the German Diagnostics Association (VDGH, Verbund ).  Find it here:

https://www.360dx.com/molecular-diagnostics/despite-challenges-german-ivd-makers-believe-ai-digitalization-will-support 

The article cites a June 2023 white paper from VDGH on the current IVD (and general medical device) reform in the EU - here.  That's in English.

But it looks like the press packet on the 2024 report links to several German-language documents:

https://www.vdgh.de/presse/pressemappe/vdgh-pressegespraech-am-27032024-zukunft-diagnostik-bilanz-2023-ausblick-2024

These include a German 2p press release, a 23p deck, and a few JPEG bar charts.

To quote briefly from 360Dx,

While 2023 saw sales decline across the industry by more than a third to €2.3 billion ($2.1 billion), mostly because of a drop-off in SARS-CoV-2 testing, VDGH believes that the industry is undergoing changes that will set it on a path toward steady growth.

Reasons for optimism include survey data indicating that most German in vitro diagnostics manufacturers expect sales to grow this year, and three quarters of polled VDGH members said they plan to launch new tests. VDGH also believes that the increased adoption of AI, as well as digitalization efforts around healthcare in Germany, will support the development of new tests.

According to VDGH Chairman Ulrich Schmid, the industry is grappling with a number of issues, including regulatory changes, sustainability, and shortages in the labor market that could constrain future growth if unaddressed.

Personnel shortages were a high concern, while hopes for digitalization and AI grow.



Friday, April 5, 2024

Windows Speech Recognition (WSR) Dead. New in Town: Windows Voice Access, WVA.

 https://support.microsoft.com/en-us/topic/use-voice-access-to-control-your-pc-author-text-with-your-voice-4dcd23ee-f1b9-4fd1-bacc-862ab611f55d


in part


This page includes accessibility help articles for people who use Windows voice access to control their PC and author text using their voice.

Voice access in Windows 11 enables everyone, including people with mobility disabilities, to control their PC and author text using their voice. For example, you can open and switch between apps, browse the web, and read and author emails using your voice. Voice access uses modern, on-device speech recognition to accurately recognize speech and works even without the internet.

To share feedback or suggestions about voice access, go to the Feedback Hub under Accessibility>Voice access. Use the Windows logo  key+F to quickly open Feedback Hub. You can also find the Feedback Hub link in the voice access Helpicon or say, "Open voice access help," then "Click give feedback" to open the Feedback Hub.

On Windows 11 22H2 and later, Windows Speech Recognition (WSR) will be replaced by voice access starting in September 2024. Older versions of Windows will continue to have WSR available.

Voice access is available in Windows 11, version 22H2 and later. For more information on Windows 11 22H2 new features, and how to get the update, see What's new in recent Windows updates. Not sure which version of Windows you have? See: Find Windows version.


Dementia Program ("GUIDE")

 https://www.cms.gov/files/document/r12563demo.pdf

https://chat.openai.com/share/088fe59f-8807-4060-b86a-fbb870c9e817

The "Guiding an Improved Dementia Experience" (GUIDE) Model is a significant initiative launched by the Center for Medicare and Medicaid Innovation (Innovation Center) to innovate within the Medicare Fee-for-Service (FFS) framework specifically for beneficiaries with dementia. This initiative is set against the backdrop of efforts to enhance care quality while managing or reducing healthcare costs, as stipulated by Section 1115A of the Social Security Act and further propelled by Executive Order 14095, aimed at improving access to high-quality care and supporting caregivers.

Overview and Objectives

  • Launch Dates: The GUIDE model is phased, starting with analysis, design, and coding from April 1, 2024, moving to testing and full implementation by July 1, 2024.
  • Purpose: It aims to test an alternative payment model to support Medicare beneficiaries with dementia, emphasizing care management, coordination, caregiver education, and support, including respite services. The overarching goals are to reduce expenditures for Medicare and Medicaid through minimizing long-term nursing home care and unnecessary hospital visits, while enhancing the quality of life for people with dementia and their caregivers.

Model Features

  • Duration and Scope: GUIDE is an 8-year, voluntary national model open to all states, U.S. territories, and the District of Columbia, targeting 600 participants with around 200 beneficiaries each.
  • Payments: Participants will receive a Per Beneficiary Per Month (PBPM) payment, known as a Dementia Care Management Payment (DCMP), adjusted for health equity and performance, to cover care management, coordination, and caregiver support.
  • Respite Services: A subset of beneficiaries will be eligible for respite services, capped annually at $2,500 per beneficiary, to help relieve caregiver burden.

Implementation Details

  • Eligibility and Participation: Eligible providers and suppliers can apply to participate in GUIDE, with the flexibility to add or remove participants over the model's duration.
  • Billing and Payments: GUIDE introduces specific G-codes for billing the DCMP and respite services. Rates vary based on the beneficiary's condition and care requirements. Claims must be standalone, with geographic adjustments factored into the payment rates.
  • System Adjustments: The implementation requires updates to claims processing systems to accommodate the new model, including beneficiary attribution and provider alignment checks, with beneficiary coinsurance and deductibles waived for GUIDE services.

Policy and Administration

  • Policy Compliance: GUIDE participants must adhere to specific billing protocols, ensuring that GUIDE-specific codes are used exclusively on claims related to the model. The model claims are subject to geographic adjustments and must be processed as standalone claims.
  • Beneficiary and Provider Alignment: The model involves a detailed process for attributing beneficiaries to providers and ensuring alignment with the model's objectives. This includes monthly updates and adjustments to participant lists and provided services.

Conclusion

The GUIDE model represents a concerted effort to address the complex care needs of Medicare beneficiaries with dementia, focusing on improving their quality of life and supporting their caregivers. By introducing an alternative payment model that emphasizes comprehensive care management and support, GUIDE seeks to achieve a balance between cost reduction and enhanced care quality, marking a significant step forward in the care of individuals with dementia within the Medicare program.


###

Is this similar to the CMS "Oncology Care Model?" ChatGPT Yes, the "Guiding an Improved Dementia Experience" (GUIDE) Model shares similarities with the Centers for Medicare & Medicaid Services (CMS) "Oncology Care Model" (OCM), particularly in its structure as an innovative payment and service delivery model. Both models are initiatives by the CMS Innovation Center, designed to improve the quality of care for beneficiaries while aiming to reduce healthcare expenditures. Here are the key similarities and differences: Similarities

  • Innovative Payment Models: Both GUIDE and OCM are part of CMS's efforts to test innovative payment and service delivery models that incentivize high-quality, coordinated care. They aim to shift away from traditional fee-for-service payment structures towards models that hold providers accountable for both cost and quality of care.
  • Focus on Specific Patient Populations: Each model targets a specific group of Medicare beneficiaries (those with dementia for GUIDE and those undergoing chemotherapy for cancer for OCM) with the goal of improving their care experiences.
  • Care Coordination and Management: Both models emphasize the importance of care coordination and management. They provide additional resources to support comprehensive care planning, which includes enhanced services such as navigation, education, and support for patients and caregivers.
  • Performance-based Payments: GUIDE and OCM include mechanisms for performance-based payments to reward providers for delivering high-quality care. These adjustments encourage practices to meet specific quality and cost metrics.

Differences

  • Disease Focus: While GUIDE focuses on improving care for Medicare beneficiaries with dementia, including support for their caregivers, OCM is centered on enhancing the care experience for cancer patients undergoing chemotherapy, aiming to improve treatment effectiveness and efficiency.
  • Model Specifics: The OCM involves a two-part payment system for participating practices, including a monthly care management payment for each beneficiary during a six-month episode of chemotherapy treatment, and potential performance-based payments for achieving cost and quality targets. GUIDE, on the other hand, introduces a Per Beneficiary Per Month (PBPM) payment for dementia care management and support, with adjustments for health equity and performance.
  • Respite Care: A unique aspect of the GUIDE model is the provision for respite services, acknowledging the significant role of caregivers in dementia care. This element directly addresses caregiver support needs, which is less emphasized in the OCM.
Both models represent CMS's broader strategy to enhance care for specific populations by fostering innovative care models that aim to improve outcomes and control costs. Each model reflects the agency's commitment to addressing the unique needs of different patient groups, showcasing a tailored approach to healthcare innovation.