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The integration of large language models (LLMs) into health care presents significant risks to patients and clinicians, inadequately addressed by current guidance. This paper adapts harm reduction principles from public health to medical LLMs, proposing a structured framework for mitigating these domain-specific risks while maximizing ethical utility. We outline tailored strategies for patients, emphasizing critical health literacy and output verification, and for clinicians, enforcing “human-in-the-loop” validation and bias-aware workflows. Key innovations include developing thoughtful use protocols that position LLMs as assistive tools requiring mandatory verification, establishing actionable institutional policies with risk-stratified deployment guidelines and patient disclaimers, and critically analyzing underaddressed regulatory, equity, and safety challenges. This research moves beyond theory to offer a practical roadmap, enabling stakeholders to ethically harness LLMs, balance innovation with accountability, and preserve core medical values: patient safety, equity, and trust in high-stakes health care settings.

The effects of plants on the biosphere, atmosphere and geosphere are key determinants of terrestrial ecosystem functioning. However, despite substantial progress made regarding plant belowground components, we are still only beginning to explore the complex relationships between root traits and functions. Drawing on the literature in plant physiology, ecophysiology, ecology, agronomy and soil science, we reviewed 24 aspects of plant and ecosystem functioning and their relationships with a number of root system traits, including aspects of architecture, physiology, morphology, anatomy, chemistry, biomechanics and biotic interactions. Based on this assessment, we critically evaluated the current strengths and gaps in our knowledge, and identify future research challenges in the field of root ecology. Most importantly, we found that belowground traits with the broadest importance in plant and ecosystem functioning are not those most commonly measured. Also, the estimation of trait relative importance for functioning requires us to consider a more comprehensive range of functionally relevant traits from a diverse range of species, across environments and over time series. We also advocate that establishing causal hierarchical links among root traits will provide a hypothesis-based framework to identify the most parsimonious sets of traits with the strongest links on functions, and to link genotypes to plant and ecosystem functioning.

Since the holobiont concept came into the limelight ten years ago, we have become aware that responses of holobionts to climate change stressors may be driven by shifts in the microbiota. However, the complex interactions underlying holobiont responses across aquatic and terrestrial ecosystems remain largely unresolved. One of the key factors driving these responses is the infochemical-mediated communication in the holobiont. In order to come up with a holistic picture, in this Viewpoint we compare mechanisms and infochemicals in the rhizosphere of plants and the eco-chemosphere of seaweeds in response to climate change stressors and other environmental stressors, including drought, warming and nutrient stress. Furthermore, we discuss the inclusion of chemical ecology concepts that are of crucial importance in driving holobiont survival, adaptation and/or holobiont breakdown. Infochemicals can thus be regarded as a ‘missing link’ in our understanding of holobiont response to climate change and should be investigated while investigating the responses of plant and seaweed holobionts to climate change. This will set the basis for improving our understanding of holobiont responses to climate change stressors across terrestrial and aquatic ecosystems.

Phytoplankton growth rate is a key variable controlling species succession and ecosystem structure throughout the surface ocean. Carbonate chemistry conditions are known to influence phytoplankton growth rates but there is no conceptual framework allowing us to compare growth rate responses across taxa. Here we analyse the literature to show that phytoplankton growth rates follow an optimum curve response pattern whenever the tested species is exposed to a sufficiently large gradient in proton (H⁺) concentrations. Based on previous findings with coccolithophores and diatoms, we argue that this ‘universal reaction norm’ is shaped by the stimulating influence of increasing inorganic carbon substrate (left side of the optimum) and the inhibiting influence of increase H⁺ (right side of the optimum). We envisage that exploration of carbonate chemistry-dependent optimum curves as a default experimental approach will boost our mechanistic understanding of phytoplankton responses to ocean acidification, like temperature curves have already boosted our mechanistic understanding to global warming.

Pancreatic cancer is considered a complex cancer requiring specific expertise in diagnostic workup and multimodality treatment. Often, multiple health care providers in different hospitals are involved during patient care. This fragmentation of care challenges health care providers in the network to deliver efficient, coherent, and continuous network care. We performed a human-centered design (HCD) sprint in order to find means to improve network care for patients diagnosed with pancreatic cancer. The sprint comprised 5 days with different goals: empathize, define, ideate, prototype, and test. Experts and stakeholders were approached from the pancreatic cancer network to contribute. By using HCD, a goal was defined, various prototypes were explored, and one prototype was tested. The HCD Sprint led to a shared goal, which was to deliver pancreatic cancer network care in a (virtual) hospital in which there is “one narrative.” This means that the patient’s context and preferences are always clear and taken into account, care is characterized by a short time to diagnosis and treatment, and patient data are easily available for patients and involved clinicians. The accompanying prototypes were (1) network agreements, (2) patient itinerary, (3) transmural trajectory guidance, and (4) data sharing. For the latter, we developed and pilot-tested a real-time data sharing dashboard called CONNECT. The first pilot-test was promising and provided feedback for further development. In this viewpoint paper, we show that a HCD sprint is able to find possible means to improve pancreatic network care in a short time span. A real-time data sharing dashboard (CONNECT) was developed and pilot tested. The next steps include further development of the dashboard, implementation in our network, and long-term evaluation studies.

Over the last 25 years, the health care sector has undergone a digital transformation; health issues and medical conditions are increasingly managed with the support of digital health technology. The internet has transformed the boundaries around physicians’ work, which raises questions about how technological artifacts are transforming the boundaries that have traditionally existed between the health care professions and patients regarding information and knowledge. This viewpoint paper analyzes how digital health technologies can transform the boundaries of physicians’ work by examining 3 examples of technology aimed at patients or citizens: Open Notes, PatientsLikeMe, and Apple Watch. Traditionally, the physician profession drew the boundaries that separated it from other professions and patients to define and protect its jurisdiction and professional knowledge. However, in the 3 artifacts analyzed, technology changes the boundaries between laypeople and physicians. Therefore, health technologies aimed at citizens impact health care and its professions, and the materiality of artifacts can change the boundaries between physicians and citizens. Thus, the initiators and developers of technology aimed at patients or citizens may have the power to transform the field of knowledge in health care.

Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care.

The arrests of people for breaching COVID‐19 public health measures [ 10] – and subsequent labelling as “intentional murderers” [ 11] and “super spreaders” [ 12] – signal the creation of the “immoral” other. [...]HIV has taught us about the complexity of stigma. Social ecological approaches to HIV remind us that stigma is intrapersonal (affecting our self‐perception and mental health), interpersonal (altering our relationships), social (embedded in community norms and values) and structural (reproduced institutionally in health, legal, employment and other practices) [ 15,16].