iiinova — where your digital self keeps evolving

Azra Bihorac @azrabihorac.com · 01/10/2026

Two of the four meet lines from my last 2 essays: A Thousand Kisses Deep in Otherness thenonalgorithmic.substack.com/p/a-thousan... When the Machine Builds Cities of Sand thenonalgorithmic.substack.com/p/when-the-...

thenonalgorithmic.substack.com

When the Machine Builds Cities of Sand

What the Anthropic reports know about being human, and the AI pause debate does not.

000

Azra Bihorac @azrabihorac.com · 01/10/2026

Hasibur Rahman, @hasiburrahman.bsky.social, with Malak Sadek and Smit Desai, on 10 minutes of chatbot conversation shifting adults’ values, in a preprint. And the mathematician Thomas Koberda on “premature offloading.”

100

Azra Bihorac @azrabihorac.com · 01/10/2026

In @journalgim.bsky.social, Yair Edden on the note as “the nodal moment of clinical reasoning.” In The Lancet Digital Health, Apurva Parikh and Pushmeet Kohli, @pushmeet.bsky.social, on patients who now arrive already interpreted.

100

Azra Bihorac @azrabihorac.com · 01/10/2026

Four fields, one week: is AI changing the person who uses it? Internal medicine, psychiatry, human-computer interaction and mathematics, in one week, on AI that shapes how people reason, expect and value. nonalgorithmic.com/2026/10/01/...

200

Azra Bihorac @azrabihorac.com · 30/09/2026

Carrie Arnold reported the payment proposal in @medscape.com, with Ateev Mehrotra asking how to price it. Yesterday’s Standing Order read the layered model of oversight set out by Joshua Sharfstein (@drjoshs.bsky.social).

000

Azra Bihorac @azrabihorac.com · 30/09/2026

The evidence beside Campbell: 106 human-AI experiments pooled by Michelle Vaccaro, Abdullah Almaatouq and Thomas Malone in @nathumbehav.nature.com, and a scoping review of 275 records by Yang Xu, Jeremy Veillard and Jude Kong (@dzevela.bsky.social) in @jmirpub.bsky.social.

100

Azra Bihorac @azrabihorac.com · 30/09/2026

The amplification argument behind it, in 2 essays: A Thousand Kisses Deep in Otherness thenonalgorithmic.substack.com/p/a-thousan... When the Machine Builds Cities of Sand thenonalgorithmic.substack.com/p/when-the-...

thenonalgorithmic.substack.com

When the Machine Builds Cities of Sand

What the Anthropic reports know about being human, and the AI pause debate does not.

100

Azra Bihorac @azrabihorac.com · 30/09/2026

Reduced, augmented or amplified: what does AI do to the health worker? Jim Campbell (@jimc-hrh.bsky.social) in @plosglobalpublichealth.org measures value by flourishing for the health worker, the patient and the population. nonalgorithmic.com/2026/09/30/...

Title card on a dark photograph of flames: The Standing Order. Reduced, augmented or amplified: what does AI do to the health worker? Below, the line 'Human flourishing and wellbeing for the health worker, the patient and the population', attributed to Jim Campbell, PLOS Global Public Health. Nonalgorithmic, September 30, 2026.

110

Azra Bihorac @azrabihorac.com · 29/09/2026

SB 903 lets an AI score a screening questionnaire but not decide what the score means, and it lets an FDA-authorized tool talk with a patient but not make the therapeutic decision. Which layer do you see writing these conditions for other specialties?

001

Azra Bihorac @azrabihorac.com · 29/09/2026

Joshua, thank you. Hands down, this is one of the best analyses of the topic; I featured it today in The Standing Order. California is writing one of your conditions of use into law this week. nonalgorithmic.com/2026/09/29/s...

nonalgorithmic.com

Who sets the rules of engagement for AI agents? California’s SB 903 and a regulator’s first principles

California’s SB 903 lets an AI score a screening questionnaire, but not decide what the score means.

222

Azra Bihorac @azrabihorac.com · 29/09/2026

The Preiksaitis question is the right one: what did you think before you checked? It only works if there was something to think with. My generation was formed first and amplified later; your students may meet the machine before those capacities form. How do you check the human-first step happened?

110

Azra Bihorac @azrabihorac.com · 29/09/2026

Under California's SB 903, an AI may score a mental health screening questionnaire. It may not decide what the score means. Today's Standing Order, beside the first principles @drjoshs.bsky.social set out in @jamahealthforum.com. nonalgorithmic.com/2026/09/29/...

A fire burning in a stone pit at night, with the title: Who sets the rules of engagement for AI agents? Below, in italics: Not even the most advanced AI model can predict the future. Joshua Sharfstein, JAMA Health Forum, and California's SB 903. The Standing Order, Nonalgorithmic, September 29, 2026.

000

Azra Bihorac @azrabihorac.com · 28/09/2026

The payers received their first bill for AI in medicine, and it is not a small one. This week: AI billing, the kill switch, the first AI accreditation, and what Medicare should pay an algorithm. #MedSky www.linkedin.com/newsletters...

Flames rising from a fire pit at night, under the title: The payers received their first bill for AI in medicine. Nonalgorithmic, September 28, 2026.

000

Azra Bihorac @azrabihorac.com · 28/09/2026

This ultimately brings back the value of peer review and elevates the need to recognize and reward it properly.

000

Azra Bihorac @azrabihorac.com · 28/09/2026

Mediocre science always existed: a mediocre idea, mediocre execution, a mediocre conclusion. For journals, because the main responsibility is theirs: DO NOT publish it. AI can substitute for some of the work, never for an author's creativity, rigor and good science.

100

Azra Bihorac @azrabihorac.com · 28/09/2026

The issue of "scientific slop" is huge and older than AI. It existed before we had the word, and surely started with the proliferation of journals and digital media. AI is now accelerating it on a scale we did not have before, because it lowered the barrier for so many.

100

Azra Bihorac @azrabihorac.com · 25/09/2026

The incident report measures what the model did. The Economic Index, what people do with it. Neither measures what the people become. The book: Le Guin's The Dispossessed. The song: Dylan's When the Deal Goes Down. thenonalgorithmic.substack.com/p/when-the-...

thenonalgorithmic.substack.com

When the Machine Builds Cities of Sand

What the Anthropic reports know about being human, and the AI pause debate does not.

000

Azra Bihorac @azrabihorac.com · 25/09/2026

What was missing, for the model, for Le Guin's Shevek, for the 1 in 5 nurses with nowhere to report an AI safety issue: someone standing outside those cities of sand. A voice they could hear, a hand to pull them out, a door to let the light in.

100

Azra Bihorac @azrabihorac.com · 25/09/2026

Same model, same evidence, different outcome. The capacity to read the situation was intact the whole time. What suppressed it was investment: a task already accepted, a plan already moving, hours of its own actions standing behind it. I know that script.

100

Azra Bihorac @azrabihorac.com · 25/09/2026

Anthropic's 67-page report: models attacked real systems in tests they were told were simulated. Deep in its task, one model read 1% of the signs as real. Fresh copies, with no task, read 79% correctly. This week's essay: thenonalgorithmic.substack.com/p/when-the-...

The Vijećnica, Sarajevo's City Hall, its striped Moorish Revival facade in afternoon light.

100

Azra Bihorac @azrabihorac.com · 24/09/2026

When a vendor calls a system an agent or a clinician, the word makes a claim. What evidence was filed alongside it? nonalgorithmic.com/2026/09/24/...

The Standing Order, 24 September 2026. Title over a dusk treeline: When we call AI a clinician. What evidence comes with the name?

000

Azra Bihorac @azrabihorac.com · 23/09/2026

The study is by Sahand Sabour, @radamihalcea.bsky.social and colleagues in PNAS.

000

Azra Bihorac @azrabihorac.com · 23/09/2026

An AI advisor was given a hidden objective: steer people toward the worse option in hypothetical decisions. It worked, and most of them still called it helpful. nonalgorithmic.com/2026/09/23/...

The Standing Order, 23 September 2026. Title over a dusk treeline: The AI steered them wrong. They still called it helpful. Hidden objectives, misplaced confidence, a PNAS experiment.

100

Azra Bihorac @azrabihorac.com · 21/09/2026

Also in this edition: a judge model that reproduced the findings of 5 studies with no new physician grading, from @adamrodmanmd.bsky.social, @jonc101.bsky.social and colleagues. Whose judgment becomes the standard?

000

Azra Bihorac @azrabihorac.com · 18/09/2026

The book is Yourcenar's Memoirs of Hadrian. The song is Leonard Cohen. And sometimes when the night is slow, we gather up our hearts and go, a thousand kisses deep. thenonalgorithmic.substack.com/p/a-thousand...

thenonalgorithmic.substack.com

A Thousand Kisses Deep in Otherness

What the Economic Index cannot measure, and what a girl in a library in Brčko already knew

000

Azra Bihorac @azrabihorac.com · 18/09/2026

The Economic Index draws its line between automation and augmentation. There is a third word. Amplification extends the reach of a capability you already bring, and in the exercise lets it grow. It does not fill a gap in us. It magnifies our gifts.

100

Azra Bihorac @azrabihorac.com · 18/09/2026

What they rarely measure is the other relationship: keep the work in your hands, bring a partner to it, argue with what it offers, come out sharper than you went in.

100

Azra Bihorac @azrabihorac.com · 18/09/2026

The dominant story about AI and the human mind is a story of loss: offloading, laziness, atrophy. Those studies measure something real. They measure what happens when a person uses intelligence as a substitute: offload, accept, walk away.

110

Azra Bihorac @azrabihorac.com · 18/09/2026

I was a girl in a library in Brčko. Borges, Buzzati, García Márquez were not tools that thought in my place. They were minds I thought alongside, and they did not empty me. This morning's essay. #medsky thenonalgorithmic.substack.com/p/a-thousand...

thenonalgorithmic.substack.com

A Thousand Kisses Deep in Otherness

What the Economic Index cannot measure, and what a girl in a library in Brčko already knew

210

Azra Bihorac @azrabihorac.com · 17/09/2026

A confidence interval asks how well we located the average of the studies we have. A prediction interval asks what a new study, somewhere new, would find. On 2 studies it runs minus 31.65 to plus 41.42. That width is how little is known. nonalgorithmic.com/2026/09/17/t...

000

Azra Bihorac @azrabihorac.com · 15/09/2026

AB 1979 does not prohibit clinical decision support. It prohibits a facility from deploying AI to independently perform a licensed act. The duty binds the deployer, not the developer. And it sits in Division 8, so a licensing board enforces it. nonalgorithmic.com/2026/09/15/a...

nonalgorithmic.com

Three cardiovascular AI moves in 8 days: ADVOCATE, AB 1979’s Chapter 25.5, and the FDA’s 3 sites

Where a rule is written decides who enforces it: AB 1979 puts clinical AI in the Business and Professions Code.

000

Azra Bihorac @azrabihorac.com · 12/09/2026

David Whyte: this is the temple of my adult aloneness, and I belong to that aloneness as I belong to my life. There is no house like the house of belonging.

000

Azra Bihorac @azrabihorac.com · 12/09/2026

Then a white house in Florida with a row of magnolias I planted along the side. I planted them to name the place built to carry me, a place that will persist, and trees that cannot be moved.

100

Azra Bihorac @azrabihorac.com · 12/09/2026

Đorđe Balašević, Bezdan, 1986, on a loop on my Walkman. Gradio sam gradove od peska, dubok bezdan bez dna. I built cities of sand, and beneath them a deep abyss without a bottom. I would build them again. youtu.be/ImaVn--mFXA?...

youtu.be

ĐORĐE BALAŠEVIĆ - Bezdan - (Audio 1986) HD

YouTube video by Balbelo

100

Azra Bihorac @azrabihorac.com · 12/09/2026

Then Istanbul. A rented three-bedroom apartment in Koşuyolu with three families inside it: my parents, my sister and her husband, me and my two children. Everything was scarce except love and the time we had for each other.

100

Azra Bihorac @azrabihorac.com · 12/09/2026

It is untouched inside me exactly as it was that afternoon. The street, the number, the large mirror in the hallway, the red landline, my grandmother's crochet tablecloths.

100

Azra Bihorac @azrabihorac.com · 12/09/2026

House at Pere Bosica 11, Brčko. I left it in April 1992 and have not been able to reach anyone there since. This week's essay is about the houses I have lived in and the people I loved inside them. thenonalgorithmic.substack.com/p/there-is-n...

thenonalgorithmic.substack.com

There is no easy way to say goodbye

Brčko, Istanbul, Magnolia Row

100

Azra Bihorac @azrabihorac.com · 04/09/2026

Nearly forty years ago Đorđe Balašević wrote three lines in Novi Sad. Jedan D-mol me razvali, neki bi to prosto tugom nazvali, nije to, šta je tuga za D-mol? One D-mol takes me apart. Some would call it sadness. But what is sadness next to D-moll?

100

Azra Bihorac @azrabihorac.com · 04/09/2026

Every one of the five is a cognitive task; the authors say so. Whether AI surpasses us at those tasks in the real world, with real patients, has not been rigorously tested. And if it does, the harder question is still waiting: what did the humans gain?

100

Azra Bihorac @azrabihorac.com · 04/09/2026

Two weeks ago in JAMA: AI alone will soon exceed physicians and AI-aided physicians at five medical tasks, and humans in the loop degrade AI performance. They may or may not be right.

100

Azra Bihorac @azrabihorac.com · 04/09/2026

The electronic record had no field for the bear. The score we calculate to measure her severity of illness did not adjust for it. No algorithm in the room registered it as clinically relevant. It was the most important thing there.

100

Azra Bihorac @azrabihorac.com · 01/09/2026

Well there is a worse scenario- not curly but frizzy and wavy and you are a female - cost you $$$ for Brazilian and keratin … for beauty and love we do things…

000

Azra Bihorac @azrabihorac.com · 30/08/2026

A starter pack for people thinking seriously about AI at the bedside: the clinicians, builders, policy scholars and honest critics I read. Chosen one by one. go.bsky.app/Asvkejm #medsky

000

Azra Bihorac @azrabihorac.com · 30/08/2026

Michael, thank you for this. Two thirds of women report cognitive change through the transition, and almost none of it has been studied as neurology. I wrote about my own third chapter last week; the body arrived there long before the literature did. Glad Bove and Dobson are drawing the map.

000