Clinical large language models with misplaced focus

On 12 September 2024, OpenAI released two new large language models (LLMs) — o1-preview and o1-mini — marking an important shift in the competitive landscape of commercial LLMs, particularly concerning their reasoning capabilities. Since the introduction of GPT-3.5, OpenAI has launched 31 LLMs in two years. Researchers are rapidly applying these evolving commercial models in clinical medicine, achieving results that sometimes exceed human performance in specific tasks. Although such success is encouraging, the development of the models used for these tasks may not align with the characteristics and needs of clinical practice.

LLMs can be categorized as either open-source or closed-source. Open-source models, such as Meta’s Llama, allow developers to access source code, training data and documentation freely. By contrast, closed-source models are accessed only through official channels or application programming interfaces (APIs). Initially, open-source models dominated the LLM landscape, until the release of OpenAI’s GPT-3 in 2020¹, which attracted considerable commercial interest and shifted focus towards closed-source approaches².