{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:51:21Z","timestamp":1792785081800,"version":"4.5.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"the German Federal Ministry of Research, Technology, and Space","award":["SEMECO (03ZU1210BA)"],"award-info":[{"award-number":["SEMECO (03ZU1210BA)"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"crossref"}]},{"name":"the German Federal Ministry of Research, Technology, and Space","award":["SEMECO (03ZU1210BA)"],"award-info":[{"award-number":["SEMECO (03ZU1210BA)"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"crossref"}]},{"name":"the German Federal Ministry of Research, Technology, and Space","award":["SEMECO (03ZU1210BA)"],"award-info":[{"award-number":["SEMECO (03ZU1210BA)"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-026-03384-w","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:49:11Z","timestamp":1791668951000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Six pragmatic steps to separate medical GenAI\u2019s promise from its inherent dangers"],"prefix":"10.1038","volume":"9","author":[{"given":"Stephen","family":"Gilbert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7808-2701","authenticated-orcid":false,"given":"Max","family":"Ostermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3323-2492","authenticated-orcid":false,"given":"Oscar","family":"Freyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"3384_CR1","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1038\/s41591-025-04176-7","volume":"32","author":"X Tao","year":"2026","unstructured":"Tao, X. et al. An LLM chatbot to facilitate primary-to-specialist care transitions: a randomized controlled trial. Nat. Med. 32, 934\u2013942 (2026).","journal-title":"Nat. Med."},{"key":"3384_CR2","unstructured":"Thaler, P. AI is starting to beat doctors at making correct diagnoses. Science (2026) https:\/\/www.science.org\/content\/article\/ai-starting-beat-doctors-making-correct-diagnoses"},{"key":"3384_CR3","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-026-04609-x","author":"L Zhang","year":"2026","unstructured":"Zhang, L. et al. On-premise medical AI agents for reliable clinical decision-making. Nat. Med. https:\/\/doi.org\/10.1038\/s41591-026-04609-x (2026).","journal-title":"Nat. Med."},{"key":"3384_CR4","doi-asserted-by":"publisher","first-page":"2490","DOI":"10.1038\/s41591-025-03832-2","volume":"31","author":"M Zitnik","year":"2025","unstructured":"Zitnik, M. AI-enabled drug discovery reaches clinical milestone. Nat. Med. 31, 2490\u20132491 (2025).","journal-title":"Nat. Med."},{"key":"3384_CR5","unstructured":"Bostrum, N. The Case Against Aging (2000). https:\/\/nickbostrom.com\/aging\/aging"},{"key":"3384_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41746-024-01345-9","volume":"7","author":"B Li","year":"2024","unstructured":"Li, B. & Gilbert, S. Artificial Intelligence awarded two Nobel Prizes for innovations that will shape the future of medicine. NPJ Digit. Med. 7, 1\u20133 (2024).","journal-title":"NPJ Digit. Med."},{"key":"3384_CR7","unstructured":"Kola, P. & Jamali, L. Anthropic Boss Dario Amodei Calls for AI Development to Slow Down https:\/\/www.bbc.com\/news\/articles\/c14dpgm0rg4o (2026)."},{"key":"3384_CR8","unstructured":"Kleinman, Z. OpenAI Agents Hijacked German Website before Hugging Face Hack, Report Claims https:\/\/www.bbc.com\/news\/articles\/ckg725z5kgzo (2026)."},{"key":"3384_CR9","unstructured":"Smith, A. Wealth of Nations, Book I, Chapter XI, Conclusion of the Chapter, p. 267, Para. 10 (1776)."},{"key":"3384_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41746-024-01344-w","volume":"7","author":"L Riedemann","year":"2024","unstructured":"Riedemann, L., Labonne, M. & Gilbert, S. The path forward for large language models in medicine is open. NPJ Digit. Med. 7, 1\u20135 (2024).","journal-title":"NPJ Digit. Med."},{"key":"3384_CR11","unstructured":"Cress, L. & Saad, N. Anthropic Blocks Possible Attempt to Use AI to Make Biological Weapons https:\/\/www.bbc.com\/news\/articles\/cx2zrrpkx20o (2026)."},{"key":"3384_CR12","doi-asserted-by":"publisher","unstructured":"Chhetri, P. Closed-loop agentic AI in drug discovery. RSC Med. Chem. https:\/\/doi.org\/10.1039\/d6md00319b (2026).","DOI":"10.1039\/d6md00319b"},{"key":"3384_CR13","unstructured":"GTIG AI Threat Tracker: From Prompting to Autonomy\u2014The Evolution of Adversarial AI https:\/\/cloud.google.com\/blog\/topics\/threat-intelligence\/from-prompting-to-autonomy-the-evolution-of-adversarial-ai (2026)."},{"key":"3384_CR14","unstructured":"How do Frontier AI Agents Perform in Multi-step Cyber-attack Scenarios? https:\/\/www.aisi.gov.uk\/blog\/how-do-frontier-ai-agents-perform-in-multi-step-cyber-attack-scenarios (2026)."},{"key":"3384_CR15","unstructured":"Satter, R. & Seetharaman, D. OpenAI\u2019s Rogue Agents Probed Hugging Face For Weaknesses Two Months Before Major Hack https:\/\/www.reuters.com\/legal\/litigation\/openais-rogue-agents-probed-hugging-face-weaknesses-two-months-before-major-hack-2026-09-16\/ (2026)."},{"key":"3384_CR16","first-page":"30","volume":"7","author":"S Li","year":"2025","unstructured":"Li, S., Surineni, K. & Prabhakaran, N. Cyber-attacks on hospital systems: a narrative review. Am. J. Geriatr. Psychiatry. Open Sci., Educ., Pract. 7, 30\u201339 (2025).","journal-title":"Am. J. Geriatr. Psychiatry. Open Sci., Educ., Pract."},{"key":"3384_CR17","unstructured":"Perlo, J. Most U.S. Doctors are Quietly Using this AI Tool. Few Patients Know about It https:\/\/www.nbcnews.com\/tech\/tech-news\/openevidence-ai-doctor-medical-physician-login-app-what-npi-uptodate-rcna341064 (2026)."},{"key":"3384_CR18","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1038\/s41746-026-02454-3","volume":"9","author":"RCA van Linschoten","year":"2026","unstructured":"van Linschoten, R. C. A., van Loon, C. M., Joanknecht, L. & Bischoff, E. W. M. A. Ambient scribe in general practice: a multi-perspective before-after longitudinal mixed-methods study. NPJ Digit. Med. 9, 299 (2026).","journal-title":"NPJ Digit. Med."},{"key":"3384_CR19","unstructured":"Wilkins, G. AI Anxiety, Worry, and Burnout Fluctuate Together in Medical Students Daily https:\/\/bioengineer.org\/ai-anxiety-worry-and-burnout-fluctuate-together-in-medical-students-daily\/ (2026)."},{"key":"3384_CR20","doi-asserted-by":"publisher","first-page":"108619","DOI":"10.1016\/j.pec.2024.108619","volume":"133","author":"W Li","year":"2025","unstructured":"Li, W. & Liu, X. Anxiety about artificial intelligence from patient and doctor-physician. Patient Educ. Couns. 133, 108619 (2025).","journal-title":"Patient Educ. Couns."},{"key":"3384_CR21","unstructured":"Sweney, M. Bill Gates Calls for \u2018Human-reserved\u2019 Jobs in Face of AI Takeover https:\/\/www.theguardian.com\/technology\/2026\/aug\/26\/bill-gates-human-reserved-jobs-ai-takeover(2026)."},{"key":"3384_CR22","unstructured":"Artificial Intelligence (AI) and Medical Device Software Regulation https:\/\/www.tga.gov.au\/products\/medical-devices\/software-and-artificial-intelligence-ai\/manufacturing\/artificial-intelligence-ai-and-medical-device-software-regulation (2026)."},{"key":"3384_CR23","unstructured":"Considerations for the Regulation of Generative AI-Enabled Medical Devices: Discussion Paper and Request for Feedback https:\/\/www.fda.gov\/medical-devices\/digital-health-center-excellence\/considerations-regulation-generative-ai-enabled-medical-devices-discussion-paper-and-request(2026)."},{"key":"3384_CR24","unstructured":"National Commission into the Regulation of AI in Healthcare: Recommendations for a Future Regulatory Framework https:\/\/www.gov.uk\/government\/publications\/national-commission-into-the-regulation-of-ai-in-healthcare-recommendations-for-a-future-regulatory-framework (2026)."},{"key":"3384_CR25","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1038\/s41568-024-00685-8","volume":"24","author":"S Gilbert","year":"2024","unstructured":"Gilbert, S. & Kather, J. N. Guardrails for the use of generalist AI in cancer care. Nat. Rev. Cancer 24, 357\u2013358 (2024).","journal-title":"Nat. Rev. Cancer"},{"key":"3384_CR26","doi-asserted-by":"publisher","unstructured":"Meczner, A., Wilks, O. & Hunter Blair, E. Clinical safety evaluation of LLM assistants using decomposed LLM-as-judges: a framework grounded in real-world interactions and formal risk assessment. SSRN Scholarly Paper at https:\/\/doi.org\/10.2139\/ssrn.7230054 (2026).","DOI":"10.2139\/ssrn.7230054"},{"key":"3384_CR27","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1038\/s41591-024-03397-6","volume":"31","author":"R Mathias","year":"2025","unstructured":"Mathias, R. et al. Safe AI-enabled digital health technologies need built-in open feedback. Nat. Med. 31, 370\u2013375 (2025).","journal-title":"Nat. Med."},{"key":"3384_CR28","doi-asserted-by":"publisher","first-page":"e662","DOI":"10.1016\/S2589-7500(24)00124-9","volume":"6","author":"O Freyer","year":"2024","unstructured":"Freyer, O., Wiest, I. C., Kather, J. N. & Gilbert, S. A future role for health applications of large language models depends on regulators enforcing safety standards. Lancet Digit. Health 6, e662\u2013e672 (2024).","journal-title":"Lancet Digit. Health"},{"key":"3384_CR29","doi-asserted-by":"publisher","first-page":"100196","DOI":"10.1016\/j.mcpdig.2025.100196","volume":"3","author":"O Freyer","year":"2025","unstructured":"Freyer, O., Wiest, I. C. & Gilbert, S. Policing the boundary between responsible and irresponsible placing on the market of large language model health applications. Mayo Clin. Proc. Digit. Health 3, 100196 (2025).","journal-title":"Mayo Clin. Proc. Digit. Health"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-03384-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-03384-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-03384-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:14:19Z","timestamp":1791670459000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-03384-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,10]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3384"],"URL":"https:\/\/doi.org\/10.1038\/s41746-026-03384-w","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,10]]},"assertion":[{"value":"18 September 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"M.O. has a consulting relationship with the Saudi Food and Drug Authority. O.F. has a leadership role and holds stock in WhalesDontFly GmbH, and has had consulting relationships with Prova Health Ltd and the Saudi Food and Drug Authority. O.F. has received honoraria from the European Society of Medical Oncology (ESMO). O.F. is an Editor for npj Digital Medicine. O.F. played no role in the internal review or decision to publish this News and Views article. S.G. has or has had consulting relationships with Ada Health GmbH, AMBOSS SE, European Commission Directorate General for Research & Innovation, Flo Ltd., FORUM Institut f\u00fcr Management GmbH, High-Tech Gr\u00fcnderfonds Management GmbH, Haleon Plc. ICURA ApS, Lindus Health Ltd., Prova Health Ltd., Rock Health Inc., Saudi Arabia Food and Drug Authority (FDA) funded through the United Nations Development Programme (UNDP), Thymia Ltd., Una Health GmbH and holds share options in Ada Health GmbH. S.G. is a News and Views Editor for\n                      npj Digital Medicine\n                      but is not part of a peer review process or decision making of this manuscript. S.G. played no role in the internal review or decision to publish this article.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"782"}}