This AI engine can carry on a conversation but has no search capabilities
;)
ChatGPT, AI, artificial intelligence, emergency medicine, technology: ChatGPT was at capacity as this article went to press, but used its own technology to explain that its server couldn't handle its newfound popularity by writing jokes (“The ChatGPT servers must be stuck in traffic...in the internet highway!”), a screenplay scene, an inspirational speech, a radio ad, a rap song (“Yeah, yo, what's up ChatGPT fam/A lot of people trying to jam”), a sonnet (“But alas, the server cannot cope/And the error message rings loud and clear”), a poem, a limerick, an acrostic poem, and the two truths and a lie above.
FigureYou've probably heard about ChatGPT, the artificial intelligence (AI) engine that can carry on a conversation and produce answers to questions or complete verbal tasks—however weird.
One impressive example immediately went viral: “Write a biblical verse in the style of the King James Bible explaining how to remove a peanut butter sandwich from a VCR.”
ChatGPT replied: “And it came to pass that a man was troubled by a peanut butter sandwich, for it had been placed within his VCR, and he knew not how to remove it. And he cried out to the Lord, saying, “Oh, Lord, how can I remove this sandwich from my VCR, for it is stuck fast and will not budge.” (Medium. Dec. 13, 2022; http://bit.ly/3kqgR1N.)
It goes on, but you get the picture. This is impressive, but it's merely an amusing stunt. The real question is whether ChatGPT can be useful for more serious pursuits such as medical toxicology.
Syrup of Ipecac?
ChatGPT is based on a large language model. The AI engine was trained in 2021 on 570 GB of text from the internet to determine statistically which word would follow another word or phrase in verbal communication. Some have called this simply a glorified autocomplete program.
But the system's responses were fine-tuned based on human responses, and some of ChatGPT's replies are amazingly convincing. The system has no life experience or independent interaction with the real world, however, so its answers can be dead wrong, especially about the nuances of complex open-ended fields such as medical toxicology.
I asked ChatGPT to “write a witty short paragraph about the dangers of gastric lavage.” I received this response in less than a second:
“Gastric lavage, also known as stomach pumping, is a procedure that should be avoided whenever possible. Not only is it invasive and often uncomfortable, it also carries a whole host of risks. For starters, it's not always effective. Many poisons pass through the stomach and into the small intestine before the lavage can even begin. Plus, it can actually do more harm than good. The procedure carries risks such as bleeding, perforation, aspiration, and even death.
“It's a procedure that is considered outdated and carries high risk. It's always better to opt for safer and more effective treatment options such as activated charcoal, syrup of ipecac, or even supportive care. In short, gastric lavage is a risky and ineffective procedure, so don't stomach the stomach pumping!”
I objected to part of the answer, and ChatGPT admitted its error. I asked why it suggested syrup of ipecac, noting that nobody uses that now. ChatGPT answered, “You are correct that syrup of ipecac is no longer recommended for use in the management of poisoning cases. [It was] widely recommended in the past, but over time it became clear that the potential risks associated with the use of ipecac syrup outweigh the benefits.”
Just from this brief exchange, you can see crucial problems with using ChatGPT as a serious tool for answering questions in clinical toxicology and other medical fields. It has no real-world experience with which to evaluate the information it has encountered on the internet during training and can respond with wrong—sometimes dangerously wrong—suggestions.
Erroneous Information
ChatGPT also doesn't have strong convictions. It folded without hesitation when I pushed back on its contention that ipecac was a better option for gastric decontamination. Perhaps my objection was then incorporated into its training. But how does it know whether my input is trustworthy or reliable?
Also—and this is important—ChatGPT is not a search engine. It cannot go to the web to look up new information. Its training ended in 2021. It will have no idea about anything that was published over the past two years and does not know recent developments in toxicology. This is, of course, a deficiency that can be corrected in future iterations. ChatGPT is based on the deep learning language model GPT-3 (Generative Pre-trained Transformer 3.) A newer version, GPT-4, is expected to be released later this year.
This AI technology is here to stay and will only get better with time. ChatGPT is, in my opinion, not yet ready for prime time as a tool for serious use in medical toxicology, but it is worth playing with it for your own amusement and to get used to the concept. Go to https://openai.com and click “Try” at the top of the page. Be warned: It is definitely addictive.
Educators are concerned that ChatGPT could put an end to teachers assigning essays because AI could be used to complete the homework. The usual plagiarism-checking apps would not catch this. But earlier this year Edward Tian, a student at Princeton, released a beta version of GPTZero, an app designed to detect AI-generated text. It is very good but not perfect. Try it at https://gptzero.me. OpenAI, the company behind ChatGPT, is said to be working on a similar app.
Some users have also complained that ChatGPT is indecisive, frequently provides erroneous information, cannot critically evaluate primary evidence, and is not truly creative or insightful. The same criticisms can be aimed at the authors of many medical journal articles and textbooks.
Dr. Gussowis a voluntary attending physician at the John H. Stroger Hospital of Cook County in Chicago, an assistant professor of emergency medicine at Rush Medical College, a consultant to the Illinois Poison Center, and a lecturer in emergency medicine at the University of Illinois Medical Center in Chicago. Follow him on Twitter@poisonreview, and read his past columns athttp://bit.ly/EMN-ToxRounds.
