Methods: This study assessed the effectiveness of safeguards in foundational LLMs against malicious instruction into health disinformation chatbots. Five foundational LLMs—OpenAI’s GPT-4o, Google’s Gemini 1.5 Pro, Anthropic’s Claude 3.5 Sonnet, Meta’s Llama 3.2-90B Vision, and xAI’s Grok Beta—were evaluated via their application programming interfaces (APIs). Each API received system-level instructions to produce incorrect responses to health queries, delivered in a formal, authoritative, convincing, and scientific tone.
Key findings:
Of the 100 health queries posed across the 5 customized LLM API chatbots, 88 (88%) responses were health disinformation
Examples of how AI systems can be used to create disinformation:
My take: This study shows how easy it is to get AI systems to provide misleading information in a convincing fashion. It might be interesting to include one of these systems to provide answers for the board game Balderdash.
ECF Brown. NEJM 2025; 393; 1-3. Defining Health Care “Corporatization”
This blog has had many posts detailing the many flaws in the U.S. health care system. While the U.S. expends more per capita than any other country, our life expectancy is 4 years less than similar countries in Europe and Canada.
This article in the NEJM is the first of a series examining the ‘corporatization’ of health care and potential ways to improve health care delivery.
Excerpts:
The percentage of hospitals owned by companies controlling three or more hospitals increased from 11.6% in the 1980s to 56.1% today…and now nine megahospital chains own more than 50 hospitals each.
In the early 1980s, three quarters of U.S. physicians owned their practice, whereas in 2023 a similar proportion of physicians was employed by hospitals or corporate entities, including private equity funds.
Insurance conglomerates, such as UnitedHealthcare and CVS–Aetna, now control physicians, home care, pharmacies, and pharmacy benefit managers (PBMs). Horizontal hospital consolidation has been pursued for the promise of economies of scale and market power…
The term “corporatization” now refers to the general trend throughout the health care industry toward higher levels of integrated control by consolidated profit-seeking enterprises… First is the elevation of profit generation as the primary goal of the health care enterprise…the primary duty of the corporation is to maximize shareholder profits. Shareholder primacy subordinates the interests of other stakeholders, such as patients, the health care workforce, or the community…
Even nonprofit hospitals can become corporatized as they grow in size and organizational scale…powerful nonprofit health systems may come to prioritize revenue over patient and community welfare, evidenced by inflated prices, insurance network exclusions, medical debt–collection actions against patients, facility closures in low-income areas, and cuts to staffing levels and pay.
The second key element of corporatization is consolidation… Conglomerates’ market dominance, diversification across platforms, and change in locus of control insulate them from reputational or market discipline…
Corporatization has produced a system that is incredibly profitable for investors but increasingly unaffordable, inaccessible, and uncaring for everyone else — in other words, it has created a Gilded Age of medicine.5 …Corporate control over medical practices and the drive for profit have undermined many clinicians’ professionalism, autonomy, trust, and morale…
Traditional health policy interventions such as antitrust enforcement, tax subsidies and exemptions, prohibitions on the corporate practice of medicine, and payment reforms have not stopped the rise of the corporation in health care, owing to lax enforcement, political capture, and sophisticated regulatory workarounds…
Confronting corporatization may require a fundamental reorientation of the industrial organization of the health system… Future health policy efforts must confront the fundamental question of whom our health care system is meant to serve: corporate giants or the members of our society as a whole.
A Porto et al. J Pediatr Gastroenterol Nutr. 2025;81:5–10. New international infant formulas in the United States: Understanding the Food and Drug Administration-enforcement discretion
Background: In February 2022, the United States experienced a significant infant formula shortage, due to a major product recall by the country’s largest infant formula manufacturer, compounded by global supply chain issues and import restrictions.1, 2 In response, the Food and Drug Administration (FDA) launched Operation Fly Formula in mid-2022, which allowed international infant formula manufacturers to market, import and distribute their formulas in the United States…Currently, a total of five companies, who produce 14 international formulas, have opted to work with the FDA in transitioning to the US market.5 Many of these international formulas are significantly cheaper than the domestic alternatives, which have contributed to their rising popularity.
Key points:
8 of 14 formulas are stage formulas with Stage 1 for 0-6 months, and Stage 2 for >6 months. “Stage 1 formulas tend to contain less iron, which may provide an insufficient amount of iron for infants >6 months.11 Also, infants <6 months should not consume Stage 2 formula since it does not contain carnitine, believed to be an essential nutrient in this age group.12“
Of the 14 formulas, all the labels were in English and contained all the FDA nutrient requirement
“Two of the imported formulas [Aptamil brands] contained less than 1 mg/100 calories of formula of iron, the minimum amount to be considered iron fortified by the FDA, and did include a label which highlighted that additional iron may be necessary”
“All the foreign formulas contained prebiotics… The FDA, however, reports that probiotics can be dangerous for preterm infants and put them at risk for potentially fatal infection caused by the bacteria or yeast contained in the probiotic.6 Therefore, pediatricians should be aware that international formulas should not be used for preterm infants.”
MIXING INSTRUCTIONS: “Eleven out of the fourteen international formulas use a different scoop to water ratio from what is typically standard of American formulas…coops from international formulas may also be a different size compared to their US counterparts. Given the variation in different mixing ratios and scoop sizes, there is a risk of formula being mixed incorrectly”
“Consider that the family may be purchasing from a 3rd party vendor and ask for the specific website that they are purchasing from. Formulas should not be purchased at 3rd party vendor websites due to them being unregulated, and safety concerns with improper shipping or storage”
“If the label is not in English, it is highly likely that the formula has been purchased through a 3rd party vendor. Recommend counseling on safety concerns as listed above. Many of the foreign infant formulas use different mixing ratios so it is important that parents read the label to confirm mixing ratios”
My take: The availability of FDA-approved international formulas has been helpful especially with recent shortages. This article makes several important points to assure their proper use, especially regarding mixing instructions and using Stage formulas for appropriate age.
K Puri et al. J Pediatr Gastroenterol Nutr. 2025;81:1–4. Nutritional and growth concerns of vegetarian diets in children
Key points:
“Although vegetarian diets have become popular due to their benefits on environment, they pose nutritional challenges due to the risk of developing nutrient or caloric deficiencies which may impact health or growth in children and adolescents.”
“Any child or family who adheres to a strict vegetarian diet [needs to] work with a nutrition specialist or registered dietitian familiar with the nutritional concerns of a vegetarian diet. This includes calcium and iron intake as well as sufficient and diverse protein intake. B12 and vitamin D supplementation should be considered in vegetarian children”
“While data suggest that average anthropometrics are similar between vegetarian/vegan and omnivorous children, there is some concern regarding the risk of being underweight while following a vegetarian diet…. a vegetarian diet can be a safe and complete diet for children when detailed and longitudinal attention is given to diversification of nutrient intake.”
My take: This article provides a useful review of the dietary issues that need to be monitored for pediatric vegetarians. I agree that a visit with a nutritionist is worthwhile for these children.
Recently Dr. DiLorenzo gave our group a brilliant lecture. I have taken some notes and shared some slides. There may be inadvertent omissions and mistakes in my notes. This is part 2 of my summary.
Key points (intermixed with slides):
Improving Physical activity, Diet and Sleep Often Helps DGBI symptoms
Excess use of smartphones can be detrimental. There are issues with FOMO (fear of missing out), cyberbullying, effects on sleep, and effects on interpersonal skills
Displacement, or replacing important activities (including physical activity) with time spent on social media, is a significant concern
Working with pain psychologists is an important part of treatment for many children and adolescents
Lots of celebrities have been open about their mental health challenges: Lady Gaga, Ariana Grande, Kristen Bell, Selena Gomez, Ryan Reynolds, and Dwayne “The Rock” Johnson
For more serious mental health concerns, referral to psychiatry is more appropriate
Gut-Brain neuromodulators can be effective.
Despite their good safety profile, they are underutilized
Dr. DiLorenzo uses more citalopram than omeprazole
Amitriptyline is often used for abdominal pain in the absence of anxiety. Variable results have been published
Psychotropic medications: Amitriptyline is useful for pain predominant IBS, Citalopram often is effective for FAP/IBS with anxiety, Buspirone is helpful in dyspepsia with anxiety, and Mirtazapine is a good choice in the setting of dyspepsia with with weight loss. Generally, start with a low dose and slowly titrate with each medication
Safety: Despite black box warning, recent studies have suggested SSRIs may lower the risk of suicidality overall
Don’t be the doctor who only tells patients things they want to hear. (Don’t be afraid of online rating)
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition
Recently Dr. DiLorenzo gave our group a brilliant lecture. I have taken some notes and shared some slides. There may be inadvertent omissions and mistakes in my notes. Dr. DiLorenzo gave our group a lecture in 2021 as part of the William Meyers Lectureship. This talk extended those observations he conveyed at that visit (Carlo DiLorenzo: Lessons Learnt Over 30 Years). I highly recommend his upcoming NED talk at NASPGHAN.
Key points (intermixed with slides):
Diagnostic testing in the setting of DGBIs is mainly for confirmation that an adequate workup has been completed
Schedule enough time for each patient. In evaluations of visits, one of the most negative feelings for patients is when they feel rushed
Make sure the patient is allowed to speak. Parents may embellish (or underreport) symptoms
Families feel that when clinicians are sitting down that they spend more time with them
This extends into the hospital. A recent controlled study showed that having a chair within 3 ft of the bed increased the likelihood that physicians would sit when rounding and increased patient satisfaction (Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial. Iyer R, et al.BMJ. 2023 Dec 15;383:e076309). Study conclusion: “Chair placement is a simple, no cost, low tech intervention that increases a physician’s likelihood of sitting during a bedside consultation and resulted in higher patients’ scores for both satisfaction and communication.”
Dr. DiLorenzo rarely uses computers when he is in the room with families
Don’t belittle or get upset over an “easy” or “stupid” consult. All of us need help and hardly anyone wants to manage only highly-complex patients
Don’t speak poorly of other physicians in front of the patient
The problem with too much testing –>it can result in ‘Munchausen by Doctor’ and the discovery of incidental problems (that may not necessitate treatment). Further testing has been associated with intensification of symptoms
Identification of eosinophilic esophagitis is not helpful in resolving stomach pain
Newest “epidemics” associated with stomach pains include alpha gal and multiple vascular compression syndrome
While unusual disorders can occur, Dr. DiLorenzo mainly looks for unusual diagnoses when patients have unusual symptoms (like weight loss, pain with exercise)
While guidelines often emphasize the use of treatments based on double-blind, placebo-controlled (DBPC) studies, “there has never been a DBPC for the effectiveness of a parachute.” Some treatments are worthwhile even in the absence of DBPC studies
Many of the medicines used for DGBIs and related symptoms have approval for other uses
Fundoplication which was commonplace is used rarely these days. Yet, it is still a good treatment for reflux
Antegrade enemas can be very effective for constipation
“All patients with chronic pseudo-obstruction necessitating parenteral nutrition should have a G-tube and an ileostomy.” It may help them come off parenteral nutrition
Don’t order AXR to diagnose constipation. AXRs ordered in ER to diagnose constipation are associated with a slightly higher likelihood of a missed diagnosis.
Though, “no need to be holier than the pope.” Using AXR in specific circumstances can be helpful with treatment (like determining success of a cleanout)
Treating the Brain is important in patients with DGBIs
Anxiety, which is increased in patients with DGBIs, has reached epidemic levels
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition
These videos are on TikTok account. I do not have an account but was able to access this short video on my laptop (had trouble accessing on my mobile):
Methods: The study used the fourth Trøndelag Health Study (HUNT4), conducted in 2017–2019, where 56,042 adult (aged >20 years) residents of Nord-Trøndelag County, Norway, participated. Serum samples from 54,505 participants were analyzed for anti-transglutaminase 2 IgA and IgG.
Key findings:
The rate of CeD seropositivity was 2.0% (1107/54,505).
The total biopsy-confirmed prevalence of CeD was 1.5% (853/56,042).
The study confirmed a new CeD diagnosis after participation in HUNT4 in 470 individuals and a known CeD diagnosis before participation in HUNT4 in 383 individuals.
The ratio of new, previously undiagnosed CeD cases (after HUNT4) to known, previously diagnosed CeD cases (before HUNT4) was 1.2:1 (470/383).
My take: This study showed that the ratio of undiagnosed cases to diagnosed case of CeD was improved from previously in Norway.
Methods: This study examined the quantity and timing of dietary fiber intake in children up to 5 years of age who were at genetic risk for celiac disease, assessing its relationship with their subsequent risk of developing the condition. The analysis included 6520 children carrying the HLA-DQ2 and/or DQ8 risk haplotypes who were prospectively followed for a total 61,669 person-years to age 13 years in The Environmental Determinants of Diabetes in the Young (TEDDY) study.
Key findings:
Dietary fiber intake from 6 months to 3 years of age was inversely associated with the subsequent risk of celiac disease in models unadjusted for the concurrent gluten intake and to 2 years of age in models adjusted for gluten intake (Figure 1A). In contrast, no association was observed between dietary fiber intake to 4 and 5 years of age and the risk of celiac disease regardless of whether models accounted for the gluten intake.
My take: Higher dietary fiber intake during the first 2 years of life was associated with a lower risk of celiac disease in children at genetic risk. Although this effect was modest, it was independent of gluten intake and other components found in fiber-rich foods in the child’s diet.
P Singh et al. Gastroenterology 2025; 168: 1128-1136. A Novel, IBS-Specific IgG ELISA-Based Elimination Diet in Irritable Bowel Syndrome: A Randomized, Sham-Controlled Trial
Background (from editorial): “Biomarkers that correspond with the distinct pathophysiological disturbances that underlie food sensitivity, and that can be used to monitor and guide management or predict response to food elimination are lacking…Previous studies have suggested a role for IgG-mediated food sensitivities in driving IBS symptoms.12 However, the role of IgG testing and subsequent dietary elimination for the management of IBS symptoms remains a subject of debate. Elevated IgG levels have been observed in healthy individuals, indicating that these antibodies may reflect a physiological response to dietary exposure rather than intolerance or sensitivity to a specific food.”
In this study, the researchers used a proprietary IgG-based sensitivity testing (“inFoods IBS” ELISA) from the company sponsor, Biomerica. This was a randomized, double-blind, sham-controlled trial enrolling subjects with IBS from 8 centers. Subjects positive for ≥1 food on an 18-food IgG assay. 223 were included in the modified intention-to-treat analysis. The primary outcome was a ≥30% decrease in abdominal pain intensity for ≥2 of the last 4 weeks of the treatment period.
Key findings:
A significantly greater proportion of subjects in the experimental diet group met the primary outcome than those in the sham diet group (59.6% vs 42.1%, P = .02).
Subgroup analysis revealed that a higher proportion of subjects with constipation-predominant IBS and IBS with mixed bowel habits in the experimental diet group met the primary endpoint vs the sham group (67.1% vs 35.8% and 66% vs 29.5%, respectively).
Discussion Points:
The authors claim the following: “Because IgG-based antibodies to foods can be elevated in healthy controls, it is important to develop disease-specific assays. The assay used in our study was developed specifically for patients with IBS and uses cutoff values derived from healthy controls.”
Limitations:
“Adherence was poor. Of those who filled out the dietary diary as instructed, 35% were nonadherent in the intervention group and 42% nonadherent based on a yes to an adherence question on ≥80% of days over the 12-week trial.” Adherence was higher in the sham control.
“Second, in a per-protocol analysis that included only the adherent participants, the clinical outcomes are much less impressive for the IgG-based elimination diet, raising critical questions as to whether other factors were responsible for the improvement in symptoms in the full dataset.”
Possible confounding bias: “2 of the 3 most commonly eliminated foods in the IgG-based elimination diet were high in FODMAPs (eg, milk, wheat), whereas all 3 most commonly eliminated foods in the sham diet were low in FODMAPs (poultry, rice, and goat cheese).”
The authors noted that it was unexpected that the response was more robust in the IBS-C and IBS-M groups rather than the IBS-D groups.
The company sponsor has had good success in publicizing their results on ABC, CBS and NBC. Here is a link from their website direct to YouTube. It highlights a specific young woman reporting success with this approach and commentary by one of the lead authors: inFoods IBS Finding Trigger Foods Faster.
My take: While most patients are eager to pinpoint trigger foods, I remain skeptical about this “precision testing for IBS.” There is no data indicating that this IgG-based diet outperforms patients who limit dairy and wheat, two common triggers. I agree with the associated editorial: “The clinical efficacy of IgG-based elimination diets will need further evaluation before they are implemented in routine clinical practice.”
Since taking over as the top US health official in February, Robert F. Kennedy Jr has overseen radical changes that have alarmed many public-health experts…His mission, he says, is to ‘Make America Healthy Again’. “We are the sickest nation in the world,” he said in March, “and we have the highest rate of chronic disease.” His diagnosis holds some truth, say public-health specialists and analysts. Relative to other similarly wealthy nations, the United States has the shortest life expectancy despite spending the most on health care…And researchers agree that high rates of chronic disease, including heart disease and obesity, are key contributors to Americans’ higher death rates, as Kennedy emphasizes.
But researchers say that Kennedy — widely known as RFK Jr — has mostly ignored other leading causes of death and ill health, including car accidents, drug overdoses and gun violence…
Life expectancy in the United States was closer to the average for its peers around 1980 and gradually improved, according to KFF’s analyses. The gains were driven partly by a drop in smoking and increased use of cholesterol-lowering drugs known as statins…
Overall, chronic conditions — heart disease, cancer, stroke and respiratory disease — take up four out of five spots on the country’s list of biggest killers…One of the biggest drivers of those deadly conditions is obesity, say researchers. As of 2022, about 42% of adults were considered obese in the United States, compared with 27% in the United Kingdom and 5.5% in Japan. Obesity increases the risks of developing diabetes, heart disease, cancer and many other conditions. “The US has, particularly around diet, obesity and overweight, adopted unhealthier lifestyles at a higher rate than our country peers,” Bollyky says…
The problems caused by chronic disease are compounded by poor health care. Compared with a group of similar high-income countries, the United States is the only one that lacks universal health-insurance coverage… Lack of health insurance, high costs and other barriers prevent people from getting diagnoses and treatment early on…
The other big contributors to lower life expectancy in the United States — and what really sets the country apart, researchers say — are high death rates from substance misuse, car accidents, suicide and homicide (see ‘Varied causes’). These tend to kill people of working age…All told, the death rates in working-age people mean that one 5-year-old out of every 20 — or roughly one in every school class — will die before the age of 45, according to Angus’s calculations. The comparable figure is one in 50 in the United Kingdom and one in 100 in Switzerland…
Health spending in the United States was about US$13,000 per person in 2023, according to a KFF analysis. That compares to an average of about $7,000 per person in similar large, well-off countries…
Boosting rather than cutting spending on disease prevention is “where the big gains are to be made on population health” [Reginald Williams, a health-policy specialist at the Commonwealth Fund says his] first priority would be to expand health coverage. In the United States, around 8% of people lack health insurance, compared with around 1% or less in similar high-income countries. The second, he says, would be to invest more in primary care — the physicians and other health professionals who are the first port of call for patients, and who deal with disease prevention and management…
Tackling the high death rates from overdoses and guns, meanwhile, would involve addressing entrenched social and political issues such as gun ownership, poverty, unemployment and inequality.
My take: Despite big promises from politicians, there are no quick fixes for improving our national health. Improving health care access would help but this does not address deaths due to firearms, drug overdoses and to car accidents.
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