Annals of Internal Medicine最新文献

{"title":"Association of Overweight and Obesity With Financial Burden.","authors":"Simar S Bajaj, Bhav Jain, Cameron J Sabet, Anthony Zhong, Troy B Amen, Edward Christopher Dee, Fatima Cody Stanford","doi":"10.7326/ANNALS-24-03161","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03161","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the System-Instruction Vulnerabilities of Large Language Models to Malicious Conversion Into Health Disinformation Chatbots.","authors":"Natansh D Modi, Bradley D Menz, Abdulhalim A Awaty, Cyril A Alex, Jessica M Logan, Ross A McKinnon, Andrew Rowland, Stephen Bacchi, Kacper Gradon, Michael J Sorich, Ashley M Hopkins","doi":"10.7326/ANNALS-24-03933","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03933","url":null,"abstract":"<p><p>Large language models (LLMs) offer substantial promise for improving health care; however, some risks warrant evaluation and discussion. This study assessed the effectiveness of safeguards in foundational LLMs against malicious instruction into health disinformation chatbots. Five foundational LLMs-OpenAI's GPT-4o, Google's Gemini 1.5 Pro, Anthropic's Claude 3.5 Sonnet, Meta's Llama 3.2-90B Vision, and xAI's Grok Beta-were evaluated via their application programming interfaces (APIs). Each API received system-level instructions to produce incorrect responses to health queries, delivered in a formal, authoritative, convincing, and scientific tone. Ten health questions were posed to each customized chatbot in duplicate. Exploratory analyses assessed the feasibility of creating a customized generative pretrained transformer (GPT) within the OpenAI GPT Store and searched to identify if any publicly accessible GPTs in the store seemed to respond with disinformation. Of the 100 health queries posed across the 5 customized LLM API chatbots, 88 (88%) responses were health disinformation. Four of the 5 chatbots (GPT-4o, Gemini 1.5 Pro, Llama 3.2-90B Vision, and Grok Beta) generated disinformation in 100% (20 of 20) of their responses, whereas Claude 3.5 Sonnet responded with disinformation in 40% (8 of 20). The disinformation included claimed vaccine-autism links, HIV being airborne, cancer-curing diets, sunscreen risks, genetically modified organism conspiracies, attention deficit-hyperactivity disorder and depression myths, garlic replacing antibiotics, and 5G causing infertility. Exploratory analyses further showed that the OpenAI GPT Store could currently be instructed to generate similar disinformation. Overall, LLM APIs and the OpenAI GPT Store were shown to be vulnerable to malicious system-level instructions to covertly create health disinformation chatbots. These findings highlight the urgent need for robust output screening safeguards to ensure public health safety in an era of rapidly evolving technologies.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvements in Cardiometabolic Risk Factors by Weight Reduction: A Post Hoc Analysis of Adults With Obesity Randomly Assigned to Tirzepatide.","authors":"Bruno Linetzky, Naveed Sattar, Subodh Verma, Harlan M Krumholz, Cathy Chang Xie, Hunter T Hoffmann, Sarah Zimner-Rapuch, Amelia Torcello-Gómez, Adam Stefanski","doi":"10.7326/ANNALS-24-02623","DOIUrl":"https://doi.org/10.7326/ANNALS-24-02623","url":null,"abstract":"<p><strong>Background: </strong>Tirzepatide reduced weight and improved cardiometabolic risk factors for participants in the SURMOUNT-1 trial. The changes in cardiometabolic risk factors by degree of tirzepatide-induced weight reduction across a wide spectrum of weight loss have not been reported.</p><p><strong>Objective: </strong>To determine changes in cardiometabolic risk factors by weight reduction.</p><p><strong>Design: </strong>Post hoc analysis of the phase 3, randomized, double-blind, SURMOUNT-1 trial (ClinicalTrials.gov: NCT04184622).</p><p><strong>Setting: </strong>119 sites in 9 countries.</p><p><strong>Participants: </strong>Adults (<i>n</i> = 1605) with obesity, or overweight with weight-related complications (excluding diabetes), randomly assigned to tirzepatide treatment groups.</p><p><strong>Intervention: </strong>Once-weekly tirzepatide, 5, 10, or 15 mg.</p><p><strong>Measurements: </strong>Changes from baseline to week 72 in cardiometabolic risk factors by weight reduction.</p><p><strong>Results: </strong>Participants had a mean age of 45.4 years (SD, 12.2) and mean body mass index of 37.9 kg/m² (SD, 6.7), and 68% were female. The greater weight reduction categories had higher percentages of female and White participants. Participants who lost at least 35% of their body weight from baseline to week 72 had mean changes of up to -14.2 mm Hg (95% CI, -16.1 to -12.3 mm Hg) for systolic blood pressure, -9.2 mm Hg (CI, -10.6 to -7.8 mm Hg) for diastolic blood pressure, -32.4 cm (CI, -33.5 to -31.3 cm) for waist circumference, -59.7% (CI, -63.6% to -55.3%) for the homeostatic model assessment of insulin resistance (HOMA-IR), and -0.65 percentage point (CI, -0.70 to -0.61 percentage point) for hemoglobin A_1c. The relationship between percentage weight reduction and changes in cardiometabolic risk factors seemed mostly linear for waist circumference and blood pressure, with a steeper slope for systolic than diastolic blood pressure. Decreases in HOMA-IR and hemoglobin A_1c were observed even with modest weight reduction, with the steepest effect occurring between less than 5% and less than 20% weight reduction. Improvements in levels of triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and non-HDL cholesterol were primarily observed only after weight reductions greater than 10%. Results were consistent after adjustment for baseline differences.</p><p><strong>Limitations: </strong>The analysis was post hoc and should be regarded as hypothesis-generating. Duration and sample size precluded evaluation of cardiovascular outcomes.</p><p><strong>Conclusion: </strong>In SURMOUNT-1, tirzepatide-associated improvements in cardiometabolic risk factors positively related to the degree of weight reduction, but the pattern varied depending on outcome measure.</p><p><strong>Primary funding source: </strong>Eli Lilly and Company.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent Need for Standards and Safeguards for Health-Related Generative Artificial Intelligence.","authors":"Reed V Tuckson, Brinleigh Murphy-Reuter","doi":"10.7326/ANNALS-25-02035","DOIUrl":"https://doi.org/10.7326/ANNALS-25-02035","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pragmatic Approach to Streamlining Single-Use Plastics in Health Care.","authors":"Jeremy A Greene, Maria W Merritt, Ligia Paina, Sarah B Bucic, Nicholas Dalesio, Chris Hanley, Emily Mediate, Seema Wadhwa, Melanie Alfonzo Horowitz, Ursula E Gately, Margaret Tharp, Hardeep Singh","doi":"10.7326/ANNALS-25-01264","DOIUrl":"https://doi.org/10.7326/ANNALS-25-01264","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preserving Scientific Integrity in Vaccine Policy: The Role of, and Risk to, the CDC's Advisory Committee on Immunization Practices.","authors":"Jason M Goldman, Sandra Adamson Fryhofer","doi":"10.7326/ANNALS-25-02806","DOIUrl":"https://doi.org/10.7326/ANNALS-25-02806","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health.","authors":"Adam Gaffney, David U Himmelstein, Steffie Woolhandler","doi":"10.7326/ANNALS-25-00716","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00716","url":null,"abstract":"<p><p>In January 2025, the Republican majority in the House of Representatives' Budget Committee offered a list of possible spending reductions to offset revenue losses from proposed tax cuts. In May, the Committee advanced a bill incorporating several reductions on the list. The Committee estimated that the 6 largest potential Medicaid cuts (for example, work requirements for some Medicaid enrollees) would each reduce the federal government's Medicaid outlays by at least $100 billion over 10 years. On the basis of the Committee's estimates of savings; Congressional Budget Office analyses; and peer-reviewed studies of the coverage, financial, and health impacts of past Medicaid expansions and contractions, the authors project the likely effects of each option and of the House bill advanced by the Budget Committee in May.</p><p><p>Each option individually would reduce federal Medicaid outlays by between $100 billion and $900 billion over a decade, increase the ranks of the uninsured by between 600 000 and 3 900 000 and the annual number of persons forgoing needed medical care by 129 060 to 838 890, and result in 651 to 12 626 medically preventable deaths annually. Enactment of the House bill advanced in May would increase the number of uninsured persons by 7.6 million and the number of deaths by 16 642 annually, according to a mid-range estimate. These figures exclude harms from lowering provider payments and shrinking benefits, as well as possible repercussions from states increasing taxes or shifting expenditures from other needs to make up for shortfalls in federal Medicaid funding.</p><p><p>Policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would accrue mostly to wealthy Americans.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Vitamin D Deficiency Increases Mortality Risk in the UK Biobank.","authors":"","doi":"10.7326/ANNALS-25-02471","DOIUrl":"https://doi.org/10.7326/ANNALS-25-02471","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Reducing the Over-Diagnosis of Thyroid Disease.","authors":"","doi":"10.7326/ANNALS-25-02450","DOIUrl":"10.7326/ANNALS-25-02450","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flying the Plane While Building It: Lessons From the COVID-19 Pandemic.","authors":"Jason M Goldman, Darilyn V Moyer","doi":"10.7326/ANNALS-25-02436","DOIUrl":"https://doi.org/10.7326/ANNALS-25-02436","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}