With the rise of telemedicine, wearable healthcare, and the greater leverage of ‘big data’ for precision medicine, various challenges present themselves to organisations, physicians, and patients. Beyond the practical, financial, and clinical considerations, we must not ignore the ethical imperative for fair and just applications to improve the field of healthcare for all. Given the increasing personalisation of medicine and the role technology will play at the interface of healthcare delivery, a thorough understanding of the challenges presented is critical for future physicians who will navigate a novel environment. This article aims to explore the ethical challenges that the adoption of digital healthcare technology presents, contextualised at multiple levels. Potential solutions are suggested to initiate a discussion about the future of medicine and digital healthcare.

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Importance The mechanisms underlying the association between chronic stress and higher mortality among individuals with cancer remain incompletely understood. Objective To test the hypotheses that among individuals with active head and neck cancer, that higher stress-associated neural activity (ie. metabolic amygdalar activity [AmygA]) at cancer staging associates with survival. Design Retrospective cohort study. Setting Academic Medical Center (Massachusetts General Hospital, Boston). Participants 240 patients with head and neck cancer (HNCA) who underwent 18F-FDG-PET/CT imaging as part of initial cancer staging. Measurements 18F-FDG uptake in the amygdala was determined by placing circular regions of interest in the right and left amygdalae and measuring the mean tracer accumulation (i.e., standardized uptake value [SUV]) in each region of interest. Amygdalar uptake was corrected for background cerebral activity (mean temporal lobe SUV). Results Among individuals with HNCA (age 59±13 years; 30% female), 67 died over a median follow-up period of 3 years (IQR: 1.7–5.1). AmygA associated with heightened bone marrow activity, leukocytosis, and C-reactive protein (P<0.05 each). In adjusted and unadjusted analyses, AmygA associated with subsequent mortality (HR [95% CI]: 1.35, [1.07–1.70], P = 0.009); the association persisted in stratified subset analyses restricted to patients with advanced cancer stage (P<0.001). Individuals within the highest tertile of AmygA experienced a 2-fold higher mortality rate compared to others (P = 0.01). The median progression-free survival was 25 months in patients with higher AmygA (upper tertile) as compared with 36.5 months in other individuals (HR for progression or death [95%CI], 1.83 [1.24–2.68], P = 0.001). Conclusions and relevance AmygA, quantified on routine 18F-FDG-PET/CT images obtained at cancer staging, independently and robustly predicts mortality and cancer progression among patients with HNCA. Future studies should test whether strategies that attenuate AmygA (or its downstream biological consequences) may improve cancer survival.

The peculiar nature of scientific publishing has allowed for a high degree of market concentration and a non-collusive oligopoly. The non-substitutable characteristic of scientific journals has facilitated an environment of market concentration. Acquisition of journals on a capabilities-based approach has seen market concentration increase in favor of a small group of dominant publishers. The digital era of scientific publishing has accelerated concentration. Competition laws have failed to prevent anti-competitive practices. The need for government intervention is debated. The definition of scientific publishing as a public good is evaluated to determine the need for intervention. Policy implications are suggested to increase competitiveness in the short-run and present prestige-maintaining alternatives in the long run. A fundamental change in scientific publishing is required to enable socially efficient and equitable access for wider society's benefit.

Background Formal leadership training has typically been targeted at senior health professionals. The Healthcare Leadership Academy (HLA) was formed in 2016 to provide a leadership programme for students and early-career health professionals. This study analyses the effectiveness of the HLA scholarship programme as an intervention for improving interest in, and preparing scholars for, future leadership roles. Methods A mixed methods study using responses from a survey developed to collect data on the effectiveness of the HLA Scholarship program in cultivating leadership development. Questions required either multiple-choice, free-text, ranking or Likert scale (‘strongly agree’, ‘agree’, ‘neither agree nor disagree’, ‘disagree’, ‘strongly disagree) responses. Descriptive statistical analyses and qualitative data coding, management, and analysis were conducted. Results 70 participants who underwent the course between 2016 and 2020 completed the questionnaire. Nearly all (99%) found that the training provided on the programme had equipped them to be more effective leaders, with 86% of respondents stating that they were more likely to take on leadership roles. Nearly all (97.1%) found the course to be either of good or very good quality. Seven themes were identified from free text responses. They were “improved self-awareness by scholars”, “expectations of the organisation”, “guidance to future careers”, “broadening horizons”, “network development”, and a description of the scholars programme as an “enjoyable and accessible course”. Conclusions Healthcare leadership is a non-negotiable component of healthcare delivery in the 21st Century. As healthcare professionals, it is our duty to be effective leaders confident and competent in navigating the increasingly-complex systems within which we operate for the benefit of ourselves, colleagues, and patients. By accounting for known shortcomings and developing ameliorative measures, the HLA Scholarship programme addresses unmet needs in a structured manner to support effective long-term healthcare leadership development.