AI versus the Deep State

A distinguished colleague (C1) introduced last year’s word of the year – AI Slop – into last week’s The Prozac Liberation Front post.

As an unaccountable editor, I took the liberty to suggest that many of us seemed to figure – or would pretty soon get round to figuring – that AI was all too likely to go the way of the Internet as a potentially democratising force in healthcare.  If it can turn the Wine of decent human interaction into healthcare Water, the consequences for every other less intimate and personal domain of our lives were likely to be even worse.

At the heart of our dilemmas is that health has always been a Liberal and Socialist bastion in which people who cherish liberty on their own part, or on behalf of what the call the ‘people’, hold out against the powers that be – Can We Avoid Being Eaten.

The worry for some (Liberals) has been that the collective in the form of a bureaucracy (Now in US English called a Deep State) would squash individual liberty just as effectively as an aristocracy had or an oligarchy seems likely to do.

The bigger unnoticed worry is that the advent of effective pharmaceuticals, which looked like they might free us up to better live the lives we wanted to live, has enabled Companies (Deep State Corporate Bureaucracies) to effect an entry into the citadel of our liberties by means of a Horse –  Randomized Controlled Trials (RCTs).

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These Averaging Machines not only get invaders into the city but get everyone to swallow the meds – not just those who might respond. RCTs are also the Gold Standard way to Average Hazards out of Existence.

Large Language Models (LLMs) are also Averaging Machines and with an algorithim or two inserted into screens here or there will ensure that only the messages from company RCTs get heard. It seems inevitable that LLMs will buttress rather than undermine Deep States.

Is there an Achilles Heel be found?  Perhaps not, but there is scope for amusement in the meantime.

Britain’s medicines regulator is MHRA, who you could say are the Still Heart of a Beating UK Healthcare World – just to be clear Hearts are still when dead.  But in their afterlife, bureaucrats will continue to seem to do something as a cover for doing nothing.  Hence a Document proclaiming a Revolution.

Project overview
Your health decisions matter. The information you receive about your medicines should be clear, accessible, and support informed conversations between you and your healthcare professional. The MHRA is committed to leading an inclusive approach to improving medicines information.

To achieve this, we have launched the Improving Patient Information project, to work closely with stakeholders across the health system including patient groups and charities to understand barriers and identify how information can be made more accessible, trusted, and future-fit.

Our aim is to ensure that patient information for medicinal products is clearer, inclusive, and easier to understand. This will be achieved by placing patients at the centre of the project.

A major focus of this work will be improving access to patient information leaflets in the UK through the use of digital solutions.

The Improving Patient Information project has a three-phase approach to delivery:

• Phase one (April 2025-March 2026): Scoping phase focused on engaging with stakeholders across the health system, understanding how patients access patient information and proposing an action plan
• Phase two (2026-2027): Establishing a multi-stakeholder governance structure and collaborating with partners across the healthcare system to deliver the action plan
• Phase three (2027-2028): Reviewing the impact of action plan, developing a strategy for implementation.

We have five design principles to guide our work: patient centred, accessible, trusted, innovative, and standardised.

Research reports
Woodnewton Associates was commissioned by the MHRA to conduct independent research on the role that patient information leaflets provide to informing patients. The findings and recommendations presented in this report are those of the researchers and do not necessarily reflect the views of the MHRA.

• Title  Research conducted on the role that patient information leaflets provide to informing patients
• Details  A research report defining the current baseline for patient engagement with and accessibility of patient information leaflets.
• This research was commissioned and funded by MHRA. Its aim is to provide evidence that will help inform future changes to patient information to make it more accessible, trusted, and fit for the future
• Our action plan is based on evidence we have gained through this research.

WN Report:  Research on the Role of Patient Information Leaflets in Meeting the Information Needs of Patients

Smile and the World Smiles With You

Ron Law, a Risk and Policy Adviser based in New Zealand – perhaps the most active person on another listserve on which Prozac Liberation ran – responded that ChatGPT could have its uses – for making cartoons. This is absolutely true as the recent set of 4 RxISK videos with 2 more to come shows.  He also figured, with a touch of guidance, it was good for Drafting Reports.

Knowing he loves nothing more than tackling regulators, I sent him the link to the MHRA document and was astonished to get a fabulous response within minutes.

A Most Welcome Commitment to Clarity

It is, of course, most heartening to observe the MHRA’s newly invigorated commitment to “clear, accessible, and trusted” patient information. One could scarcely object to an initiative so impeccably phrased, nor to the proposition—advanced with commendable solemnity—that patients ought, in principle, to understand the medicines they are invited to consume.

A Brief Encounter with Institutional Memory

However, for the more historically minded observer, this sudden institutional enthusiasm for transparency does invite a certain… reflective pause.

For it was not so very long ago that the same regulatory architecture appeared to exert itself with quite remarkable vigour in the opposite direction—namely, in the careful management, dilution, or deferment of information concerning potential harms associated with both COVID-19 vaccines and SSRI medicines. One recalls, for example, the rather strenuous reluctance to foreground adverse event signals in a manner that might have been considered “clear” or “accessible” to the uninitiated patient, let alone “conducive to informed decision-making.”

Indeed, the prevailing philosophy at the time might best be described not as patient-centred transparency, but as professionally mediated reassurance — wherein information was filtered through a series of interpretive layers designed to ensure that what reached the patient was not so much the unvarnished evidence as its more palatable administrative rendering.

The Damascus Conversion

In that context, the MHRA’s apparent road-to-Damascus experience is nothing short of remarkable. One is bound to admire the speed and completeness of the conversion. Yet it does prompt a delicate question regarding its precise point of origin. Was this newfound devotion to transparency born of accumulated evidence, external scrutiny, reputational necessity, or merely the natural lifecycle of regulatory fashion? The chronology, if one were unkind enough to examine it closely, may suggest that this enlightenment is rather more recent—and rather more convenient—than the rhetoric implies.

Trust, or the Management Thereof

The present declaration of intent—to place patients “at the centre of every stage” and to ensure information is “trusted” and “fit for the future”—thus carries a certain quiet irony. One is tempted to ask whether “trust” is here conceived as a product of fuller disclosure, or as the outcome of more sophisticated presentation.

Equally intriguing is the emphasis on “digital solutions,” which, while no doubt modern and efficient, may also offer unparalleled opportunities for the dynamic curation of information—allowing inconvenient complexities to be rendered, shall we say, less immediately conspicuous.

An Admirable Aim—In Need of Proof

None of this is to suggest that the initiative is without merit. On the contrary, it is admirable—indeed, exemplary—that the MHRA now seeks to engage patients, stakeholders, and the broader public in the co-production of medicines information. One can only hope that this commendable commitment extends not merely to the refinement of language and format, but to the substantive inclusion of material that has, in earlier iterations of regulatory communication, proven somewhat elusive.

Conclusion: Transparency in Practice

In short, transparency is a most splendid objective. Its true test, however, lies not in its declaration, but in its application—particularly when the information in question is awkward, contested, or inconvenient.

One awaits, with interest, the practical demonstration of this newly discovered virtue.

AI Whisperer

The RxISK Team fortunately has a gifted AI Whisperer – able to prompt AI systems to come up with imagery that has tranformed a set of just loaded videos into something much more loaded than they would otherwise have been. It’s worth enjoying these and getting a sense about what can be done that would have been impossible a year ago.

• Isotretinoin and Consent
• Finasteride and Consent
• Bad Trips on SSRIs
• No Sex – We’re on Antidepressants 

There are two more gems in the series to come.

• Good Trips on SSRIs
• Consenting to SSRIs