David Steensma, MD Profile picture
Mar 27, 2023 14 tweets 7 min read Read on X
@OpenAI #ChatGPT4 "hallucinations" remind me of a now-amusing event from way back in Grade 3 when I was 7, involving the last time I knowingly confabulated. I was assigned to write a report about airplanes.✈️ One thing I already knew about airplanes: they were expensive! (1/12) Stock photo of a blond girl...
According to my parents, the high cost of airplane tickets was why our family always drove the tedious 800+ miles from our NYC suburban home to see relatives in Michigan at Christmas🎄If 4 airplane *tickets* were expensive, I reasoned an *entire airplane* must be hugely costly. Cool airplane origami made ...
I found lots of good airplane info, which went into that report. But couldn't find ANYTHING about cost. I looked everywhere a kid could look in the 1970s: encyclopedias, school books, library books. Nothing. Desperate, I made up a plausible number 😲 and added it to the report. 1970s World Book.  I used o...
Something about that number, which seemed so plausible to me - perhaps because it started with 199 trillion dollars, and had lots of trailing 8s & 7s - invited skepticism from my teacher. She thought it was invented! (Shrewd at spotting data falsification, like @MicrobiomDigest ) Image
When the reports were handed back after grading, I had no grade, only a circle around the $199 trillion number and the dreaded red "See me after class" mark. So I stayed behind to be interrogated during recess. Image
To my embarrassment 40 years later, I recall that initially I (half-heartedly) claimed I'd encountered this $199 trillion cost number in an older encyclopedia, - one that the school didn't have - and suggested that might be why it was so surprising to her. She remained skeptical. Image
She said my report was otherwise well written but because of lingering questions about the validity of that one data point, she couldn't hang my report on the big bulletin board in front of the classroom where the best work went. To that point my work had *always* gotten hung up. Image
This was devastating, like the pediatric equivalent of a scientific/medical journal rejection.😢 I was in tears, and offered to retract this one controversial data point if I could just have the report hung up on the big blue board. But it was too late; the damage had been done. Image
She gave me a lecture on honesty which I never forgot. She even mentioned George Washington and the cherry tree. In hindsight, countering dishonesty with a myth about a Founding Father was problematic, but we'll give her the benefit of the doubt that her intentions were good. Image
She then handed the report back to me and said I could instead write something *truthful* about trains to make up for it. This was an act of mercy, because she knew I really liked trains. So I wrote that report with passion and zeal - and it got hung up on the big blue board. Image
So I asked #ChatGPT who I am (I know, I know😉) and here is the response. Paragraph 1: Bogus. For the record, I've never worked in Medical Affairs & was at @DanaFarber / @harvardmed 2009-2020. (It also thinks my terrific solid tumor compatriot Alice Shaw works at another company) Image
Where does AI get this stuff?! 🙃 This week's @NEJM has articles about use of AI in health care, which is so promising, and there's even a new journal from NEJM on AI. But hallucinations need to get sorted before it is ready for real time. /End

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More from @DavidSteensma

Nov 29, 2023
Did you ever wonder why our marrow is located inside of our *bones*, #MedTwitter? There’s no a priori anatomical reason it should be sited there. Blood cells could form in our spleens & livers, as they do during our fetal lives; or elsewhere, as in some animals. Let’s discuss! /1
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After all, zebrafish get along just fine making blood cells in their “kidney marrow”, keeping @leonard_zon's lab running. Drosophila make blood-like cells in abdominal hubs, and frogs… frogs mix it up. Jeremiah Bullfrog & frog cousins make blood in kidneys, marrow, liver, etc./2


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Hematopoietic stem cells (HSCs) are like seafarers or long-haul truckers: they have a tough, unforgiving job requiring long hours. They must generate >2×10¹¹ blood cells daily, over the course of an organismal lifespan that might span >100 years. (HSC time image: @Goodell_Lab)/3
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Read 19 tweets
Sep 6, 2023
I was reviewing marrow failure history in preparation for an upcoming @aamdsif conference, and I’m completely awed by the observational skills of young physician Paul Strübing in Greifswald, Germany in 1882 describing the first clear case of paroxysmal nocturnal hemoglobinuria./1 Image
This was the only photo I could find of Strübing, from over 20 years later (circa 1905). At the time of publication of his prescient 1882 paper, Strübing was 29 years old and had graduated from medical school 6 years earlier. /2 Image
As William Crosby @TuftsMedSchool wrote in 1951 @BloodJournal, “Strübing’s paper on [PNH] might well be regarded as a classic of clinical investigation. He recognized clearly that the disease was a new entity and characterized it by a careful description of his patient."/3

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Read 14 tweets
May 2, 2023
Today marks the end of an era: publication of the final philatelic vignette (authors.elsevier.com/a/1g-uM5qq8Xpp3) co-authored by Robert Kyle @MayoClinic. Bob turned 95 this year and decided to step down from helping prepare these. He published his first vignette @JAMA_current back in 1969!/1 Image
This longstanding series focused on medical & scientific-themed postage stamps began in 1961. At the 109th Annual Meeting of @AmerMedicalAssn in the then-new convention center in Miami Beach, Florida in June 1960, John Mirt (1897-1968) discussed “Medical Pathfinders on Stamps”./2 ImageImage
At the time, Mr. Mirt – a devoted Freemason - worked in press relations for the AMA in Chicago. After the meeting, he was asked by then-editor of @JAMA_current John Talbott (1902-1990) to start composing short articles about physicians & scientists featured on postage stamps./3 ImageImage
Read 21 tweets
Dec 21, 2022
I’ve never posted a @tiktok_us link before, but this is a rare opportunity to observe one of the most poorly understood disorders in #hematology: Gardner-Diamond syndrome. This young woman's skin lesions first appear about 40 seconds in./1 #MedTwitter tiktok.com/@nancy.xoxx/vi…
The syndrome was described by Drs. Frank Gardner (1919-2013) and Louis K. Diamond (1902-1999) in Boston in 1955, in @BloodJournal. They reported 4 cases, all women, who had a peculiar form of bruising on face or extremities but had no other bleeding & normal coagulation tests./2
The key finding in Gardner-Diamond syndrome: unexplained painful bruises, most commonly on extremities or face, often during times of stress. The pathophysiology is unclear, as described below. Many patients have been dismissed by physicians as having a fictitious disorder./3 Facial ecchymoses on Nancy Morel's TikTok
Read 13 tweets
Nov 23, 2022
Among the many things I am #thankful for: recent progress in hematologic malignancies. When I started my career - not that long ago! - standard therapy for myeloma was melphalan & prednisone or VMP, chlorambucil for CLL, CHOP (without R) for NHL, epoetin & transfusions for MDS./1
CML was treated with Hydrea, busulfan, or interferon & Ara-C,and the big debate was transplant timing. Most patients didn't have an allo transplant donor & the age cutoff was 50-55. Karyotyping was inconsistently done even in AML/MDS; FISH was new; single gene testing was rare./2
No one knew about JAK2 mutations, let alone envisioning specific JAK2 inhibitors. There were elderly patients with polycythemia we treated with radiophosphorous. Many clinical trials were small IITs. The most "exciting" progress was in hairy cell leukemia: pentostatin & 2-CDA./3
Read 6 tweets
Oct 30, 2022
A medical textbook nostalgia thread! I dug up my @UChicagoMed transcript & recalled what books we used for each class. Buying books online was rare back then, so most came from the University bookstore at 58th & S Ellis, or the claustrophobic but amazing @SeminaryCoop on 57th./1 ImageImageImage
Year 1, Term 1 (Autumn): Netter’s Atlas of Human Anatomy (1989 edition), Wheater’s Functional Histology (1987), Moore’s Developing Human: Clinically Oriented Embryology (1988), Stryer’s Biochemistry (1990). (If you had another biochem text from undergrad, you could use that.)/2 ImageImageImageImage
One weird fact about U of C medical school: back then med student skeletal anatomy was taught by paleontologists, including @NatGeo Explorer-in-Residence Paul Sereno (here's his Facebook image). So we learned not just about human anatomy, but how humans differ from dinosaurs.🦖🦕 Image
Read 19 tweets

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