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As a fourth-year ophthalmology resident at Emory University School of Medicine, Riley Lyons biggest responsibilities include triage: When a patient comes in with an eye-related complaint, Lyons must make an immediate assessment of its urgency. Use Our Content

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He often finds patients have already turned to Dr. Google. Online, Lyons said, they are likely to find that any number of terrible things could be going on based on the symptoms that they’re experiencing.

So, when two of Lyons fellow ophthalmologists at Emory came to him and suggested evaluating the accuracy of the AI chatbot ChatGPT in diagnosing eye-related complaints, he jumped at the chance.

In June, Lyons and his colleagues reported in medRxiv, an online publisher of health science preprints, that ChatGPT compared quite well to human doctors who reviewed the same symptoms and performed vastly better than the symptom checker on the popular health website WebMD. And despite the much-publicized hallucination problem known to afflict ChatGPT its habit of occasionally making outright false statements the Emory study reported that the most recent version of ChatGPT made zero grossly inaccurate statements when presented with a standard set of eye complaints.

The relative proficiency of ChatGPT, which debuted in November 2022, was a surprise to Lyons and his co-authors. The artificial intelligence engine is definitely an improvement over just putting something into a Google search bar and seeing what you find, said co-author Nieraj Jain, an assistant professor at the Emory Eye Center who specializes in vitreoretinal surgery and disease.

But the findings underscore a challenge facing the health care industry as it assesses the promise and pitfalls of generative AI, the type of artificial intelligence used by ChatGPT: The accuracy of chatbot-delivered medical information may represent an improvement over Dr. Google, but there are still many questions about how to integrate this new technology into health care systems with the same safeguards historically applied to the introduction of new drugs or medical devices.

The smooth syntax, authoritative tone, and dexterity of generative AI have drawn extraordinary attention from all sectors of society, with some comparing its future impact to that of the internet itself. In health care, companies are working feverishly to implement generative AI in areas such as radiology and medical records. Email Sign-Up

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When it comes to consumer chatbots, though, there is still caution, even though the technology is already widely available and better than many alternatives. Many doctors believe AI-based medical tools should undergo an approval process similar to the FDAs regime for drugs, but that would be years away. Its unclear how such a regime might apply to general-purpose AIs like ChatGPT.

There’s no question we have issues with access to care, and whether or not it is a good idea to deploy ChatGPT to cover the holes or fill the gaps in access, it’s going to happen and it’s happening already, said Jain. People have already discovered its utility. So, we need to understand the potential advantages and the pitfalls.

The Emory study is not alone in ratifying the relative accuracy of the new generation of AI chatbots. A report published in Nature in early July by a group led by Google computer scientists said answers generated by Med-PaLM, an AI chatbot the company built specifically for medical use, compare favorably with answers given by clinicians.

AI may also have better bedside manner. Another study, published in April by researchers from the University of California-San Diego and other institutions, even noted that health care professionals rated ChatGPT answers as more empathetic than responses from human doctors.

Indeed, a number of companies are exploring how chatbots could be used for mental health therapy, and some investors in the companies are betting that healthy people might also enjoy chatting and even bonding with an AI friend. The company behind Replika, one of the most advanced of that genre, markets its chatbot as, The AI companion who cares. Always here to listen and talk. Always on your side.

We need physicians to start realizing that these new tools are here to stay and they’re offering new capabilities both to physicians and patients, said James Benoit, an AI consultant. While a postdoctoral fellow in nursing at the University of Alberta in Canada, he published a study in February reporting that ChatGPT significantly outperformed online symptom checkers in evaluating a set of medical scenarios. They are accurate enough at this point to start meriting some consideration, he said.

Still, even the researchers who have demonstrated ChatGPTs relative reliability are cautious about recommending that patients put their full trust in the current state of AI. For many medical professionals, AI chatbots are an invitation to trouble: They cite a host of issues relating to privacy, safety, bias, liability, transparency, and the current absence of regulatory oversight.

The proposition that AI should be embraced because it represents a marginal improvement over Dr. Google is unconvincing, these critics say.

That’s a little bit of a disappointing bar to set, isn’t it? said Mason Marks, a professor and MD who specializes in health law at Florida State University. He recently wrote an opinion piece on AI chatbots and privacy in the Journal of the American Medical Association. I don’t know how helpful it is to say, Well, let’s just throw this conversational AI on as a band-aid to make up for these deeper systemic issues, he said to KFF Health News.

The biggest danger, in his view, is the likelihood that market incentives will result in AI interfaces designed to steer patients to particular drugs or medical services. Companies might want to push a particular product over another, said Marks. The potential for exploitation of people and the commercialization of data is unprecedented.

OpenAI, the company that developed ChatGPT, also urged caution.

OpenAIs models are not fine-tuned to provide medical information, a company spokesperson said. You should never use our models to provide diagnostic or treatment services for serious medical conditions.

John Ayers, a computational epidemiologist who was the lead author of the UCSD study, said that as with other medical interventions, the focus should be on patient outcomes.

If regulators came out and said that if you want to provide patient services using a chatbot, you have to demonstrate that chatbots improve patient outcomes, then randomized controlled trials would be registered tomorrow for a host of outcomes, Ayers said.

He would like to see a more urgent stance from regulators.

One hundred million people have ChatGPT on their phone, said Ayers, and are asking questions right now. People are going to use chatbots with or without us.

At present, though, there are few signs that rigorous testing of AIs for safety and effectiveness is imminent. In May, Robert Califf, the commissioner of the FDA, described the regulation of large language models as critical to our future, but aside from recommending that regulators be nimble in their approach, he offered few details.

In the meantime, the race is on. In July, The Wall Street Journal reported that the Mayo Clinic was partnering with Google to integrate the Med-PaLM 2 chatbot into its system. In June, WebMD announced it was partnering with a Pasadena, California-based startup, HIA Technologies Inc., to provide interactive diital health assistants. And the ongoing integration of AI into both Microsofts Bing and Google Search suggests that Dr. Google is already well on its way to being replaced by Dr. Chatbot.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Related Topics California Health Industry States Georgia Contact Us Submit a Story Tip

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I’ve followed the PM wherever he goes in his first year in office – here’s what I’ve observed

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I've followed the PM wherever he goes in his first year in office - here's what I've observed

July 5 2024, 1pm: I remember the moment so clearly.

Keir Starmer stepped out of his sleek black car, grasped the hand of his wife Vic, dressed in Labour red, and walked towards a jubilant crowd of Labour staffers, activists and MPs waving union jacks and cheering a Labour prime minister into Downing Street for the first time in 14 years.

Starmer and his wife took an age to get to the big black door, as they embraced those who had helped them win this election – their children hidden in the crowd to watch their dad walk into Number 10.

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Keir Starmer, not the easiest public speaker, came to the podium and told the millions watching this moment the “country has voted decisively for change, for national renewal”.

He spoke about the “weariness at the heart of the nation” and “the lack of trust” in our politicians as a “wound” that “can only be healed by actions not words”. He added: “This will take a while but the work of change begins immediately.”

A loveless landslide

That was a day in which this prime minister made history. His was a victory on a scale that comes around but one every few decades.

He won the largest majority in a quarter of a century and with it a massive opportunity to become one of the most consequential prime ministers of modern Britain – alongside the likes of Margaret Thatcher or Tony Blair.

But within the win was a real challenge too.

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Starmer’s was a loveless landslide, won on a lower share of the vote than Blair in all of his three victories and 6 percentage points lower than the 40% Jeremy Corbyn secured in the 2017 general election.

It was the lowest vote share than any party forming a post-war majority government. Support for Labour was as shallow as it was wide.

In many ways then, it was a landslide built on shaky foundations: low public support, deep mistrust of politicians, unhappiness with the state of public services, squeezed living standards and public finances in a fragile state after the huge cost of the pandemic and persistent anaemic growth.

Put another way, the fundamentals of this Labour government, whatever Keir Starmer did, or didn’t do, were terrible. Blair came in on a new dawn. This Labour government, in many ways, inherited the scorched earth.

The one flash of anger I’ve seen

For the past year, I have followed Keir Starmer around wherever he goes. We have been to New York, Washington (twice), Germany (twice), Brazil, Samoa, Canada, Ukraine, the Netherlands and Brussels. I can’t even reel off the places we’ve been to around the UK – but suffice to say we’ve gone to all the nations and regions.

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Starmer pushed on scale of “landslide” election win

What I have witnessed in the past year is a prime minister who works relentlessly hard. When we flew for 27 hours non-stop to Samoa last autumn to the Commonwealth Heads of Government Meeting (CHOGM) summit, every time I looked up at the plane, I saw a solitary PM, his headlight shining on his hair, working away as the rest of us slept or watched films.

He also seems almost entirely unflappable. He rarely expresses emotion. The only time I have seen a flash of anger was when I questioned him about accepting freebies in a conversation that ended up involving his family, and when Elon Musk attacked Jess Phillips.

I have also witnessed him being buffeted by events in a way that he would not have foreseen. The arrival of Donald Trump into the White House has sucked the prime minister into a whirlwind of foreign crises that has distracted him from domestic events.

When he said over the weekend, as a way of explanation not an excuse, that he had been caught up in other matters and taken his eye off the ball when it came to the difficulties of welfare reform, much of Westminster scoffed, but I didn’t.

I had followed him around in the weeks leading up to that vote. We went from the G7 in Canada, to the Iran-Israel 12-day war, to the NATO summit in the Hague, as the prime minister dealt with, in turn, the grooming gangs inquiry decision, the US-UK trade deal, Donald Trump, de-escalation in the Middle East and a tricky G7 summit, the assisted dying vote, the Iran-Israel missile crisis.

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In September 2024, the PM defended taking £20k GCSE donation

He was taking so many phone calls on Sunday morning from Chequers, that he couldn’t get back to London for COBRA [national emergency meeting] because he couldn’t afford to not have a secure phone line for the hour-long drive back to Downing Street.

He travelled to NATO, launched the National Security Review and agreed to the defence alliance’s commitment to spend 5% of GDP on defence by 2035. So when he came back from the Hague into a full-blown welfare rebellion, I did have some sympathy for him – he simply hadn’t had the bandwidth to deal with the rebellion as it began to really gather steam.

Dealing with rebellion

Where I have less sympathy with the prime minister and his wider team is how they let it get to that point in the first place.

Keir Starmer wasn’t able to manage the latter stages of the rebellion, but the decisions made months earlier set it up in all its glory, while Downing Street’s refusal to heed the concerns of MPs gave it momentum to spiral into a full-blown crisis.

The whips gave warning after 120 MPs signed a letter complaining about the measures, the Work and Pensions Secretary Liz Kendall had done the same, but Starmer and Reeves were, in the words of one minister, “absolutist”.

“They assumed people complaining about stuff do it because they are weak, rather than because they are strong,” said the minister, who added that following the climbdown, figures in Number 10 “just seemed completely without knowledge of the gravity of it”.

That he marks his first anniversary with the humiliation of having to abandon his flagship welfare reforms or face defeat in the Commons – something that should be unfathomable in the first year of power with a majority that size – is disappointing.

To have got it that wrong, that quickly with your parliamentary party, is a clear blow to his authority and is potentially more chronic. I am not sure yet how he recovers.

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Welfare vote ‘a blow to the prime minister’

Keir Starmer said he wanted to rule country first, party second, but finds himself pinned by a party refusing to accept his centrist approach. Now, ministers tell MPs that there will be a financial consequence of the government’s decision to delay tightening the rules on claiming disability benefits beyond the end of 2026.

A shattered Rachel Reeves now has to find the £5bn she’d hoped to save another way. She will defend her fiscal rules, which leaves her the invidious choice of tax rises or spending cuts. Sit back and watch for the growing chorus of MPs that will argue Starmer needs to raise more taxes and pivot to the left.

That borrowing costs of UK debt spiked on Wednesday amid speculation that the chancellor might resign or be sacked, is a stark reminder that Rachel Reeves, who might be unpopular with MPs, is the markets’ last line of defence against spending-hungry Labour MPs. The party might not like her fiscal rules, but the markets do.

What’s on the horizon for year two?

The past week has set the tone now for the prime minister’s second year in office. Those around him admit that the parliamentary party is going to be harder to govern. For all talk of hard choices, they have forced the PM to back down from what were cast as essential welfare cuts and will probably calculate that they can move him again if they apply enough pressure.

There is also the financial fall-out, with recent days setting the scene for what is now shaping up to be another definitive budget for a chancellor who now has to fill a multi-billion black hole in the public finances.

But I would argue that the prime minister has misjudged the tone as he marks that first year. Faced with a clear crisis and blow to his leadership, instead of tackling that head on the prime minister sought to ignore it and try to plough on, embarking on his long-planned launch of the 10-year NHS plan to mark his year in office, as if the chancellor’s tears and massive Labour rebellions over the past 48 hours were mere trifles.

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Why was the chancellor crying at PMQs?

It was inevitable that this NHS launch would be overshadowed by the self-inflicted shambles over welfare and the chancellor’s distress, given this was the first public appearance of both of them since it had all blown up.

But when I asked the prime minister to explain how it had gone so wrong on welfare and how he intended to rebuild your trust and authority in your party, he completely ignored my question. Instead, he launched into a long list of Labour’s achievements in his first year: 4 million extra NHS appointments; free school meals to half a million more children; more free childcare; the biggest upgrade in employment rights for a generation; and the US, EU and India free trade deals.

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Starmer defends reaction to Reeves crying in PMQs

I can understand the point he was making and his frustration that his achievements are being lost in the maelstrom of the political drama. But equally, this is politics, and he is the prime minister. This is his story to tell, and blowing up your welfare reform on the anniversary week of your government is not the way to do it.

Is Starmer failing to articulate his mission?

For Starmer himself, he will do what I have seen him do before when he’s been on the ropes, dig in, learn from the errors and try to come back stronger. I have heard him in recent days talk about how he has always been underestimated and then proved he can do it – he is approaching this first term with the same grit.

If you ask his team, they will tell you that the prime minister and this government is still suffering from the unending pessimism that has pervaded our national consciousness; the sense politics doesn’t work for working people and the government is not on their side.

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Fiscal rules are silly but important

Starmer knows what he needs to do: restore the social contract, so if you work hard you should get on in life. The spending review and its massive capital investment, the industrial strategy and strategic defence review – three pieces of work dedicated to investment and job creation – are all geared to trying to rebuild the country and give people a brighter future.

But equally, government has been, admit insiders, harder than they thought as they grapple with multiple crises facing the country – be that public services, prisons, welfare.

It has also lacked direction. Sir Keir would do well to focus on following his Northern Star. I think he has one – to give working people a better life and ordinary people the chance to fulfil their potential.

But somehow, the prime minister is failing to articulate his mission, and he knows that. When I asked him at the G7 summit in Canada what his biggest mistake of the first year was, he told me: “We haven’t always told our story as well as we should.”

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Beth Rigby asks the PM to reflect on a year in office

I go back to the Keir Starmer of July 5 2024. He came in on a landslide, he promised to change the country, he spoke of the lack of trust and the need to prove to the public that the government could make their lives better through actions not words.

In this second year, he is betting that the legislation he has passed and strategies he has launched will drive that process of change, and in doing so, build back belief.

But it is equally true that his task has become harder these past few weeks. He has spilled so much blood over welfare for so little gain, his first task is to reset the operation to better manage the party and rebuild support.

But bigger than that, he needs to find a way to not just tell his government’s story but sell his government’s story. He has four years left.

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Politics

Did Keir Starmer screw up his own anniversary?

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Did Keir Starmer screw up his own anniversary?

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Sir Keir Starmer wanted to be talking about what he sees as Labour’s achievements after 12 months in government and his 10-year plan for the NHS.

But, after another dramatic policy U-turn and the sight of his own chancellor crying at PMQs, when he kept his support for her slightly vague, Beth Rigby, Harriet Harman and Ruth Davidson discuss if his start in office has been shattered by this week.

They also wonder if the solution to make relations with his own MPs a bit easier would be to make better use of Angela Rayner.

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World

Gaza aid group reacts to claims American contractors fired at starving Palestinians

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Gaza aid group reacts to claims American contractors fired at starving Palestinians

Israeli-backed American contractors guarding aid centres in Gaza are using live ammunition and stun grenades as starving Palestinians scramble for food, an investigation has claimed.

The Associated Press has reported the accounts by two contractors from the Gaza Humanitarian Foundation (GHF), although the organisation has strongly denied the allegations, describing them as “categorically false”.

GHF was established in February to deliver desperately needed aid to people in the besieged enclave, but its work has been heavily criticised by international aid groups.

It has also been subject to intense scrutiny about its operations, which Sky News previously reported are associated with a significant increase in deaths.

AP’s claims, which have not been independently verified by Sky News, came from GHF contractors who spoke on condition of anonymity as they were revealing their employer’s internal operations.

Palestinians dispersing away from tear gas fired at an aid distribution site in Gaza. Pic: AP
Image:
Palestinians are shown scrambling for aid in the footage provided to AP. Pic: AP

They said they were motivated to speak out as they were disturbed by what they considered dangerous practices by security staff who were often heavily armed.

AP reported the contractors had claimed “their colleagues regularly lobbed stun grenades and pepper spray in the direction of the Palestinians” and “bullets were fired in all directions – in the air, into the ground and at times toward the Palestinians, recalling at least one instance where he thought someone had been hit”.

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Contractor: ‘Innocent people being hurt’

“There are innocent people being hurt. Badly. Needlessly,” the contractor told AP.

Videos reportedly provided by one contractor show aid sites, located in Israeli military-controlled zones, with hundreds of Palestinians crammed between metal gates, scrambling to reach aid.

In the background, gunfire can be heard, and stun grenades are allegedly fired into crowds.

Palestinians dispersing away from tear gas fired at an aid distribution site in Gaza. Pic: AP
Image:
Footage provided to the AP news agency allegedly shows tear gas being fired at an aid distribution site in Gaza. Pic: AP

The footage does not show who was shooting or what was being shot at, but another video shows contractors in a compound, when bursts of gunfire can be heard. One man is then heard shouting in celebration: “Whoo! Whoo!”.

“I think you hit one,” another says, followed by the comment: “Hell, yeah, boy!”

The contractor who took the video told AP that colleagues were shooting in the direction of Palestinians.

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‘More than 90 killed’ in Israeli strikes in Gaza
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According to the Hamas-run Gaza Health Ministry and witnesses, several hundred people have been killed and hundreds more wounded since the GHF sites started operating more than a month ago, amid claims by Palestinians of Israeli troops opening fire almost every day at crowds seeking to reach the aid.

In response, Israel’s military says it fires only warning shots and is investigating reports of civilian harm. It denies deliberately shooting at any innocent civilians and says it’s examining how to reduce “friction with the population” in the areas surrounding the distribution centres.

Gunfire can be heard as Palestinians run towards aid being distributed. Pic: AP
Image:
Bursts of gunfire can be heard in the footage as Palestinians run towards aid being distributed. Pic: AP

GHF attacks ‘false claims’

GHF has vehemently denied the accusations, adding that it has investigated AP’s allegations.

In a statement on X, GHF wrote: “Based on time-stamped video footage and sworn witness statements, we have concluded that the claims in the AP’s story are categorically false. At no point were civilians under fire at a GHF distribution site.

“The gunfire heard in the video was confirmed to have originated from the IDF, who was outside the immediate vicinity of the GHF distribution site.

“It was not directed at individuals, and no one was shot or injured. What is most troubling is that the AP refused to share the full video with us prior to publication, despite the seriousness of the allegations.”

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Safe Reach Solutions, the logistics company subcontracted by GHF, told the AP there have been no serious injuries at any of their sites to date.

But the organisation admitted that, in isolated incidents, security professionals fired live rounds into the ground and away from civilians to get their attention.

A Safe Reach Solutions spokesperson told AP this happened at the start of their operations at “the height of desperation where crowd control measures were necessary for the safety and security of civilians”.

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