[ecosystem]

The American Medical Association owns copyright to all the codes and their descriptions. They have an extremely restrictive and expensive licensing options and they strictly forbid training models with the codes.

This month, the practice was called out (https://www.help.senate.gov/rep/newsroom/press/chair-cassidy...) so the Overton window may be opening.

The AMA (a nonprofit!) clears ~$300M/year revenue from the codes, which is the direct cost passed through to consumers, but the indirect costs are the byzantine nightmare of OP.

[pbhjpbhj]

A code is not an artistic expression and so can't be copyrightable. The layout of a book of codes, for sure, but the information in it... might be protectable with other IPR but not copyright.

Does not stop people threatening you though.

This is my opinion only, not legal advice, and does not relate to my employment.

[fsckboy]

>A code is not an artistic expression and so can't be copyrightable.

that was changed

https://www.bitlaw.com/copyright/database.html

Databases are generally protected by copyright law as compilations. Under the Copyright Act, a compilation is defined as a "collection and assembling of preexisting materials or of data that are selected in such a way that the resulting work as a whole constitutes an original work of authorship." 17. U.S.C. § 101. The preexisting materials or data may be protected by copyright, or may be unprotectable facts or ideas (see the BitLaw discussion on unprotected ideas for more information).

(I did not use AI, but this appeared at the top of my search and I think the search engine used AI to generate it):

In the European Union, databases are protected under the Database Directive, which provides legal protection based on the originality of the selection or arrangement of their contents...Some countries offer additional protections for databases that do not meet the originality requirement, often through sui generis rights.

[marcosdumay]

That means the organization and selection of data is copyrightable, and only if they are creative. If you write your own tags for the codes, and makes a compilation of them all, none of that will cover your database.

[hedora]

Also, I think the bitlaw interpretation is incorrect. “Sweat of the brow” doesn’t magically produce copyright protection, and they don’t mention that.

Taking their example, if you had a collections from quotes from presidents, and I got a bunch of similar collections, then made my own ultimate definitive collection based partially on your list, then there’s very little chance I’d be liable for violating your copyright. If I copied the list and typesetting verbatim, you’d have a better case.

Also, modern rulings about LLM training (the topic of this thread) certainly mean copyrights on compilations of facts don’t survive training + inference cycles.

[fsckboy]

>“Sweat of the brow” doesn’t magically produce copyright protection

...then you go on to make the "sweat of the brow" argument

"typesetting" doesn't enter into it, "database" is meant to include the computerized version

[fsckboy]

creation of a database is a creative act

[gpm]

Judging by Judge Alsup's ruling even if the codes were copyrighted it would most likely not be copyright infringement to train on them either, and as such even if they are copyrightable and they do own copyright on them it remains beyond their abilities to forbid training on them. (Also opinion, also not legal advice, I'm also not a lawyer and sort of doubt the person I'm responding to is).

[themafia]

> not be copyright infringement to train on them either

Copyright is about reproduction. It does not cover uses. Once you bought it, it's yours, as long as you don't reproduce it outside of fair use.

The problem with most language models is they will often uncritically reproduce significant portions of copyrighted works.

[MostlyStable]

If you buy the codes, yes. If you only license them (which is what the original comment claims is the only way to get them legally), and that license explicitly forbids training, that seems to be less clear-cut. I have no idea if such restrictions are legal or would hold up to challenge, but it's less clear than the case where you buy a book and can then do whatever you want with it.

[pbhjpbhj]

IANAL, you're right.

[Zambyte]

Software I write at work is not artistic expression yet is covered by copyright.

This isn't a counter argument, just pointing out how absurd copyright is.

[jimbokun]

Your software is definitely artistic expression. You signed over the rights to those expressions to your employer.

(IANAL)

[Zambyte]

My software is definitely not artistic expression. I signed over the rights to the software to my employer. These statements are not codependent in any way.

[hamdingers]

Always disappointing to hear creative writers denigrate their craft just because their main audience happens to be computers.

[kemitchell]

Copyright under US law does not require "artistic expression". One of the requirements is called "creativity", but it's very easy to meet. The key phrase is literally "some minimal degree of creativity".

The fundamental policy choice was to protect computer software under intellectual property law, with exclusive rights and market compensation. There were a number of ways that could have been done. Other jurisdictions toyed with new, software-specific laws. But in the end the call in the US was to bring it under existing copyright law with some tweaks to definitions and a small handful of software-specific rules.

[fluoridation]

A code in this sense is something different. It's a shorthand for a longer description of an object. It'd be like a hotel copyrighting the relationship between a room number and its physical location within the building, or copyrighting resistor colors.

[Zambyte]

I understand. The different meanings of "code" in this conversation is why I said "software" in my comment instead of code.

Copyrighting software is as absurd the other things you listed.

[papercrane]

In the US copyright just requires a level of originality. The bar isn't very high, but for example simple logos, like IBMs blue lines logo is not copyrightable.

There are examples of software code that is probably not copyrightable, but that's limited to very simple code that has only obvious implementations.

[fluoridation]

>Copyrighting software is as absurd the other things you listed.

I don't really agree, and for context I think copyright in general is nonsense.

[hathawsh]

Consider these thoughts: https://wiki.c2.com/?SoftwareIsArt

[Zambyte]

Our role as programmers being closer to artists than engineers does not make code closer to paintings than bridges. We do have highly repeatable patterns. Nearly every program can be essentially boiled down to some subset of CRUD + tranformation.

Even if it is art (I'm not convinced), the recent artificial scarcity on art is absurd. Some other thoughts to consider:

- https://drewdevault.com/2020/08/24/Alice-in-Wonderland.html

- https://drewdevault.com/2021/12/23/Sustainable-creativity-po...

[hamdingers]

I've never seen a bridge I wouldn't consider a work of art either.

[embedding-shape]

Also the collection of essays carrying the name "Hackers & Painters" is of relevance.

[maxerickson]

Artistic expression isn't the standard in US law.

[philipallstar]

> The layout of a book of codes, for sure, but the information in it

Are you talking about copyright here? It sounds more like design protection.

Wouldn't the book be as copyrightable as any other non-fiction work?

[pbhjpbhj]

The work I know of, I'm not in USA only have an interest in copyright laws in general, is Feist v Rural Telephone (1991) -- which appears to mirror codes for health procedures quite closely; but not exactly.

There's old but more recent law from Practice Management v AMA (1997) supporting that AMA's codes can't be copyrightable as they're part of legislation.

Berne's Art 2(8), to which USA are signed, related to non-copyright of facts.

I'm afraid I'm not appraised of the full situation, however.

[adriand]

No - see https://en.wikipedia.org/wiki/Feist_Publications%2C_Inc._v._....

[onionisafruit]

And yet people are collectively paying $300M licensing these non-copyrightable codes? With that kind of money somebody must have looked into not paying for licensing

[mr_toad]

I’m sure it’s crossed the mind of many people in the industry. But it’s a comprehensive taxonomy of all diseases, medical conditions, causes, procedures and treatments. Starting from scratch would be much more expensive than just paying the licensing.

[sowbug]

Here in California, Senate Bill 478 bans many junk fees, such as the mandatory "service fee" to buy a concert ticket. It's a stretch, but I could see an argument that if hospitals use a billing system that's incomprehensible without licensing an expensive codex, then the hospital is on the hook to provide the codex to you.

Fight fire with fire.

[onionisafruit]

What I mean is using it without paying the license, because if GP is accurate there is no copyright preventing it.

[mr_toad]

In that case its probably cheaper for most organisations just to pay the license fees than risk paying legal fees which would probably be more, even if they won.

[BurningFrog]

It's important to understand that a "nonprofit" can be just as greedy as any other organization.

It can't pay out profits to shareholders, but it can hire its owners as employees and pay them any number of millions.

[broguinn]

Doesn't the AMA serve the medical industry? They don't have to make profits themselves. If a byzantine coding process raises medical treatment costs, they'll do it. Just like how they intentionally cap med school admissions to keep doctors in demand and inflate their salaries.

[BurningFrog]

The AMA is functionally the trade union for doctors. They work to maximize the income of their members. Maintaining a shortage of doctors is one of their primary tools.

If this also helps the medical industry, it's an accidental side effect.

[antisthenes]

Any non-profit can always claim to inflate their expenditures up to (and above) their expenses and pay lavish bonuses to their employees, like you said.

Doesn't change what it basically is - aka Scamming the Public, and privatising the gains.

[GrinningFool]

Reading between the lines, it seems like this is a threat made to bring AMA in line with the administration's policies around medically supporting transgender people.

I would expect that if (when) the AMA folds on the matter, concerns around the codes will be somehow forgotten

[ecosystem]

Probably, but it wouldn't be the first time an axe grinding broke a sponsored monopoly.

[tw04]

>This month, the practice was called out (https://www.help.senate.gov/rep/newsroom/press/chair-cassidy...) so the Overton window may be opening.

So you think the same Senate that is planning on gutting healthcare for millions of Americans is going to go after the AMA billing codes? Is this real life? They MIGHT demand some donations to the ballroom, but I doubt they care enough to even do that.

Ahh, here's the correct link and as I suspected, this has absolutely nothing to do with reducing healthcare costs for the average american. It is a direct attack on the AMA for advocating for supportive care for transgender citizens.

https://www.help.senate.gov/rep/newsroom/press/chair-cassidy...

With opinions like this, you can rest assured Cassidy is concerned with healthcare costs for the average citizen:

>This comes after Cassidy denounced the AMA for defying President Trump’s Executive Order by promoting gender mutilation and castration of children.

[like_any_other]

So what you're saying is the AMA is openly hostile to Americans.

[antisthenes]

Anything related to healthcare (except some genuine minority of doctors and staff) is almost openly hostile to Americans.

I used to think American healthcare was in part expensive because Americans have poor health (e.g. high obesity).

Now I am beginning to think that Americans have poor health by design for the healthcare industry to be able to maximize their profits. Making some Americans healthy just seems to be a side product.

[kldg]

I will throw a story out here because I don't know where else to put it and want it off my chest (I will leave a lot out of this):

Daughter tried suicide a few weeks ago. "It was not a serious attempt," but obviously it is. We go to only local hospital; they don't have a pediatric unit, so ER basically just looks at her and aren't sure what to do because it's not like she's bleeding out. They clean the cuts and ask if I want county behavioral health involved. I'm in over my head and need help, so I say yes.

Behavioral health mobile response person comes out -- good guy, made me see something I hadn't prior -- because I've had her in therapy for half a year prior but we weren't really making much progress on anxiety/depression issues -- but he says we weren't going to get anywhere with therapy before drugs, that she was too far out, and in retrospect that was absolutely the right call. Anyway, he puts her on 72-hours mandatory hold. Here, this means the child must be transferred to a pediatric health facility with suicide watch and psychiatric services. This became a big problem.

Cincinnati Childrens Hospital had no beds (and I have ill will toward them anyway). Dayton had no beds. Charge nurse was calling people for hours and hours, and I joined in calling places (we stayed at hospital the whole time without sleeping), and it wasn't until 24 hours after admission we're finally transferred. My mom was/is a social worker for those with developmental disabilities, and spent about a decade working at long-term facilities for juveniles, where it was almost always court-ordered. I spent a fair bit of my time there for economic/childcare reasons while she was working -- awful place for the kids (not for me; I hung out in staff rooms and watched movies). Doors, by law, could not be locked, and they were terribly understaffed; violence and rape was expected. We had a second person from county behavioral come out, and once I realized the only kinds of places open to us, started pleading and insisting to have the hold lifted, but they refused. I wind up with one out-of-state option, and one in-state; both about an hour and a half away, and both the kinds of facilities I was terrified of. I later talked to other parents and was surprised to find time to find a facility, lack of beds, and travel time were all common issues between us. I went for visitation every day, and at least one adult would almost always come out of visitation crying, not realizing these places are poorly-staffed, unsafe prisons until they first visit and talk with their kid.

Anyway, so the 72-hour clock starts only once daughter's transferred to this pediatric psych facility (she wound up staying for 5 days; this is a whole other issue where they had no social worker available to provide AMA paperwork, they claimed). -And this place is a long-term juvenile psych facility, so it tends to have a lot of kids who were sentenced by courts to be there; violent offenders, but it was a mix (daughter has a story about playing Uno with a kid experiencing "weed psychosis", which'd I'd never heard of before; interesting stuff). You know, so I'm going to bed every night, and I've got some wild nightmares I could share -- BUT everything turned out mostly fine. At one point, daughter witnessed staff slam a kid against the wall hard enough for him to bleed from the head, and didn't clean the blood off the wall; the toilet in her room didn't work and the room smelled like feces; they couldn't lock doors, and the facility was severely understaffed. A recipe for disaster, but it could have been a LOT worse than it was, though trauma is there nonetheless from the experience.

Now, the reason the county insisted on sending her to this hellhole is because it's the only way to unlock county behavioral services. You must first have committed an attempt to harm yourself or someone else, or be ordered by courts. I wrote at the beginning I was able to get a counselor before all this, but this took a lot of emails and phone calls, and the place I found with help required 2 hours on the road per visit. The person I got was new in the field and didn't specialize in pediatric; he was not a licensed psychologist nor psychiatrist, but he was the only person I could get and I was grateful for any assist. There were/are no available pediatric psychiatrists or psychologists EXCEPT through county behavioral; they have them all locked away from the market, basically.

The total bill for all this, by the way (uninsured, cash, including the ambulance) was $8,709.45. I didn't negotiate; I've planned for this, I took out $20k from broker on the first day I got to go home. Money isn't the issue; it's the non-availability of service which's the real problem here, for us. I was surprised to walk into county behavioral and be told while registering at front desk they don't accept self-pay; that they aren't set up for it. I've never run into this before, and it got a morbid chuckle out of me because this's been a heck of a roll of the dice up to now, specifically to get in county services, and now I'm told they don't offer anything for us.

I ask for the people who insisted on the 72-hour hold (and btw, the facility which held daughter prescribed nothing but an antihistamine, with trauma inflicted, though minor; worthless experience except to unlock services) to speak with me, and I get one of them. She talks to supervisor, and apparently nobody knows their own policies because they do, in fact, accept self-pay. I had to fill out a Medicaid form, which we don't qualify for. Now, the strange part about this is if you have insurance (and this is why they have you apply for Medicaid), they charge you on a sliding scale, but if you don't have any insurance and get rejected by Medicaid, they really don't have any system set up to bill you, so everything's free. The psychiatrist and counselor both are free; it's crazy, so I'll kick some money to food pantries while SNAP's cut off in the state due to federal shutdown, but it's like nobody's ever really thought through the systems we have for healthcare; it's inefficient and brittle from every angle, not just the providers/insurers screwing people over for capitalism angle; like a proof-of-concept someone slapped together over a weekend where everyone's spinning their wheels without a clue what to do, except it's something we've had for centuries and are spending $trillions/year on. -And every time the government provides new weapons or issues new mandates, it somehow seems to get worse.

(Things are going well now, btw; we got a real psychologist scheduled same-day, and first appointment with psychiatrist was 2-3 days after intake. She's doing better, but the journey here was straight Hell.)

[almosthere]

It has been forever, what planet are you on? Their official policy would be to make any native american cure (upon which many of the medications we use from big pharma, are based on in origin) to be illegal. They would want all profit going through them, whether that is good for you or not.

[aqme28]

It’s quite literally a cartel and it acts like one. They heavily restrict the supply of doctors, which means our medical costs are higher in favor of higher doctor salaries.

[DesiLurker]

and imagine doing that to earn just $300M thats like a dollar per citizen.

[red-iron-pine]

take a look at the Fortune 100 list and notice how many healthcare companies are in the top 20

the AMA is their homie and is sponsored by them

[iAMkenough]

You could argue the lawmakers that granted copyright protections are openly hostile to Americans. Many fine people are saying that Congress values profits over people.

[newZWhoDis]

Insurance companies get a lot of (deserved) hate, but the doctor cartel seems to skate on by in the eyes of the public.

The white coats are far from blameless here.

[RandallBrown]

Google tells me that the AMA made about 468 million last year in revenue. If they made that much from the codes it seems like they wouldn't necessarily pass the IRS Public Support test. (Unless somehow this licensing counts as "public support."

I seem to remember this test is why the Mozilla Foundation and the Mozilla Corporation exist, but I could be mistaken.

Edit: Seems that the AMA is a 501c6, which is a different kind of non profit.

[ecosystem]

Right, it seems a lot like the public support test fails for the AMA -- their purpose and actions are highly misaligned on CPTs, but IANAL.

[mr_toad]

> extremely restrictive and expensive licensing options

The license is meaningless if training AI is considered fair use, and if you never agreed to the license.

They might be able to lean heavily on medical researchers and the like (who probably need a license for other uses), but when push comes to shove I suspect Google and OpenAI would win.

[ecosystem]

The bigger issue is software development, imo. eg the IT team at a hospital or the medical office can't build a tool to help coding efficiency or accuracy. Further, public resources/websites with code-related information get DMCA takedowns. It's a stranglehold on innovation/progress.

[almosthere]

A subscriber of the code can use it agentically by using snomed,icd,cpt etc.. in their official capacity to look up meanings.

It would also be permissible to search existing records and prices (if an actor has them) to cross check average prices for some procedure.

[topaz0]

$300M/year is less than $1 per person. This is not why healthcare is expensive.

[paulryanrogers]

The opaque costs add up. If nothing else all the layers make things slow, when time is the difference between life/health and death/illness.

[ecosystem]

It's ~$1/person direct, but how much indirect cost? Things become inexpensive when automation and technological progress makes them so, and the code copyright and restriction is a major barrier to do that.

[Danjoe4]

Quick guys someone make an MCP server with the codes. Fuck em!

[bnjms]

I have heard this also how some state law works. That it’s difficult to directly reference state law or relevant information which define the meaning of state law.

[datavirtue]

The codes are data. The restrictions are empty threats.