Brief Note by Kip Hansen — 19 August 2023

Do you read medical journals?  If not, you really should.  At least glance through the indexes of the latest issues of the leading journals…they can be utterly fascinating.  Maybe it is because my father was a doctor (pediatrician, before you ask), or maybe because my first major at university was pre-med, the fates only know, but I still make sure I get email alerts from the major medical journals and subscribe to some.  I don’t read everything – no one could – but I read what catches my attention.

In June 2023, there was an odd little Perspective piece in JAMA. [ .pdf here ].  As a whole, it was not very interesting unless you happen to be a medical intern somewhere or you supervise interns at a teaching hospital.  But this intern, Teva D. Brender MD, fantasizes about having an AI ChatBot write some of her reports and discharge instructions and other paper work that increases the length of her work day.  In her piece she makes the following statement about AI ChatBots:

“Finally, these programs are not sentient, they simply use massive amounts of text to predict one word after another, and their outputs may mix truth with patently false statements called hallucinations.”

She gives a cite for that statement, a February 2023  NY Times article written by  Kevin Roose titled:  “A Conversation With Bing’s Chatbot Left Me Deeply Unsettled”.  In that article, Roose said: “[advanced A.I. chatbots] are prone to what A.I. researchers call ‘hallucination,’ making up facts that have no tether to reality.” Roose is not the only one to notice and worry about this: Google search “AI ChatBot hallucinations“.

Having already read the NY Times piece in February, I didn’t give the issue another thought until….on August 14, 2023, in the JAMA Letters section, there appeared a Comment & Response written by Rami Hatem BS, Brianna Simmons BS, and Joseph E. Thornton MD (all associated with the University of Florida College of Medicine, Gainesville) in response to Brender’s  Perspective mentioned above. The response is titled:  “Chatbot Confabulations Are Not Hallucinations”.

Now, when I saw that there was a response to the original Brender Perspective,  I assumed (fool, me) that doctors would be objecting to the use of AI ChatBots to write medical reports because …well, Advanced AI ChatBots have been found to be “making things up” – inventing ‘facts’ and citing non-existent references:  diagnoses that are not real diseases? citing references that don’t exist?   

But no, Hatem et al. had this main point:

“In a recent issue of this journal, Dr. Brender provides an informative perspective on the implications of the available AI tools for the practice of medicine. However, we would like to draw attention to the conventional misuse of the term hallucination to describe material that is fabricated in the narrative by generative AI programs. The word confabulation is a more appropriate term, consistent with clinical usage, heuristic in addressing the problem, and avoids further stigmatization of both AI and persons who experience hallucinations. A hallucination is by definition a false sensory perception and may lead to aberrant behaviors in accordance with those perceptions. Confabulations are fabricated but they are usually logically generated semantic statements. For example, citing references that do not exist is a confabulation.”

Now, of course, we must be careful not to cause any “further stigmatization of … AI”.  Hatem et al. are not concerned that AI ChatBots “fabricate” facts and references, but that AI ChatBots might somehow be further stigmatized by saying they have “hallucinations” – and feel it is better that the hallucinations they have be called confabulations, so as not to hurt their feelings. 

As is proper in these circumstances, Brender then replies:

“When the term hallucination was first used by researchers to describe any potentially beneficial emergent properties of Artificial Intelligence (AI), it carried a positive connotation.  However, AI hallucination is now commonly understood by academicians and the public to describe the ‘unfaithful or nonsensical’  text that these large language models sometimes produce. It was this latter definition that informed my discussion regarding the need for judicious integration of AI into everyday clinical practice.”

There, at last, Brender takes the stand there exists a “need for judicious integration of AI into everyday clinical practice.”

And I couldn’t agree with her more. 

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Author’s Comment:

I have doubts about AI (in general), AI ChatBots, Advanced AI ChatBots and all that.  Hard to pinpoint exactly what doubts I have about them.  But I know that I do not think that AIs are “intelligent” and thus cannot be “artificial intelligences.”   However, I am not prepared to argue that issue, not here at any rate . 

But I am happy to read your take on AI ChatBot’s  having hallucinations (or confabulations, your pick) and returning fabrications — facts and references that are entirely made up, false, not real — as results/output. For instance, do you think that the AI ChatBot “knows” it has made up that fabricated fact, that  fabricated citation?

And now, there are additional concerns about “AI Drift”.

And what does it all mean for industry, medicine, education and other fields that are incorporating AI into their daily activities?

This is your chance to have a meaningful, civil, conversation on the issue.

Thanks for reading.

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