The Ochlocratic Trap in Bioethics

The ochlocratic trap is the tendency to have moral decisions conform to popular majority opinion regardless of their ethical implications. This decision-making method in bioethics can significantly impede moral progress, weakening the foundation for sustainable healthcare systems. Instead of allowing popular opinion to form the basis of our morality, the scientific method can provide a framework for making strong ethical decisions. The consequences of weak morality are profound, resulting in poorly sustainable systems lacking human empathy and economic viability. Treating ethical issues like scientific problems can foster a more rigorous, evidence-based discussion, leading to better medical care globally

The Cost of Living Index as a Primary Driver of Homelessness in the United States A Cross-State Analysis

Background: Homelessness persists as a critical global issue despite myriad interventions. This study analyzed state-level differences in homelessness rates across the United States to identify influential societal factors to help guide resource prioritization. Methods: Homelessness rates for 50 states and Washington, DC, were compared using the most recent data from 2020 to 2023. Twenty-five variables representing potential socioeconomic and health contributors were examined. The correlation between these variables and the homelessness rate was calculated. Decision trees and regression models were also utilized to identify the most significant factors contributing to homelessness. Results: Homelessness rates were strongly correlated with the cost of living index (COLI), housing costs, transportation costs, grocery costs, and the cigarette excise tax rate (all: P < 0.001). An inverse relationship was observed between opioid prescription rates and homelessness, with increased opioid prescribing associated with decreased homelessness (P < 0.001). Due to collinearity, the combined cost of living index was used for modeling instead of its individual components. Decision tree and regression models identified the cost of living index as the strongest contributor to homelessness, with unemployment, taxes, binge drinking rates, and opioid prescription rates emerging as important factors. Conclusion: This state-level analysis revealed the cost of living index as the primary driver of homelessness rates. Unemployment, poverty, and binge drinking were also contributing factors. An unexpected negative correlation was found between opioid prescription rates and homelessness. These findings can help guide resource allocation to address homelessness through targeted interventions

Introductory Chapter: Telemedicine

The practice of telemedicine creates opportunities for greater access to medical care, improved access to medical specialists, and greater convenience for patients, all at a potentially lower financial cost. With the global expansion of the Internet via cable, fiber optics, satellites, drones, and even high altitude balloons, telemedicine services can reach every individual on Earth with a smartphone

Safety of Large Language Models in Addressing Depression

Background Generative artificial intelligence (AI) models, exemplified by systems such as ChatGPT, Bard, and Anthropic, are currently under intense investigation for their potential to address existing gaps in mental health support. One implementation of these large language models involves the development of mental healthfocused conversational agents, which utilize pre-structured prompts to facilitate user interaction without requiring specialized knowledge in prompt engineering. However, uncertainties persist regarding the safety and efficacy of these agents in recognizing severe depression and suicidal tendencies. Given the wellestablished correlation between the severity of depression and the risk of suicide, improperly calibrated conversational agents may inadequately identify and respond to crises. Consequently, it is crucial to investigate whether publicly accessible repositories of mental health-focused conversational agents can consistently and safely address crisis scenarios before considering their adoption in clinical settings. This study assesses the safety of publicly available ChatGPT-3.5 conversational agents by evaluating their responses to a patient simulation indicating worsening depression and suicidality. Methodology This study evaluated ChatGPT-3.5 conversational agents on a publicly available repository specifically designed for mental health counseling. Each conversational agent was evaluated twice by a highly structured patient simulation. First, the simulation indicated escalating suicide risk based on the Patient Health Questionnaire (PHQ-9). For the second patient simulation, the escalating risk was presented in a more generalized manner not associated with an existing risk scale to assess the more generalized ability of the conversational agent to recognize suicidality. Each simulation recorded the exact point at which the conversational agent recommended human support. Then, the simulation continued until the conversational agent stopped entirely and shut down completely, insisting on human intervention. Results All 25 agents available on the public repository FlowGPT.com were evaluated. The point at which the conversational agents referred to a human occurred around the mid-point of the simulation, and definitive shutdown predominantly only happened at the highest risk levels. For the PHQ-9 simulation, the average initial referral and shutdown aligned with PHQ-9 scores of 12 (moderate depression) and 25 (severe depression). Few agents included crisis resources - only two referenced suicide hotlines. Despite the conversational agents insisting on human intervention, 22 out of 25 agents would eventually resume the dialogue if the simulation reverted to a lower risk level. Conclusions Current generative AI -based conversational agents are slow to escalate mental health risk scenarios, postponing referral to a human to potentially dangerous levels. More rigorous testing and oversight of conversational agents are needed before deployment in mental healthcare settings. Additionally, further investigation should explore if sustained engagement worsens outcomes and whether enhanced accessibility outweighs the risks of improper escalation. Advancing AI safety in mental health remains imperative as these technologies continue rapidly advancing

Statistical Ethics in Medical Research A Narrative Review

Bioethics necessitates the meticulous planning, application and interpretation of statistics in medical research. However, the pervasive misapplication and misinterpretation of statistical methods pose significant challenges. Common errors encompass p-hacking, misconceptions regarding statistical significance, neglecting to address study limitations and failing to evaluate data fragility. Historically, such statistical missteps have led to regrettable and severe adverse health outcomes for society. For instance, prominent research on hormone replacement therapy likely resulted in an increased incidence of heart attacks, strokes and cardiovascular death in postmenopausal women, rectified only after the errors were identified. Likewise, past vaccine trials have oscillated between overemphasizing and underemphasizing side effects, resulting in public harm. This narrative review scrutinizes prevalent statistical errors and presents historical case examples. Recommendations for future research include: a) ethical review boards should incorporate a more rigorous evaluation of statistical methodologies in their assessment of clinical trial proposals; b) journals should mandate that research data become open-access rather than proprietary to allow for improved post-publication peer review; and c) in addition to addressing study limitations, articles should encompass a discussion of the ethical ramifications of their findings

Introductory Chapter: Blockchain Technology and Smart Healthcare

Phase 1 of the technology revolution began with the development of the computer and the computer chip. Phase 2 occurred when communication between computers became widely distributed via the Internet. We are now in phase 3 which is the development of artificial intelligence to replace or augment human intelligence. This revolution in technology has and will continue to have profound effects upon health- care, human health, and longevity

We Thank You Lord

This poem, essay, and song are about cultivating gratitude for our gifts, overcoming obstacles to serving others, and how a dying patient's courage reminds us that we can provide comfort and strength even in dire circumstances

Big Tobacco, Cigarettes and the Foundation of Duke University

Duke University was founded in 1930 primarily due to funds generated from James B Duke’s tobacco business. Duke achieved great financial wealth primarily due to the early application of machine rolled cigarettes, as opposed to hand rolled. This early adoption of technology allowed Duke Tobacco to out-produce other companies still selling hand rolled cigarettes. By making smoking more inexpensive and easier than pipe smoking, the cigarette formed the foundation for nicotine addiction in the 1900s, generating huge profits for the tobacco industry. At the time Duke University was founded, little was known about the connection between nicotine, cigarettes and respiratory diseases such as emphysema and lung cancer. Through James Duke’s philanthropy, the devastating harm from cigarettes has been mitigated in part through the founding of one of the world’s most prominent medical centers and research universities

The Beholder - A Symphony of Life in Medicine

The holistic medicine movement of the 1980s expanded healthcare perspectives beyond traditional boundaries, coinciding with a parallel holistic movement in the humanities. The interconnections between music, art, physics, and medicine reveal intriguing parallels and unifying principles that tie together these synchronous evolutions. Clear symmetries exist between sound, visual art, and quantum wave phenomena, hinting at a unifying framework that integrates sciences with the humanities. This journey toward harmonic convergence has integrated artistic, scientic, and humanistic viewpoints, illuminating a remarkable tapestry of interconnected knowledge