Ethical and regulatory challenges of large language models in medicine

Affiliations

¹ Division of Pharmacy, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
² Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Biomedical Sciences and Engineering, Mbarara University of Science and Technology, Mbarara, Uganda.
⁴ Bakar Computational Health Sciences Institute, and Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA; Center for Data-Driven Insights and Innovation, University of California Health, Oakland, CA, USA.
⁵ Stanford Health Care, Palo Alto, CA, USA; Department of Medicine, and Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA.
⁶ Department of Pharmacy, National University of Singapore, Singapore; Singapore Health Services, Pharmacy and Therapeutics Council Office, Singapore; Department of Pharmacy, National Cancer Centre Singapore, Singapore.
⁷ Duke-NUS Medical School, National University of Singapore, Singapore.
⁸ Harvard Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
⁹ StatNLP Research Group, Singapore University of Technology and Design, Singpore.
¹⁰ Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK.
¹¹ Duke-NUS Medical School, National University of Singapore, Singapore; Artificial Intelligence and Digital Innovation, Singapore Eye Research Institute, Singapore National Eye Center, Singapore Health Service, Singapore; Byers Eye Institute, Stanford University, Palo Alto, CA, USA. Electronic address: daniel.ting@duke-nus.edu.sg.

PMID: 38658283
DOI: 10.1016/S2589-7500(24)00061-X

Free article

Review

Ethical and regulatory challenges of large language models in medicine

Jasmine Chiat Ling Ong et al. Lancet Digit Health. 2024 Jun.

Free article

. 2024 Jun;6(6):e428-e432.

doi: 10.1016/S2589-7500(24)00061-X. Epub 2024 Apr 23.

Authors

Affiliations

¹ Division of Pharmacy, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
² Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Biomedical Sciences and Engineering, Mbarara University of Science and Technology, Mbarara, Uganda.
⁴ Bakar Computational Health Sciences Institute, and Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA; Center for Data-Driven Insights and Innovation, University of California Health, Oakland, CA, USA.
⁵ Stanford Health Care, Palo Alto, CA, USA; Department of Medicine, and Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA.
⁶ Department of Pharmacy, National University of Singapore, Singapore; Singapore Health Services, Pharmacy and Therapeutics Council Office, Singapore; Department of Pharmacy, National Cancer Centre Singapore, Singapore.
⁷ Duke-NUS Medical School, National University of Singapore, Singapore.
⁸ Harvard Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
⁹ StatNLP Research Group, Singapore University of Technology and Design, Singpore.
¹⁰ Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK.
¹¹ Duke-NUS Medical School, National University of Singapore, Singapore; Artificial Intelligence and Digital Innovation, Singapore Eye Research Institute, Singapore National Eye Center, Singapore Health Service, Singapore; Byers Eye Institute, Stanford University, Palo Alto, CA, USA. Electronic address: daniel.ting@duke-nus.edu.sg.

PMID: 38658283
DOI: 10.1016/S2589-7500(24)00061-X

Abstract

With the rapid growth of interest in and use of large language models (LLMs) across various industries, we are facing some crucial and profound ethical concerns, especially in the medical field. The unique technical architecture and purported emergent abilities of LLMs differentiate them substantially from other artificial intelligence (AI) models and natural language processing techniques used, necessitating a nuanced understanding of LLM ethics. In this Viewpoint, we highlight ethical concerns stemming from the perspectives of users, developers, and regulators, notably focusing on data privacy and rights of use, data provenance, intellectual property contamination, and broad applications and plasticity of LLMs. A comprehensive framework and mitigating strategies will be imperative for the responsible integration of LLMs into medical practice, ensuring alignment with ethical principles and safeguarding against potential societal risks.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests DSWT holds patents on a deep-learning system for the detection of retinal diseases. AJB is a cofounder and consultant for Personalis and NuMedii; is a consultant to Mango Tree Corporation; has previously been a consultant for Samsung, 10x Genomics, Helix, Pathway Genomics, and Verinata (Illumina); has served on paid advisory panels or boards for Geisinger Health, Regenstrief Institute, Gerson Lehman Group, AlphaSights, Covance, Novartis, Genentech, and Merck, and Roche; is a shareholder in Personalis and NuMedii; is a minor shareholder in Apple, Meta (Facebook), Alphabet (Google), Microsoft, Amazon, Snap, 10x Genomics, Illumina, Regeneron, Sanofi, Pfizer, Royalty Pharma, Moderna, Sutro, Doximity, BioNtech, Invitae, Pacific Biosciences, Editas Medicine, Nuna Health, Assay Depot, and Vet24seven, and several other non-health related companies and mutual funds; has received honoraria and travel reimbursement for invited talks from Johnson and Johnson, Roche, Genentech, Pfizer, Merck, Lilly, Takeda, Varian, Mars, Siemens, Optum, Abbott, Celgene, AstraZeneca, AbbVie, Westat, and many academic institutions, medical-specific or disease-specific foundations and associations, and health systems; receives royalty payments through Stanford University for several patents and other disclosures licensed to NuMedii and Personalis; has done research funded by NIH, Peraton (as the prime on an NIH contract), Genentech, Johnson and Johnson, FDA, Robert Wood Johnson Foundation, Leon Lowenstein Foundation, Intervalien Foundation, Priscilla Chan and Mark Zuckerberg, and the Barbara and Gerson Bakar Foundation; and has previously done research funded by the March of Dimes, Juvenile Diabetes Research Foundation, California Governor's Office of Planning and Research, California Institute for Regenerative Medicine, L’Oreal, and Progenity. NL is a scientific advisor to TIIM SG. NHS is a cofounder of Prealize Health (a predictive analytics company) and Atropos Health (an on-demand evidence generation company); receives funding from the Gordon and Betty Moore Foundation for developing virtual model deployments; and is a member of working groups of the Coalition for Health AI (CHAI), a consensus-building organisation providing guidelines for the responsible use of artificial intelligence in health care. JS, through his involvement with the Murdoch Children's Research Institute, receives funding from the Victorian State Government through the Operational Infrastructure Support (OIS) programme. JCLO is supported by grants from the National Medical Research Council Singapore (MOH-CIAINV21nov-001) and AI Singapore OTTIC (AISG2-TC-2022-006). All other authors declare no competing interests.

References

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- ClinicalKey
- Elsevier Science

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Ethical and regulatory challenges of large language models in medicine

Affiliations

Ethical and regulatory challenges of large language models in medicine

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources