Yes, OpenEvidence, “the default operating system of medical knowledge in the United States” (their words, emphasis included), is a tech startup zipping through the first phase of enshittification, i.e. attracting users with a high-quality offering. …
I won’t cry for the billionaires involved. I will, however, mourn the opportunity cost of so many smart physicians and programmers on their medical and technical teams spending their time on point-one-percenter enrichment instead of truly building our generation’s PubMed. It would not even require compute! The true value of OE is the curated collection and unrestricted access to peer-reviewed journals, treatment guidelines, and systematic reviews, supplements and all. Let me google all that — or better yet, look it up on Kagi — and I will not care at all for the LLM-generated veneer glued onto man-made knowledge. But good luck having NEJM, JAMA et al. open their vaults without the VC-backed carrot of (I suspect) God knows how many millions of dollars for access rights combined with the FOMO stick that Anthropic and OpenAI’s PR teams have been so diligently whittling.
… the mounds of AI slop added to OE search results aren’t just wasteful, they are dangerous. Back in the Triassic era when shmucks like yours truly were nursing their middle-finger calluses writing progress notes by hand you knew that every part of that note contained useful knowledge. With the electronic medical record mandate — thanks, Obama — much of it became an unreadable mix of computer-generated charts and copypasta; you had to look at the end of the note to find actual human thought, whether it is in the Assessment and Plan or the Attending Addendum section. Well, I can report from the front lines that much of the time even that one meager paragraph has become a copy/paste job carrying with it that distinct LLM waft.
I am not against using LLMs for progress notes — we have been using human scribes for decades to write up the facts of the doctor-patient encounter. But those are costly and your rural primary care physician certainly won’t have one, so why not delegate that work to AI? The assessment and plan, however, are where you infuse those facts with meaning and then act on them, which is the entire purpose of the physician’s job. Writing is thinking and millions of US medical professionals have decided to delegate the one job they have to AI while keeping all the moral and legal responsibility, reverse-centauring themselves willingly and with eyes wide open.