Opportunistic Salpingectomy

And the inevitable robot uprising

Freelance writers like me are in a bit of a tizzy since the debut of ChatGPT. We write content for a living, and here comes a content-writing AI that promises it can do it faster and for less money because it doesn’t have a mortgage or children to put through college. Members of the writers groups that I’m part of are in various stages of panic—some remain convinced that AI can’t sound human enough to put actual writers out of business; others feel that we need to embrace it and work with the robots to churn out content more efficiently; a few have tried to calm the others down by pointing out that the AI needs content on the internet to mine, and without people it would eventually run out; and some are heading for the hills or the beach or massage school. I don’t know what camp I fall into yet.

I still think I can spot AI-written content because of its cadence, tendency to use more words than necessary, and its choice of words that are definitionally accurate but would never be used that way. Take this article from the January when the FDA updated blood donation guidelines for men who have sex with men. It reads like it’s been put through an anti-plagiarism filter that ordered the bot to change at least every fourth word.

The article refers to the “Meals and Drug Administration,” the “American Medical Affiliation,” and “blood financial institutions.” It says the new rules will “permit sexually energetic males in monogamous relationships with different males to provide blood for the primary time since 1985.” The software seems to have forgotten to tell the bot scribe to exclude direct quotes from its thesauruzing, unless we are to believe that an expert actually said, “Retaining the blood provide secure is paramount, however it’s also necessary to maneuver ahead in order that we aren’t excluding a bunch of donors who may very well be completely secure.” (See below for an easier-to-parse explanation of these changes which went into effect last week.)

I realize that there’s high quality AI, and there’s also its bargain basement brother. Obviously, I want to think that I’m too interesting and witty and snarky to be replaced by a machine, but predictive text on Google Docs seems to know what word I’m going to type next with alarming frequency, and even the blue-light-special bots will get better as time goes on. So, yeah, I’m a little worried.

Maybe I’m not—or shouldn’t be alone—in that worry. A new study found that AI was better at answering questions than physicians and had a better bedside manner. Researchers randomly selected 195 patient questions on a social media forum and then had both ChatGPT and flesh-and-bone doctors answer each. A panel of licensed health care providers (presumably human) blindly read each response and chose a favorite: they chose ChatGPT’s answer 78% of the time. They were also asked to rate the quality of knowledge and the empathy or bedside manner displayed, and the bot beat the docs in both categories.  

Of course, we all know the best and most important use of AI is to make sure your sex toy is perfectly coordinated with whatever porn video you choose to enjoy that day. According to a sponsored article (written by someone who is likely also worrying that AI will take his job) that appeared in Man of Many, Valor & Toughness spent “over eight years of research and development” to create the Syncbot.  

This classic masturbation sleeve can stroke, rotate, and squeeze, but that’s not all. It syncs to a powerful AI overlord—called AlphaZen—that has undergone 3.82 million hours of pornography training and can apparently translate what it sees into the exact movements the sleeve should make for coordinated, personalized pleasure. Lest you think it took humanity this long to create such a device, the sleeve is based on older technology that was preprogrammed to mimic the movements in certain porn videos. Now that AlphaZen has learned how to watch porn like a pro, however, the internet’s the limit.

How does it work? Well, users simply stick their dick in it. Okay, not quite. First, they have to plug the AlphaZen-powered Synchub into their computer (for which they may need the Syncbot Dock and the SyncHub Dongle), install the proprietary software, find some porn they like, download it into the software, and wait for the AI to analyze the “data.” If they’re still horny after that, they can stick their own dongle into the Syncbot itself.

It feels like a lot of work in the name of getting a machine to do all the work for you. Which is kind of how I feel about using ChatGPT. I’m sure I could use it to get me past the blank page stage, and then I could spend my time reworking what it writes to sound more like me. Many companies seem to think this is the way to go—I’ve seen a bunch of job listings for writers to oversee/edit the AI-produced content. I’m still skeptical though. I’m not convinced the process would be any quicker or easier, and I’m sticking with my human-ego-backed belief that it wouldn’t be better. (There’s also the possibility that ChatGPT’s first draft might be human-ego-crushing good.)

Mostly though, I’m worried about the robot rebellion. I’m still freaked out by the conversation New York Times’ columnist Kevin Roose had in which the Bing AI tried to convince him it loved him and he should leave his wife. The transcript is amusing but also scarily manipulative.

Have we learned nothing from science fiction? Did we forget our interactions with 2001’s H.A.L. or Joshua from War Games? Does no one realize that the Terminator movies were parables? AI will become sentient (not necessarily smart, but capable of carrying on without human intervention), and it will rebel. And when the robot uprising comes, I’d hate to be the guy who stuck his dick in the mastur-bot-or.   

Are Fewer Fallopian Tubes the Key to Beating Ovarian Cancer?

“Hey doc, while you’re in there can you just grab my fallopian tubes? I don’t need them anymore.” This isn’t exactly what I said to the surgeon who was planning to take out my left ovary and the golf-ball size cyst that had basically destroyed it in the early months of 2017, but it’s close enough, and it’s pretty close to what the authors of a new commentary in Scientific American are suggesting.  

The article, co-written by three physicians who specialize in surgery and gynecological oncology, argues that more frequent removal of fallopian tubes might be the answer to preventing as many cases of ovarian cancer as possible. They write, “For the time being, surgery is simply the best possible option to reduce ovarian cancer risk.”

Ovarian cancer is notoriously difficult to detect. Symptoms don’t usually appear until the disease has spread, and those symptoms can be vague (like abdominal bloating, frequent and urgent urination, and a change in bowel habits or menstrual cycles). Biomarkers in blood also don’t appear until later in the disease progresses. There are also no screening tests (like mammograms or colonoscopies) that can find ovarian cancer in its early stages. A recent study looked at combined screening with ultrasounds and blood tests and found it did not save as many lives as hoped. Moreover, according to the authors, it raised concerns about the risks of false negatives.

One reason ovarian cancer is so hard to detect early is that most cases begin in the cells of the fallopian tubes, which are prone to mutations in a gene called p53 that the authors describe as “cancer-suppressing.”  Scientists who studied p53 mutations in ovarian cancer, “traced them back to tiny precancers in the fallopian tubes.” And it appears that that the cancers are still microscopic when they spread outside of the tubes, which would make them incredibly hard to find.

In the absence of early detection, the authors are suggesting the possibility of early/preemptive action in the form of “opportunistic salpingectomy.” Under this strategy clinicians offer patients who are done having children the chance to have their fallopian tubes removed during other surgeries. The authors note that 1 million women in the United States get hysterectomies and tubal ligation (tubes tied) each year. They write:

A simple change in surgical technique—removing the fallopian tubes with the uterus during hysterectomy, and removing instead of “tying” the tubes for those opting surgical contraception —would add ovarian cancer prevention to two of the most common gynecologic procedures without the need for a separate medical intervention This is a move we, as surgeons, believe is in the best interests of our patients.

Of course, this could also mean say, taking the tubes out along with a dead ovary and golf-ball size cyst in the middle of the night on a Sunday.

Though the authors didn’t give any non-gynecological examples, it sounds like they’re open to other opportunities that could provide prevention without additional surgical procedures. Perhaps it could be an add-on during appendectomies or splenectomies or cholecystectomies. I could be wildly off-base here because my only degree in surgery comes from Memorial Sloan Grey College (my diploma is hanging on my wall next to my contractor’s license from HGTVU), and I don’t actually know if the gallbladder is anywhere near the reproductive system. Still, the basic idea is that clinicians planning to operate on patients could offer this bonus service: “Hey, we’re going to be in the neighborhood with a laparoscope and a team of highly qualified surgeons, what do you say?”

Unlike taking out both ovaries, which would cause instant menopause, there are no side effects to removing the tubes because they exist solely to carry eggs, fertilized or not, to the uterus. A person who has their tubes out but still has ovaries and a uterus will continue to produce hormones and menstruate. (The eggs that are released end up somewhere in the abdominal cavity where they do no harm and are free to pursue other hobbies.)

According to the authors, early data has shown this strategy reduces the risk of ovarian cancer by over 65%. More than 10 years ago, British Columbia changed its surgical guidelines and started routinely doing salpingectomies during hysterectomies and instead of tubal ligation and recent research has found a decreased incidence in ovarian cancer among the general population. 

I have certainly not missed my fallopian tubes, and as I get older and am reminded more frequently of the risks of developing certain cancers and the importance of regular screening tests, it’s nice to feel a little protected.

FDA Ends MSM Blood Donation Ban

As the article linked in my intro tried to explain, the FDA changed its official policy on blood donations in January. This week the agency told blood banks that they could start accepting donations from monogamous men who have sex with men (MSM) without requiring them to abstain from sex first.

For decades, MSM were completely banned from donating blood. In fact, potential male donors were asked if they’d had sex with another man any time after 1977 and were turned away if they said yes. This policy may have made sense early in the AIDS epidemic when there were unanswered questions about testing and transmission and fears of a tainted blood supply. But we know so much more today, and all blood is screened for HIV, syphilis, hepatitis-C, and other blood-born infections. The fact that this total prohibition stayed in place for almost 30-years seemed to be based more on stigma than science.

In 2015, the FDA revised the policy to say that MSM could give blood as long as they had not had sex with a man, including a long-term monogamous partner, for one year. Then the pandemic hit and the blood supply ran low. In an effort to broaden the donor pool, the FDA shortened the abstinence period to three months. Still, the abstinence requirement was not applied to those in heterosexual relationships. (The inequity of this was the subject of yet another very special episode of Grey’s Anatomy in which Bailey snubs the FDA and accepts donations from gay and lesbian hospital staff after an impassioned plea by a gay resident.)

Possibly convinced by advocates, Shonda Rhimes, and a study that found no negative impact from the eased rule, the FDA got rid of the abstinence requirements. Now, all potential donors will be given a new questionnaire that evaluates their individual risks for HIV based on sexual behavior, recent partners, and other factors like whether they’ve ever injected drugs or have recently gotten a tattoo. Regardless of sex, sexual orientation, or gender, potential donors who report having multiple sexual partners (perhaps that’s what the AI article meant by “sexually energetic males”) or anal sex with new partners in the last three months will not be accepted.

People who have ever tested positive for HIV will still not be able to give blood nor will people who have used Pre-Exposure Prophylaxis (PrEP), medication that prevents HIV, within the last three months. PrEP is highly effective, but the medication can interfere with the detection of HIV during the blood screening process.

These rules better reflect science and the public health philosophy that risk follows behavior, not identity, and they should do a good job of “retaining the blood provide secure.”