Friedman says has been forced to change how he talks to patients when he needs to prescribe hydroxychloroquine. “I’ve now worked into my scripting: ‘Hey, I want to start you on this medicine. You may have heard about it related to covid, that it was being used as a cure and it’s not,’” he says. “It got a lot of negative press. However, in dermatology we’ve been using it for decades for these different things.”
To understand the extent to which this confusion might also be ivermectin’s future, I went to r/Rosacea, the subreddit for advice on dealing with the chronic condition.
People with rosacea know ivermectin not as an unproven covid drug, but as a proven and effective treatment that helps some people with a type of rosacea that causes bumps on the skin. On the subreddit, one user was confused by the sudden influx of attention, asking: “Why are ivermectin memes popping up everywhere right now? And how does the mainstream know what it is?”
For people on the subreddit, ivermectin is a pretty persistent topic of discussion. There’s an expensive topical cream called Soolantra that contains the drug, and a generic version was released this summer. But a subset of those users also knew that the same drug was in horse paste, because some people diagnosed with rosacea have also bought the veterinary form—usually because they can’t otherwise get access to the creams or can’t afford a prescription.
This practice is controversial among people with rosacea, and dermatologists have raised concerns about experimenting with a product that contains an inappropriate dosage or untested ingredients with potentially adverse effects. However, Friedman says, a person with rosacea turning to horse paste for cost reasons is in a categorically different medical and ethical universe from the one in which people are eating horse paste to “cure” covid. For diagnosed rosacea patients who need ivermectin to control the condition, Friedman says, “unfortunately, the best medication is the one patients can get.”
People who use Soolantra or the generic version of ivermectin topically are, as of right now, unlikely to be encountering shortages, says Friedman. There are reports of farm supply stores running short on horse paste, however. In addition to some practical issues of access—while reporting this story, I spoke to one person who had to purchase horse paste from the UK in order to treat his pet rats for mites a few weeks ago—there’s now an added layer of scrutiny and stigma. How do you explain that you use horse paste on yourself, but not like that?
“Attached to this oversimplified idea”
The subreddit’s moderators were already pretty familiar with misinformation about ivermectin.
People use the site, like many online communities, to discuss and trade information based on their experience: for example, discussing the best facial cleansers, asking how to avoid triggering a flare-up, or sharing how their treatment is progressing over time. But they can also incubate and promote misinformation, which moderators have to monitor and remove.
Although there are some Facebook groups that promote horse paste for those with rosacea, the r/Rosacea subreddit neither encourages nor bans discussion of its use. One moderator told me the biggest risk is that people will self-diagnose with rosacea and decide to treat themselves with a DIY version of a medication that, even in a form intended for use by humans, should only be used with the guidance of a physician.
Not all rosacea is the same, however, and the reasons ivermectin might work for some is still a subject of scientific debate.
There is a connection between rosacea and demodex mites, which live in the hair follicles on more or less everyone’s face. in people with any form of rosacea, those mites are there in excess. But the exact relationship isn’t clear. “The question is chicken or egg,” Friedman says. Are people with rosacea ideal environments for demodex mites to live in excess, or “or is it this overgrowth that then exacerbates rosacea?”
That uncertainty has led to some pretty dangerous suggestions online, said Ryan, a Reddit moderator who asked that I withhold his last name.
“People get attracted and attached to this oversimplified idea that if they just kill the mites, their rosacea and their problems will go away,” he said. “We’ve even seen some pretty crazy things, like people recommending wearing flea collars or using pesticides on their face.”
Data voids and poisoned wells
Online peddlers of misinformation often exploit a data void, telling people to search for specific terms that they know will lead to results that promote what they’re trying to say. At worst, as the misinformation researcher Renee DiResta has written in the past, the top results can end up coming entirely from people who believe in and promote the misinformation.
Yann LeCun has a bold new vision for the future of AI
Melanie Mitchell, an AI researcher at the Santa Fe Institute, is also excited to see a whole new approach. “We really haven’t seen this coming out of the deep-learning community so much,” she says. She also agrees with LeCun that large language models cannot be the whole story. “They lack memory and internal models of the world that are actually really important,” she says.
Natasha Jaques, a researcher at Google Brain, thinks that language models should still play a role, however. It’s odd for language to be entirely missing from LeCun’s proposals, she says: “We know that large language models are super effective and bake in a bunch of human knowledge.”
Jaques, who works on ways to get AIs to share information and abilities with each other, points out that humans don’t have to have direct experience of something to learn about it. We can change our behavior simply by being told something, such as not to touch a hot pan. “How do I update this world model that Yann is proposing if I don’t have language?” she asks.
There’s another issue, too. If they were to work, LeCun’s ideas would create a powerful technology that could be as transformative as the internet. And yet his proposal doesn’t discuss how his model’s behavior and motivations would be controlled, or who would control them. This is a weird omission, says Abhishek Gupta, the founder of the Montreal AI Ethics Institute and a responsible-AI expert at Boston Consulting Group.
“We should think more about what it takes for AI to function well in a society, and that requires thinking about ethical behavior, amongst other things,” says Gupta.
Yet Jaques notes that LeCun’s proposals are still very much ideas rather than practical applications. Mitchell says the same: “There’s certainly little risk of this becoming a human-level intelligence anytime soon.”
LeCun would agree. His aim is to sow the seeds of a new approach in the hope that others build on it. “This is something that is going to take a lot of effort from a lot of people,” he says. “I’m putting this out there because I think ultimately this is the way to go.” If nothing else, he wants to convince people that large language models and reinforcement learning are not the only ways forward.
“I hate to see people wasting their time,” he says.
The Download: Yann LeCun’s AI vision, and smart cities’ unfulfilled promises
“We’re addicted to being on Facebook.”
—Jordi Berbera, who runs a pizza stand in Mexico City, tells Rest of World why he has turned to selling his wares through the social network instead of through more conventional food delivery apps.
The big story
“Am I going crazy or am I being stalked?” Inside the disturbing online world of gangstalking
Jenny’s story is not linear, the way that we like stories to be. She was born in Baltimore in 1975 and had a happy, healthy childhood—her younger brother Danny fondly recalls the treasure hunts she would orchestrate. In her late teens, she developed anorexia and depression and was hospitalized for a month. Despite her struggles, she graduated high school and was accepted into a prestigious liberal arts college.
There, things went downhill again. Among other issues, chronic fatigue led her to drop out. When she was 25 she flipped that car on Florida’s Sunshine Skyway Bridge in an apparent suicide attempt. At 30, after experiencing delusions that she was pregnant, she was diagnosed with schizophrenia. She was hospitalized for half a year and began treatment, regularly receiving shots of an antipsychotic drug. “It was like having my older sister back again,” Danny says.
On July 17, 2017, Jenny jumped from the tenth floor of a parking garage at Tampa International Airport. After her death, her family searched her hotel room and her apartment, but the 42-year-old didn’t leave a note. “We wanted to find a reason for why she did this,” Danny says. And so, a week after his sister’s death, Danny—a certified ethical hacker—decided to look for answers on Jenny’s computer. He found she had subscribed to hundreds of gangstalking groups across Facebook, Twitter, and Reddit; online communities where self-described “targeted individuals” say they are being monitored, harassed, and stalked 24/7 by governments and other organizations—and the internet legitimizes them. Read the full story.
The US Supreme Court has overturned Roe v. Wade. What does that mean?
Access to legal abortion is now subject to state laws, allowing each state to decide whether to ban, restrict or allow abortion. Some parts of the country are much stricter than others—Arkansas, Oklahoma and Kentucky are among the 13 states with trigger laws that immediately made abortion illegal in the aftermath of the ruling. In total, around half of states are likely to either ban or limit access to the procedure, with many of them refusing to make exceptions, even in pregnancies involving rape, incest and fetuses with genetic abnormalities. Many specialized abortion clinics may be forced to close their doors in the next few days and weeks.
While overturning Roe v Wade will not spell an end to abortion in the US, it’s likely to lower its rates, and force those seeking them to obtain them using different methods. People living in states that ban or heavily restrict abortions may consider travelling to other areas that will continue to allow them, although crossing state lines can be time-consuming and prohibitively expensive for many people facing financial hardship.
The likelihood that anti-abortion activists will use surveillance and data collection to track and identify people seeking abortions is also higher following the decision. This information could be used to criminalize them, making it particularly dangerous for those leaving home to cross state lines.
Vigilante volunteers already stake out abortion clinics in states including Mississippi, Florida and North Carolina, filming people’s arrival on cameras and recording details about them and their cars. While they deny the data is used to harass or contact people seeking abortions, experts are concerned that footage filmed of clients arriving and leaving clinics could be exploited to target and harm them, particularly if law enforcement agencies or private groups were to use facial recognition to identify them.
Another option is to order so-called abortion pills to discreetly end a pregnancy at home. The pills, which are safe and widely prescribed by doctors, are significantly less expensive than surgical procedures, and already account for the majority of abortions in the US.