Artificial intelligence (AI) tools such as ChatGPT have hundreds of millions of users—but are they medically safe and reliable? Chris Stokel-Walker asks patients and physicians about the benefits and risks in an AI world In August this year Hayley Brackley lost a large part of her vision, completely out of the blue. She’d gone to her local chemist with eye pain, and a prescribing pharmacist diagnosed sinusitis. She took the recommended medicine to try to resolve the pain, but it began affecting her ability to see. Her first thought was to turn to ChatGPT for advice on what to do next. The chatbot advised her to go back and get the problem checked out more, which she did. Further examination by an optician found that she had significant inflammation and a haemorrhage in her optic nerve, which is currently being treated. It’s not surprising that Brackley’s first port of call was ChatGPT. She prefers ChatGPT to a search engine such as Google because it can hold a conversation and more quickly find the information she wants. She’s not alone: 200 million of us use the world’s most popular generative AI chatbot every day.1 Neither is it surprising that, before her meeting with the eye consultant in which her condition was diagnosed, she sought to use ChatGPT to see what sorts of questions might be asked. Brackley has attention deficit/hyperactivity disorder (ADHD) and autism, and she thought that being forewarned about what she might be asked could help her in the interaction. But this begs several questions. Should patients be using AI tools? How should the healthcare system react to patients using a new, often untested, tool in addition to human diagnoses? And what does patients’ use of AI tell us about the gaps in the health service and how …
{"title":"How patients are using AI","authors":"Chris Stokel-Walker","doi":"10.1136/bmj.q2393","DOIUrl":"https://doi.org/10.1136/bmj.q2393","url":null,"abstract":"Artificial intelligence (AI) tools such as ChatGPT have hundreds of millions of users—but are they medically safe and reliable? Chris Stokel-Walker asks patients and physicians about the benefits and risks in an AI world In August this year Hayley Brackley lost a large part of her vision, completely out of the blue. She’d gone to her local chemist with eye pain, and a prescribing pharmacist diagnosed sinusitis. She took the recommended medicine to try to resolve the pain, but it began affecting her ability to see. Her first thought was to turn to ChatGPT for advice on what to do next. The chatbot advised her to go back and get the problem checked out more, which she did. Further examination by an optician found that she had significant inflammation and a haemorrhage in her optic nerve, which is currently being treated. It’s not surprising that Brackley’s first port of call was ChatGPT. She prefers ChatGPT to a search engine such as Google because it can hold a conversation and more quickly find the information she wants. She’s not alone: 200 million of us use the world’s most popular generative AI chatbot every day.1 Neither is it surprising that, before her meeting with the eye consultant in which her condition was diagnosed, she sought to use ChatGPT to see what sorts of questions might be asked. Brackley has attention deficit/hyperactivity disorder (ADHD) and autism, and she thought that being forewarned about what she might be asked could help her in the interaction. But this begs several questions. Should patients be using AI tools? How should the healthcare system react to patients using a new, often untested, tool in addition to human diagnoses? And what does patients’ use of AI tell us about the gaps in the health service and how …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Watkin was a firm believer in the importance of teaching, but he felt that the training he received was inadequate. “The number of operations for which a consultant directly supervised me could be counted on the fingers of one hand,” he wrote. He worked tirelessly to do better for his staff—and not just doctors and medical students. Shortly after taking up his consultant post in general surgery at Leicester Royal Infirmary in 1971, he set up training for intensive care nurses and created a course for the new grade of operating department assistants. When he was appointed inaugural clinical subdean for the new Leicester Medical School, which opened in 1975, he was given a free hand to set up clinical training, which included designing the course, allocating clinical attachments, running the exams, and caring for the students. He believed in the importance of …
{"title":"David Watkin: General surgeon who improved surgical training and helped establish the Leicester Medical School","authors":"Sally Watkin","doi":"10.1136/bmj.q2562","DOIUrl":"https://doi.org/10.1136/bmj.q2562","url":null,"abstract":"David Watkin was a firm believer in the importance of teaching, but he felt that the training he received was inadequate. “The number of operations for which a consultant directly supervised me could be counted on the fingers of one hand,” he wrote. He worked tirelessly to do better for his staff—and not just doctors and medical students. Shortly after taking up his consultant post in general surgery at Leicester Royal Infirmary in 1971, he set up training for intensive care nurses and created a course for the new grade of operating department assistants. When he was appointed inaugural clinical subdean for the new Leicester Medical School, which opened in 1975, he was given a free hand to set up clinical training, which included designing the course, allocating clinical attachments, running the exams, and caring for the students. He believed in the importance of …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chris van Tulleken, Nigel Rollins, Rebecca Coombes
Harmful industries still exert their influence over health professionals, academia, and health systems; robust change is required, write Chris van Tulleken, Nigel Rollins, and Rebecca Coombes In the 1950s, smoking was proven beyond doubt to cause cancer and yet efforts to curb this pandemic were stalled over the next half century by a network of individuals and institutions with competing interests. The industry paid doctors, academics, charities, and policy makers to dilute and distort the science and public health messaging.1 By the 1980s, the largest tobacco companies bought the largest food companies2 and used the same methods to create a food environment where poor diet has overtaken tobacco as the leading cause of early death globally.3 Food and tobacco are just two of the industries that use their economic power to evade effective regulation; food, alcohol, pharmaceuticals, gambling, and fossil fuels, among others, have the same commercial incentives and obligations as the tobacco industry and directly impact human and planetary health. The World Health Organization (WHO) has defined these commercial determinants of health as “…private sector activities that affect people’s health, directly or indirectly, positively or negatively”. To varying degrees, all these industries fund and partner with those that would regulate them. From de facto regulators, including charities, press offices, health professional associations, academic departments, doctors, and influencers, to formal …
{"title":"Conflicts of interest: moving towards zero tolerance","authors":"Chris van Tulleken, Nigel Rollins, Rebecca Coombes","doi":"10.1136/bmj.q2574","DOIUrl":"https://doi.org/10.1136/bmj.q2574","url":null,"abstract":"Harmful industries still exert their influence over health professionals, academia, and health systems; robust change is required, write Chris van Tulleken, Nigel Rollins, and Rebecca Coombes In the 1950s, smoking was proven beyond doubt to cause cancer and yet efforts to curb this pandemic were stalled over the next half century by a network of individuals and institutions with competing interests. The industry paid doctors, academics, charities, and policy makers to dilute and distort the science and public health messaging.1 By the 1980s, the largest tobacco companies bought the largest food companies2 and used the same methods to create a food environment where poor diet has overtaken tobacco as the leading cause of early death globally.3 Food and tobacco are just two of the industries that use their economic power to evade effective regulation; food, alcohol, pharmaceuticals, gambling, and fossil fuels, among others, have the same commercial incentives and obligations as the tobacco industry and directly impact human and planetary health. The World Health Organization (WHO) has defined these commercial determinants of health as “…private sector activities that affect people’s health, directly or indirectly, positively or negatively”. To varying degrees, all these industries fund and partner with those that would regulate them. From de facto regulators, including charities, press offices, health professional associations, academic departments, doctors, and influencers, to formal …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A grassroots food assistance programme in Brazil that grew out of the pandemic is now trying to counter obesity and other diseases of poverty. Rodrigo de Oliveira Andrade reports “When the covid-19 pandemic began, I knew Brazil would face a battle against hunger,” says Adriana Salay Leme, a historian in the city of São Paulo. So when their restaurant was forced to shut during the pandemic, Leme and her husband, the chef Rodrigo Oliveira, started feeding people living in Vila Medeiros, a poor neighbourhood on the outskirts of the city, helping to spawn a mass movement for distributing free meals to people affected by the pandemic. “We closed in March 2020 in compliance with the emergency measures, and the next day we started serving free lunch boxes from the front door,” Leme tells The BMJ . This is how the project “Quebrada Alimentada” (Feed the outskirts) was born. Today, in addition to daily lunch boxes, Quebrada Alimentada distributes monthly basic food hampers to around 260 families in Vila Medeiros, including in Jardim Julieta, an informal settlement that formed during the pandemic in mid-2020. Similar solidarity kitchens, as this sort of initiative has been dubbed, have proliferated across the country, providing not just food but education and health access to the most vulnerable people—and inspiring government funding for a scheme. Brazil was once a global leader in the fight against hunger. Between 2004 and 2013, government policies aimed at eradicating poverty reduced the …
{"title":"Solidarity kitchens: how pandemic food assistance developed to offer much more","authors":"Rodrigo de Oliveira Andrade","doi":"10.1136/bmj.q2462","DOIUrl":"https://doi.org/10.1136/bmj.q2462","url":null,"abstract":"A grassroots food assistance programme in Brazil that grew out of the pandemic is now trying to counter obesity and other diseases of poverty. Rodrigo de Oliveira Andrade reports “When the covid-19 pandemic began, I knew Brazil would face a battle against hunger,” says Adriana Salay Leme, a historian in the city of São Paulo. So when their restaurant was forced to shut during the pandemic, Leme and her husband, the chef Rodrigo Oliveira, started feeding people living in Vila Medeiros, a poor neighbourhood on the outskirts of the city, helping to spawn a mass movement for distributing free meals to people affected by the pandemic. “We closed in March 2020 in compliance with the emergency measures, and the next day we started serving free lunch boxes from the front door,” Leme tells The BMJ . This is how the project “Quebrada Alimentada” (Feed the outskirts) was born. Today, in addition to daily lunch boxes, Quebrada Alimentada distributes monthly basic food hampers to around 260 families in Vila Medeiros, including in Jardim Julieta, an informal settlement that formed during the pandemic in mid-2020. Similar solidarity kitchens, as this sort of initiative has been dubbed, have proliferated across the country, providing not just food but education and health access to the most vulnerable people—and inspiring government funding for a scheme. Brazil was once a global leader in the fight against hunger. Between 2004 and 2013, government policies aimed at eradicating poverty reduced the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"128 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mollet and colleagues discuss oral health in children.1 Due attention is paid to oral health as a component of the World Health Organization’s global strategy and action plan, including a focus on a “rights based approach” to motivate and challenge policy makers to tackle the root causes of poor oral health. Domestically, children’s …
{"title":"Vaping and children’s oral health","authors":"Daniel J Chivers","doi":"10.1136/bmj.q2514","DOIUrl":"https://doi.org/10.1136/bmj.q2514","url":null,"abstract":"Mollet and colleagues discuss oral health in children.1 Due attention is paid to oral health as a component of the World Health Organization’s global strategy and action plan, including a focus on a “rights based approach” to motivate and challenge policy makers to tackle the root causes of poor oral health. Domestically, children’s …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It’s natural to want to be included, but there are things you can do when you don’t feel part of the team, Abi Rimmer hears Kirsty Shires, salaried GP, GP appraiser, coach, and mentor, West Midlands, says, “For many of us, fitting in at work is important to our sense of self, identity, and belonging. When this is lacking, it can affect our confidence and ability to perform well—which in healthcare could affect patient care as well as our own wellbeing. “There could be many factors involved in that sense of fitting in, but if we notice this feeling then it is worth taking stock and exploring it. This might mean asking questions about the situation we find ourselves in, the organisation we’re working for, the people we’re working with, and, perhaps most pertinently, ourselves. “From my own experience of working in different organisations, and from listening to others who are having qualms about fitting in, the difficulty can arise from a mismatch between your own values and those of the wider organisation. “Sometimes, it might be because of different styles of communication, or there may be a culture at the …
{"title":"I don’t fit in at work, what should I do?","authors":"Abi Rimmer","doi":"10.1136/bmj.q2513","DOIUrl":"https://doi.org/10.1136/bmj.q2513","url":null,"abstract":"It’s natural to want to be included, but there are things you can do when you don’t feel part of the team, Abi Rimmer hears Kirsty Shires, salaried GP, GP appraiser, coach, and mentor, West Midlands, says, “For many of us, fitting in at work is important to our sense of self, identity, and belonging. When this is lacking, it can affect our confidence and ability to perform well—which in healthcare could affect patient care as well as our own wellbeing. “There could be many factors involved in that sense of fitting in, but if we notice this feeling then it is worth taking stock and exploring it. This might mean asking questions about the situation we find ourselves in, the organisation we’re working for, the people we’re working with, and, perhaps most pertinently, ourselves. “From my own experience of working in different organisations, and from listening to others who are having qualms about fitting in, the difficulty can arise from a mismatch between your own values and those of the wider organisation. “Sometimes, it might be because of different styles of communication, or there may be a culture at the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The latest MBRRACE-UK report on maternal mortality highlights action needed to prevent maternal deaths and reduce underlying inequities—especially for women who are migrants or known to social care, writes Kirsty Kitchen This year’s annual confidential inquiry on maternal deaths–MBRRACE saving lives, improving mothers’ care 2024–finds evidence of high levels of inequality and little progress.1 Many trajectories have worsened. The maternal death rate is at its highest level for almost 20 years and inequities for race and deprivation are enduring or widening. We cannot reverse these trends without tackling the structural issues and social determinants at play. For the fifth year running, the number of women who died while known to social services has risen, now standing at 22% of the deaths reported. Maternal suicide remains the leading direct cause of death between six weeks and a year after giving birth. Past MBRRACE reports have highlighted that a large proportion of the women who died by suicide or because of substance use were at risk of having their baby removed from their care. Birth Companions has been campaigning for improvements in the care of women …
{"title":"Inequities are not inevitable: tackling them can reduce maternal deaths","authors":"Kirsty Kitchen","doi":"10.1136/bmj.q2557","DOIUrl":"https://doi.org/10.1136/bmj.q2557","url":null,"abstract":"The latest MBRRACE-UK report on maternal mortality highlights action needed to prevent maternal deaths and reduce underlying inequities—especially for women who are migrants or known to social care, writes Kirsty Kitchen This year’s annual confidential inquiry on maternal deaths–MBRRACE saving lives, improving mothers’ care 2024–finds evidence of high levels of inequality and little progress.1 Many trajectories have worsened. The maternal death rate is at its highest level for almost 20 years and inequities for race and deprivation are enduring or widening. We cannot reverse these trends without tackling the structural issues and social determinants at play. For the fifth year running, the number of women who died while known to social services has risen, now standing at 22% of the deaths reported. Maternal suicide remains the leading direct cause of death between six weeks and a year after giving birth. Past MBRRACE reports have highlighted that a large proportion of the women who died by suicide or because of substance use were at risk of having their baby removed from their care. Birth Companions has been campaigning for improvements in the care of women …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean Carruthers, an ophthalmologist, came home from work one evening and told her dermatologist husband Alastair about a conversation she had had with a patient. As part of a clinical trial1 she was using botulinum toxin to treat patients with dystonia, an involuntary spasm of the eyelids. One of her patients had asked to be treated between her eyes. When Jean told the patient that she had not thought she was spasming there, the patient replied that she was not, but every time Jean injected her there, her frown lines disappeared. Alastair was intrigued and the couple, working in private practice in Canada, decided to see if botulinum toxin had the same effect on others. Their receptionist, Cathy Bickerton Swann, then aged 30, had deep frown lines and agreed to the experiment. Carruthers administered the injections and in a few days they had almost disappeared. The couple’s first peer reviewed study of frown lines—the glabellar lines—involved 18 patients. Before they started, Carruthers injected his wife, at her request, to show that the procedure was safe. “I haven’t frowned since 1987,” …
{"title":"Alastair Carruthers: dermatologist who pioneered cosmetic use of Botox in partnership with ophthalmologist wife Jean","authors":"Rebecca Wallersteiner","doi":"10.1136/bmj.q2532","DOIUrl":"https://doi.org/10.1136/bmj.q2532","url":null,"abstract":"Jean Carruthers, an ophthalmologist, came home from work one evening and told her dermatologist husband Alastair about a conversation she had had with a patient. As part of a clinical trial1 she was using botulinum toxin to treat patients with dystonia, an involuntary spasm of the eyelids. One of her patients had asked to be treated between her eyes. When Jean told the patient that she had not thought she was spasming there, the patient replied that she was not, but every time Jean injected her there, her frown lines disappeared. Alastair was intrigued and the couple, working in private practice in Canada, decided to see if botulinum toxin had the same effect on others. Their receptionist, Cathy Bickerton Swann, then aged 30, had deep frown lines and agreed to the experiment. Carruthers administered the injections and in a few days they had almost disappeared. The couple’s first peer reviewed study of frown lines—the glabellar lines—involved 18 patients. Before they started, Carruthers injected his wife, at her request, to show that the procedure was safe. “I haven’t frowned since 1987,” …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unlocking NHS data requires public trust","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.q2547","DOIUrl":"https://doi.org/10.1136/bmj.q2547","url":null,"abstract":"Katie Bramall-Stainer’s name was …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mollet and colleagues call for a rights based approach to children’s oral health.1 There is an established link between poor oral health and lower socioeconomic status. Poor paediatric oral health is associated with education delay and increased morbidity in adulthood.2 Unfortunately, these associations are not new and have been known for at least 150 years. In 1905, James Kerr, a medical doctor, and Charles …
莫莱特及其同事呼吁对儿童口腔健康采取以权利为基础的方法。儿童口腔健康不良与教育延迟和成年后发病率增加有关。2 不幸的是，这些关联并非新现象，至少在 150 年前就已为人所知。1905 年，医学博士 James Kerr 和查尔斯...
{"title":"Children’s right to oral health: other strategies needed for less democratic countries","authors":"Anthony MacKenzie-Gureje","doi":"10.1136/bmj.q2507","DOIUrl":"https://doi.org/10.1136/bmj.q2507","url":null,"abstract":"Mollet and colleagues call for a rights based approach to children’s oral health.1 There is an established link between poor oral health and lower socioeconomic status. Poor paediatric oral health is associated with education delay and increased morbidity in adulthood.2 Unfortunately, these associations are not new and have been known for at least 150 years. In 1905, James Kerr, a medical doctor, and Charles …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"249 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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