Chatbots, generative AI, and scholarly manuscripts: WAME recommendations on chatbots and generative artificial intelligence in relation to scholarly publications

This statement revises our earlier "WAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications" (January 20, 2023). The revision reflects the proliferation of chatbots and their expanding use in scholarly publishing over the last few months, as well as emerging concerns regarding lack of authenticity of content when using chatbots. These recommendations are intended to inform editors and help them develop policies for the use of chatbots in papers published in their journals. They aim to help authors and reviewers understand how best to attribute the use of chatbots in their work and to address the need for all journal editors to have access to manuscript screening tools. In this rapidly evolving field, we will continue to modify these recommendations as the software and its applications develop.

Esta declaración revisa las anteriores "Recomendaciones de WAME sobre ChatGPT y Chatbots en Relation to Scholarly Publications" (20 de enero de 2023). La revisión refleja la proliferación de chatbots y su creciente uso en las publicaciones académicas en los últimos meses, así como la preocupación por la falta de autenticidad de los contenidos cuando se utilizan chatbots. Estas recomendaciones pretenden informar a los editores y ayudarles a desarrollar políticas para el uso de chatbots en los artículos sometidos en sus revistas. Su objetivo es ayudar a autores y revisores a entender cuál es la mejor manera de atribuir el uso de chatbots en su trabajo y a la necesidad de que todos los editores de revistas tengan acceso a herramientas de selección de manuscritos. En este campo en rápida evolución, seguiremos modificando estas recomendaciones a medida que se desarrollen el software y sus aplicaciones.

Typhoid appendicitis and ‘the man from Istanbul’

We describe typhoid appendicitis in a 19-year-old girl. The appendix showed aggregates of macrophages in the mucosa and in the wall. Blood culture yielded Salmonella enterica serovar Typhi. The presence of macrophages in an appendicectomy specimen should prompt the pathologist to consider the possibility of typhoid fever, even in the absence of supporting microbiological investigations.

Medical ethics in laboratory medicine: A review, with an oath for pathologists

The basic tenets of medical ethics are: autonomy of the patient, beneficence, non-maleficence and justice. These are usually interpreted in the light of the practice of clinical medicine but also apply to pathology and laboratory medicine, a field in which there is often no direct patient contact. We wished to evaluate these basic tenets of medical ethics with respect to laboratory medicine and to provide insights into some of the issues that laboratory physicians, in routine practice and in academia, face on a regular basis. This was done by using the published literature related to the topic of medical ethics, with a special focus on laboratory medicine, as well as the authors’ interpretations and opinions, based on their experience. We conclude that the idea of autonomy of the patient or research participant is pertinent with respect to specimens, autopsies and in legal issues such as consent for publication in the media and social media. Beneficence is relevant with respect to laboratory values in reports, financial issues and in research and education. The concept of non-maleficence is important from the point of view of doing no harm, communication with patients and colleagues, reducing/containing error and misdiagnosis in medicine, screening for disease and in over diagnosis. Justice is applicable to issues of distribution of resources and manpower, and their equitable usage. Many of the tenets, however, need to be interpreted in the light of local laws and customs which differ across the world. We conclude with an Oath for pathologists and laboratory physicians. Key words: medical ethics, misconduct, autonomy, beneficence, non-maleficence, justice, informed consent, medical research, oaths

An editor speaks: Setting the record straight

An opportunity to read the memoirs of one of the most famous medical editors of our times, of one of the most prestigious medical journals of all time, was not something I could pass up. Thus, it was with glee and curiosity that I took up the job of reading and reviewing the memoirs of Dr Jerome Kassirer, former editor-in-chief of the New England Journal of Medicine (NEJM).

Reminiscences, reflections and reasoning

Dr Mani is a pioneering nephrologist in India. He tells us about his mentors – right from the age of 7 or 8 years – when he decided to become a doctor – and how he stuck to the straight and narrow path, the razor’s edge of medical practice in India. Dr Mani practised medicine in Government Medical College, Madras (now Chennai), before going to Australia for training in nephrology, then returning to India to work in Madras; and then at the Jaslok Hospital in Bombay (now Mumbai). Subsequently, he returned to his roots and has been at the Apollo Hospital, Chennai. Because this book was first published in 1989, the story ends in the 1980s. I had expected to see an update to this and would have liked to read about his life and work in Chennai. However, he has chosen not to make any changes from the first edition.

Geographic eponyms: A history of geography in medicine.

Geographic eponyms have commonly been used in medical terminology, with diseases and medical entities being named after the place where the condition was discovered (e.g. Bombay Blood group) or invented (Jaipur Foot) or where the disease was first detected (Rocky Mountain Spotted fever) or where a consensus meeting has been held (Banff) or for other reasons (Argentina flag, Congo red stain). In 2015, the WHO decided to adopt a politically correct method to name infectious diseases in the future. We illustrate, in verse form, some of the places that have been used in medical terminology, over the centuries. An accompanying essay explains the specific reasons for the selection of these locales in our vocabulary. Natl Med J India 2016;29:166–8

'Living in the clouds of a vain illusion': The decline and fall of clinical autopsies

Autos is Greek for oneself and opsis refers to the act of viewing; combined into autopsy, the word refers to the act of seeing for oneself.1,2 Historically, autopsies have been crucial to our understanding of the natural history of disease and the efficacy of our attempts to treat them. They have also humbled us by showing our shortcomings and errors. Campos and Rocha have reviewed autopsies over the past 4000 years and have highlighted their pedagogical value.3 In the era preceding Roentgen, autopsies were an unparalleled means for learning pathology. Works of great masters such as Giovanni Battista Morgagni (1682–1771) and Rudolph Virchow (1821–1902) were based on meticulous autopsies; Virchow added the use of the microscope. Carl Rokitansky (1804–78), working at the Allgemeine Krankenhaus in Vienna, performed 30 000 autopsies personally and supervised many more, making his institute one of the most respected training centres in pathology in Europe.1,2 The names of two early clinicians, who used autopsies to understand disease, come to mind. Pierre Charles Alexandre Louis (1787–1872) studied enteric fevers and distinguished typhoid from other causes of fevers. He correlated the intestinal lesions termed Peyer’s patches (after Johann Conrad Peyer [1653–1712] who had described them in the 1670s) with typhoid and used medical statistics to lay the foundation of what we now term evidence-based medicine.4 The surviving volumes of autopsy notes by William Osler at McGill University, the Montreal General Hospital and Philadelphia General Hospital, stand witness to his enthusiasm and competence in extracting the last bit of information from his subjects. His genius lay in correlating autopsy findings with clinical features to build unforgettable descriptions of several diseases. The lessons learnt in the autopsy room were disseminated to his students at dissections, through papers, books and at meetings.

The ethics of research on stored biological samples: outcomes of a Workshop.

Research is often conducted using laboratory samples and data. The ethical issues that arise in a study involving residual samples are considerably different from those arising in a prospective study. Some of these ethical issues concern the risks to confidentiality, individual autonomy, trust in and credibility of the researcher or the research, commercialisation and even the nomenclature involved.

News from here and there.

1 December 2015, the Pan American Health Organization (PAHO) issued an epidemiological alert warning of a suspected link between Zika and Guillain–Barré syndrome or microcephaly, but with the caveat that final proof was lacking. However, the health ministries of Brazil and Mexico, where Zika cases have been seen, have stated that the link is Zika virus. Zika virus disease is a mosquito-borne viral disease caused by the Zika virus, a member of the Flavivirus genus, family Flaviviridae. The virus is named after the Zika forest in Uganda where it was first isolated in 1947 in rhesus monkeys in the course of mosquito and primate surveillance. It then spread to Southeast Asia where it caused small sporadic infections. In 2007, the first major outbreak occurred in the Yap Islands of Micronesia. In 2013, a bigger outbreak occurred in French Polynesia, where the estimated infection rates were 70% on some islands. There were also reports of Guillain–Barré syndrome among adults. The virus first appeared in the western hemisphere in February 2014, on Chile’s Easter Island. Since then, it has spread over the length and breadth of Latin America. The first confirmed Zika virus infection in Brazil was in March 2015. Over the past 5 years, Brazil (population: 204 million), had 130 to 170 cases of microcephaly each year. From January to September 2015, this figure roughly doubled, and between October and December 2015, over 2400 new cases have been reported. Zika virus is a 40 nanometre enveloped virus with an icosahedral shape. It has a non-segmented single-strand, positive sense RNA genome. The genome encodes for a polyprotein with three structural proteins and seven non-structural proteins. The virus is primarily transmitted to people through the bite of an infected Aedes species mosquito (A. aegypti/A. albopictus). The Zika virus can be transmitted from an infected pregnant woman to her foetus during pregnancy or around the time of birth. Currently, there are no reports of Zika virus transmission through breastfeeding. Sexual transmission of the virus is possible. The virus is present longer in semen than in blood. Zika virus has been detected in blood and other body fluids including urine, semen, saliva, amniotic fluids as well as cerebrospinal fluid. During the outbreak in French Polynesia, 2.8% of blood donors tested positive for Zika virus. The virus has also been found in blood donors in previous outbreaks. There have been multiple reports of transmission of the virus through blood transfusion in Brazil. Most Zika virus infections are asymptomatic. Severe infection leading to hospitalization is uncommon and case fatality is low. However, as mentioned above, there is a likely link between Zika virus infection and Guillain–Barré syndrome or microcephaly. Infection is likely to give lifelong immunity. No specific antiviral treatment is available for Zika virus infection. Infected people should get plenty of rest, sufficient fluids, and analgesics and antipyretics.

Addressing the gaps in cytopathology training: The transition from resident to practitioner.

It is not unusual to see young doctors who were confident as residents face the ‘slings and arrows’ of private practice. Much of this is due to the teaching structure and general pattern of education in Indian medical schools. It is unlikely that there have been sweeping changes in the pattern of education in most medical colleges over the past five decades despite overwhelming changes in the practice of medicine during this time. A substantial number of students have limited access to learning new skills or revising old concepts once they leave medical school. There are no reliable data on the percentage of doctors in India in private practice or in the public sector. However, private practice is more popular than government service. A recent study of one specific batch of students showed that 94 of 106 students on whom data were available had opted for the private sector.1 I shall use the subject of cytopathology to discuss some shortcomings of our educational system and some possible remedies. Of course, this approach can be adapted for other areas of medicine and medical education. Our current method of teaching pathology consists of rotating a student through different aspects of the subject, including cytopathology, over a period of three years. That postgraduate training in pathology in India can be improved upon and the manner of doing it have been discussed by Bhusnurmath and Bhusnurmath.2 Their paper deals with pathology in general; however, given that cytology is a part of pathology, all the lessons apply. Some of the deficiencies in the current system include lack of a defined career track in branches of laboratory medicine, absence of teaching of communication skills and professional behaviour. Similarly, a recent paper from the College of American Pathologists also addresses the best practices in preparing residents for practice because of such training gaps that are increasingly obvious.3 Finally, we learn from an editorial from England that cytology is the major reason that candidates for FRCPath Part 2 fail their examinations.4 Clearly, there seems to be consensus among experts across continents that there are gaps in the training of postgraduates in pathology and that these gaps include cold clinical medicine as well as social and practical aspects of medical practice.

Regressive trend: MCI's approach to assessment of medical teachers' performance.

he Medical Council of India (MCI) has taken a regressive step. Its circular (No. MCI-12(1)/2015-TEQ/131880, dated September 3, 2015), which is entitled “Clarification with regard to research publications in the matter of promotion for teaching faculty in medical colleges/institutions”, is regressive and in partial dissonance with the current trends in medical science publications and norms of ethical publishing. Such an approach could have an adverse impact on the teaching faculty as it might encourage them to indulge in research misconduct. We appeal to the MCI to revisit its approach to the assessment of the performance of the teaching faculty in medical colleges and institutes. We make a strong case for the revocation of the MCI circular with immediate effect on four counts.

Gastrointestinal ALκ amyloidosis presenting as protein-losing enteropathy correctly diagnosed by immunohistochemistry using amyloid-type-specific antibodies.

A 54-year-old man presented with protein-losing enteropathy. Biopsies from the stomach, duodenum, ileum and colon showed deposits of amyloid. The bone marrow showed plasmacytosis. After an initial misdiagnosis of AA amyloid, a revised diagnosis of ALκ amyloidosis was made at an expert referral laboratory. Care must be taken in the use of antibodies and proper controls in the performance and interpretation of immunohistochemistry for amyloidosis. A wide panel of amyloid-type-specific antibodies must be used and interpreted in comparative mode to avoid misdiagnosis. Natl Med J India 2015;28:129–31

Medical journals – in the news and for the wrong reasons.

2013 has been a landmark year, in fact, a bad year for biomedical journals. Medical journals and their editors have been respected for long, as they are the harbingers of change and of progress in scientific thought. Science expects transparency from the agents through which scientists publish their latest research findings and this expectation is usually fulfilled. Recent developments have, however, thrown into doubt the integrity of some science journals, their editors, and by extension, the entire field of biomedical and science publishing. These developments involve wide-ranging issues - the impact factor, the International Committee of Medical Journal Editors (ICMJE), and the birth, existence and rise of predatory journals.

Are surgeons spunkier than non-surgeons.

Background. Surgeons are known to be bolder than other members of the medical profession. Testosterone levels are known to be higher in aggressive men. We wondered whether the above two statements indicated that the spunkiness of surgeons was related to higher testosterone levels. Methods. Sixteen surgeons and 16 non-surgeons, all men, aged 32–59 years took part in a prospective study that assessed their testosterone levels. Results. There was no statistical difference between the testosterone levels of the two groups. Conclusion. The reason for the gutsy behaviour of surgeons is not linked to their testosterone levels. Surgeons were disappointed to know this while non-surgeons were amused and a bit relieved.

Vitamin B12 deficiency in India: Mean corpuscular volume is an unreliable screening parameter.

Background. Vitamin B12 deficiency is thought to be more common than was previously believed, but there are little data from India on this. It has protean clinical manifestations, and raised mean corpuscular volume (MCV) is commonly used by physicians as an indicator for megaloblastic anaemia caused by vitamin B12 deficiency. We evaluated the clinical profiles of our patients with vitamin B12 deficiency and tried to ascertain how useful MCV and the peripheral smear were in diagnosis. Methods. We evaluated the clinical picture, haematology indices and peripheral smear findings of 117 patients with low vitamin B12 levels. Serum folic acid, ferritin values and biopsy findings of some patients were also assessed. Results. Patients were commonly detected to have reduced levels of serum vitamin B12 during the work-up for anaemia (n=45) or for neurological symptoms (n=31). Of the 94 cases in which smears were examined, 26 showed macrocytes and hypersegmented neutrophils were present in 24. Twentysix patients showed a raised MCV, 50 patients had an MCV within the reference range and 28 had low MCV. Pancytopenia was present in 5 patients. Concomitant iron deficiency, as judged by serum ferritin levels, was present in 18 patients. Conclusion. Vitamin B12 deficiency is not uncommon in India. It is often diagnosed during the work-up for a haematological disorder or for neurological symptoms. MCV is unreliable as a screening parameter for the presumed diagnosis of macrocytic anaemia, which is associated with vitamin B12 deficiency.