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I think you are missing the point here. what matters is for that user the local models are good enough for their use case.


this is one of the most popular options. Self hosted. https://immich.app/


> "An AI and a pair of human doctors were each given the same standard electronic health record to read"

This is handicapping the human doctors abilities. There is a lot more information a human doctor can gather even with a brief observation of the patient.


On the other hand,

> there are few things as dangerous as an expert with access to open-ended data that can be interpreted wildly, like a clinical interview.

https://entropicthoughts.com/arithmetic-models-better-than-y...


They have covered this in the article.

> But it is not curtains for emergency doctors yet, the researchers said. The study only tested humans against AIs looking at patient data that can be communicated via text. The AI’s reading of signals, such as the patient’s level of distress and their visual appearance, were not tested. That means the AI was performing more like a clinician producing a second opinion based on paperwork.


> The study only tested humans against AIs looking at patient data that can be communicated via text.

This is like saying that LLMs can evaluate paintings better than art experts. But only when looking at data that can be communicated via text.

Of course they can, because it makes no sense to do such a thing.


> That means the AI was performing more like a clinician producing a second opinion based on paperwork.

That actually seems like a good application – automatically get a quick AI second opinion for everything; if it's dissenting the first/human medic can re-review, or comment why it's slop, or get a third/second-human opinion.

(I'm assuming most cases would be You're absolutely right, that's an astute diagnosis.)


Agreed. I think the best use of this sort of tech is to use both to their strengths. Use AI to go over the record and suggest diagnoses which you have the doctor review after observing the patient.

The other thing is that common issues are common. I have to wonder how much that ultimately biases both the doctor and the LLM. If you diagnose someone that comes in with a runny nose and cough as having the flu you will likely be right most of the time.


You could say the same about the Ai. Ai is incredibly well suited for extracting knowledge through chats.

In this regard. A doctor also just have 15 minutes for an interview. An Ai can be with the patient for days leading up to a consultation.

So if we remove this "handicap" this Ai will likely really start to win.


Chat seems like a really bad way to get patient information. You'll miss out on various cues doctors will use to diagnose you. People can get ashamed of their symptoms and may try to hide them.


It’s not good for a doctor to be your best friend. It doesn’t seem any LLM is capable of that emotional distance.


It’s the ER. People aren’t always in a position to “chat” when they go there.


You think current ER people work in complete silence? No words uttered?


You think that they have “days leading up to consultation”? Please don’t be so disingenuous; I’m sure you know exactly what the person you’re replying to meant.


> I’m sure you know exactly what the person you’re replying to meant.

No.

There are a lot of different modus operandi, and you can always find an outlier.

> Please don’t be so disingenuous;

Ditto


My doctor makes me wait for weeks, then googles my symptoms in front of me, asks me if I checked on the internet first before I came and then gives me the first google result as an answer, as well as suggests me to wait longer. He does this several times.

When I got tired of this I just lied to the emergency line and was admitted to hospital based on my lie, and they discovered a brain tumor which explained the other stuff.

I WISH I could just use AI.


This feels like a deeply important observation. Now also, would be interesting to include e.g. a short video or photograph for the AI to use as well.


Can't the same be said for the AI?


If the answer is yes, let’s see that study.

This one compares AI to a human doctor practicing in a very unrealistic way.


No? Can an AI examine a patient in the physical world?


Why not?


Bonus, health networks now push doctors to use AI transcription software for the EHR entries. Doctors and nurses like it because they don't have to type it up. But it is a complete shitshow on whether the records are reviewed for transcription errors which happen quite often

Now feed a flawed transcripted into an AI diagnosis system and bam-o. The AI will treat it as gospel, while the doctor may go wait what.


So o1 can do more with less?


> did anyone on the team really not push back?

This is the real question. If they are serious about not doing something like this again, they NEED to look at what process failed and let something like this get proposed, designed, implemented and pushed to production. Usually things get reviewed at each stage. Did the people who pushed back on this get steam rolled? If no one pushed back, that's an even serious culture question and the entire org would need training.

A serious "we won't do it again", needs to be accompanied by a COE on this for identifying what went wrong, and identifying what guardrails can be put in place and then actually implementing them.


> did anyone on the team really not push back?

That's a tough one. In the big meeting? In the small meeting? "Officially" push back? Encouraged to make the push back unofficial? Etc. Even just internally, it can be hard to quantify. From internal > external, more so.


This so much.

The number of times I’ve had to defend someone else’s customers let alone my own is exhausting.

And that dynamic is only allowed within close circles.

I’ve found once “the decision” is made, the bigger the subsequent meeting, protests are often swept under the rug.

On most occasions the worst part is that folks intentionally withhold information to get their way. And thats real hard to compete against without making an ass out of yourself, or losing the trust of others.

This is why core principals matter so much.


It seems like this was implemented as a way to insert tips, and then abused to insert ads, so the developers involved might not have been aware of that part until later?


> Owning the decision

Owning a decision means you have something at stake if things go wrong. What would happen to Jack if this decision turns out to be wrong? Any consequences?


Owning stock?


> I've worked at companies that are literally 10x more effective than other competitors in the market purely due to good engineering practices.

Most big tech companies get taken over by leadership with no tech background eventually and the engineering bar drops to the floor.


Are the model weights burned into the silicon / part of the architecture? Or can you update the model weights on these chips? If they cannot be updated, these chips will be outdated the moment they are made given the breakneck speed at which new and improved models are introduced.


https://en.wikipedia.org/wiki/Who_Killed_the_Electric_Car%3F

https://www.youtube.com/watch?v=uep5zOrsAEA

Incredible documentary about the politics around EV's made before Tesla's became mainstream.

People were demanding and protesting asking GM to let time buy their EV'1 after the lease, but they destroyed all the cars. So did Toyota for the EV RAV4's.


I drove a electric Rav4, but couldn't stomach the 40 mile range for the price. But it was a fun car, and it seemed huge (compared to my miata).


> It's all a sliding slope until it reaches a breaking point and falls off like a cliff.

Would it be a gradual decline or a step change after some point?


> A Claude Code subscription should not work with other software.

why not though? aren't you paying for the model usage regardless of the client you use?


No, you are paying to use Claude code… it uses the model underneath, but you aren’t paying for raw model usage. For whatever reason, Anthropic thinks this is the best way to divide up their market.

They want to charge more for direct access to the model.


> No, you are paying to use Claude code

Why would anyone pay a subscription for barebones LLM agent?

You can beat that drum all you want, but you know it's bullshit. People pay the subscription for the AI, not the tool that consumes it. That tool being crap is why everyone started using third-party tools.

The reason they are blocking third-party usage is they want developers to use only their models and no competitors.


Except if you pay the per-token rate, it will work just fine with the other tools. It is only the subscription that doesn’t work.


That's not up to you or me. I think it's pretty clear by the phrase "Claude Code subscription" that it's meant for only "Claude Code". Why are you confused?

This could be so easily abused by companies who spend thousands of dollars per month for API costs you could just reverse engineer it and use the subscription tokens to get that down to a few hundred


That phrase isn't the official one. It's "The Max Plan" which "combines Claude Desktop and mobile apps and Claude Code in one subscription".


Yes, so... pretty clearly not OpenCode.


Yeah, exactly.


It’s like saying Netflix is wrong to require an official Netflix client to access their service. Total dud of an argument if you ask me.


Well, they are wrong, and the argument is still a dud.


Netflix would not even exist if you could just freely download all of the media to your computer and play it anytime because of licensing agreements and other factors. So you can think that they are wrong but that's not really rooted in reality or practicality.


That is possible, was always possible, and will continue to be possible, judging by the availability of 4K rips available via piracy.


Can I script and scrape Claude Code to provide the exact same data for consumption by the banned client? (This sounds like an interesting challenge for Claude Code to try...)


Yes they even offer an SDK for it now so "scraping" is not required


Claude Code provides a headless mode that you can do this exact same thing with:

$ claude -p “fix the eslint in file XYZ”


I don't think they are confused. They are simply challenging the assertion that the model should not work with other software. Which is fair because there is a lot of precedent around whether a service can dictate how it must be consumed. It's not a simple answer and there are good reasons for both sides. Whichever path we take will have wide consequences and shape our future in a very distinct way. So it is an important decision, and ultimately up to us, as a society to influence and guide.


"challenging the assertion that the model should not work with other software"

This has nothing to do with "the model". You can use "the models" through the API for anything.

This has to do with access to a specific product being abused to then get low-cost API access for other use cases


IDK if Anthropic wants to offer a service at below cost, I don't think they should gate keep which client you access that service over. Or in other terms, I won't use a service that locks me into a client I don't like.


How do you draw that conclusion? If Anthropic wants to offer a service at below cost, they seem a lot more justified in restricting how and where they subsidize usage.


Yeah fair, I could've chosen better words. My conclusion is: "I don't want to pay for that", not "they shouldn't be able to do that".


> IDK if Anthropic wants to offer a service at below cost, I don't think they should gate keep which client you access that service over.

Are you going to say why you think they shouldn't? You didn't give a reason.


That seems mutual. They don’t want you to use this service with an arbitrary client and you don’t want to use this service that won’t allow an arbitrary client. So both of you don’t want the relationship. Seems fine.

For my part, I’m fine understanding that bundling allows for discounting and I would prefer to enable that.


> Or in other terms, I won't use a service that locks me into a client I don't like.

Then don't! Or just use the API which doesn't lock you into any client.


But they get telemetry, feedback, good will, etc. That’s one reason why usage is discounted to a subscription fee.


They don't get any telemetry or feedback data from me, as I've turned all that off. So why should I be limited to CC?


If you don’t want to use CC, just use the API


Good will, huh?


You don’t think Claude Code has generated good will for Anthropic? People just liking a brand is powerful.


I don't think this move is generating good will.


A tiny minority being inconvenienced because they are breaking terms of use is fine for them vs pricing claude subscriptions at the true cost.


> aren't you paying for the model usage

No, you’re paying for “Claude Code” usage.


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