Severe hyponatremia due to trimethoprim-sulfamethoxazole-induced SIADH.

Hyponatremia, a serum sodium level of <135 mEq/L, is the most common electrolyte abnormality occurring in 5%-35% of hospitalized patients. It is a predictor of increased morbidity and mortality. Diuretics, psychotropic, and antiepileptic drugs are commonly implicated in drug-induced hyponatremia. Trimethoprim-sulfamethoxazole and spironolactone are two commonly prescribed drugs; unfortunately, most providers are unfamiliar with these two drugs causing hyponatremia. Simultaneous use of trimethoprim-sulfamethoxazole and spironolactone can cause serious drug interactions that increase the risk of hyponatremia, hyperkalemia, and overall mortality. Despite recommendations to avoid using these two drugs concurrently, many healthcare providers continue to prescribe them together. We report a case of an elderly female with severe hyponatremia caused by trimethoprim-sulfamethoxazole superimposed on a chronic but stable mild hyponatremia.

Unusual presentation of a small cell lung cancer with bilateral breast metastases: Case report and a brief review of the literature.

Small cell lung cancer (SCLC) is a smoker's disease and occurs almost exclusively in smokers. SCLC is a high-grade neuroendocrine tumor and commonly presents as a central tumor with bulky mediastinal adenopathy. It is notorious for causing widespread disease and paraneoplastic syndromes. The usual sites of metastasis include the liver, brain, bone, and adrenals. SCLC presenting with breast metastasis is unusual; however, there are reports of unilateral and bilateral breast metastases. SCLC with bilateral breast metastases is extremely rare, with only five previously reported cases available in the literature. We are taking this opportunity to report and add to the growing literature on the unusual presentation of a small cell lung cancer with bilateral breast metastases.

Increasing Trends in Mortality Rate Among Salivary Gland Tumors in Non-Geriatric African Americans.

Background: The treatment of salivary gland tumors has not changed significantly in the past two decades. However, the increase in the geriatric population with these tumors poses a new challenge for their management. This study explores the incidence-based mortality trends in the geriatric and non-geriatric population for the time period of 2000 - 2014 and compares the trends between races. Methods: Mortality data were extracted from the Surveillance, Epidemiology, and End Results (SEER) Database for the years 2000 - 2014. Incidence-based mortality for all stages of salivary gland tumors was queried and the results were grouped by age (geriatric vs. non-geriatric determined as 65 vs. below 65 years of age) and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). All stages and both genders were included in the analysis. T-test was used to determine statistically significant difference between various subgroups. Linearized trend lines were used to visualize the mortality trends between various subgroups (geriatric vs. non-geriatric and Caucasian vs. African American). Results: Incidence-based mortality for salivary gland tumors has worsened since 2000 to 2014 for both geriatric and non-geriatric patients (P < 0.05). There was a statistically significant difference between these two groups in both Caucasian/White patients and African American/Black patients. Notably, the worst incidence-based mortality rates were noted in African American/Black non-geriatric patients followed by Caucasian/White non-geriatric patients. However, there was no statistical difference in incidence-based mortality between Caucasian/White patients and African American/Black geriatric patients. Conclusions: The similarity in incidence-based mortality for geriatric patients with salivary gland tumors in both Caucasian/White patients and African American/Black groups suggests that the effects of race may not be pronounced in the elderly population. The high rate of incidence-based mortality in African American/Black non-geriatric patients may suggest environmental influence and warrants further study.

Advances in the Treatment of Mucoepidermoid Carcinoma.

Mucoepidermoid carcinoma (MEC) represents 10-15% of salivary neoplasms. Due to their low incidence, it is challenging to conduct clinical trials and develop treatment guidelines. Although surgery is the most common approach for a resectable tumor, various treatment options such as chemotherapy, radiotherapy, and immunotherapy have been investigated. There is a need to implement a standardized treatment protocol to effectively manage MEC as it is a common histological subtype. Furthermore, it has become essential to assess chromosomal and genetic abnormalities recently identified with MEC, including alterations of CDKN2A, TP53, CDKN2B, BAP1, etc. These mutations are involved in the transformation of low-grade tumors to high-grade tumors, presenting a vital tool for evaluating the aggressive behavior of this carcinoma. Detailed immunohistochemical and translocation studies can help develop targeted therapies and monitor treatment response. Therefore, biomarker-driven research will immensely improve the outcome, especially in advanced cases. Based on thorough histology and chromosomal translocations, a more personalized treatment plan can improve the overall disease outcome. The purpose of this article is to elaborate on the current treatment advancements, particularly chemotherapy and targeted therapy, as an effective treatment modality for the management of MEC and highlight the comparison with traditional treatment approaches.

Tumor Dormancy: Biologic and Therapeutic Implications.

Metastatic cancer can arise years after treatment of the primary tumor because residual tumor cells can enter dormancy and evade elimination by anti-neoplastic therapies. The mechanisms underlying this phenomenon have been investigated and a number of hypotheses have been proposed. Tumor mass dormancy involves a balance between apoptotic and proliferative cells, keeping a micrometastatic lesion constant in size. This induces a need for blood supply which involves angiogenic dormancy. Cellular dormancy is also considered a mechanism of dormancy, where dormancy is induced due to cells entering a quiescent, reversible, growth-arrested state. In addition to all of these mechanisms, important changes in the tumor microenvironment, including the extracellular matrix, the oxygenation levels of the environment, and endoplasmic reticulum stress, are involved in inducing and maintaining tumor dormancy. Since dormant tumors are commonly known to be resistant to chemotherapy, gaining more knowledge of the mechanism of dormant tumor cells is of importance, as it can lead to the development of future treatment strategies.

Do high-dose corticosteroids improve outcomes in hospitalized COVID-19 patients?

Coronavirus disease 2019 (COVID-19) is characterized by dysregulated hyperimmune response and steroids have been shown to decrease mortality. However, whether higher dosing of steroids results in better outcomes has been debated. This was a retrospective observation of COVID-19 admissions between March 1, 2020, and March 10, 2021. Adult patients (≥18 years) who received more than 10 mg daily methylprednisolone equivalent dosing (MED) within the first 14 days were included. We excluded patients who were discharged or died within 7 days of admission. We compared the standard dose of steroids (<40 mg MED) versus the high dose of steroids (>40 mg MED). Inverse probability weighted regression adjustment (IPWRA) was used to examine whether higher dose steroids resulted in improved outcomes. The outcomes studied were in-hospital mortality, rate of acute kidney injury (AKI) requiring hemodialysis, invasive mechanical ventilation (IMV), hospital-associated infections (HAI), and readmissions. Of the 1379 patients meeting study criteria, 506 received less than 40 mg of MED (median dose 30 mg MED) and 873 received more than or equal to 40 mg of MED (median dose 78 mg MED). Unadjusted in-hospital mortality was higher in patients who received high-dose corticosteroids (40.7% vs. 18.6%, p < 0.001). On IPWRA, the use of high-dose corticosteroids was associated with higher odds of death (odds ratio [OR] 2.14; 95% confidence interval [CI] 1.45-3.14, p < 0.001) but not with the development of HAI, readmissions, or requirement of IMV. High-dose corticosteroids were associated with lower rates of AKI requiring hemodialysis (OR 0.33; 95% CI 0.18-0.63). In COVID-19, corticosteroids more than or equal to 40 mg MED were associated with higher in-hospital mortality.

Outcomes of Covid 19 patients-Are Hispanics at greater risk?

Disparities in outcomes exist in outcomes of coronavirus disease-19 (COVID-19). Little is known about other ethnic minorities in United States. We included all COVID-19 positive adult patients (≥18 years) hospitalized between March 1, 2020 and February 5th 2021. We compared in hospital mortality, use of intensive care unit services and inflammatory markers between non-Hispanic whites with non-White/Black Hispanic. Multivariable Cox proportional Hazard models were used to adjust for differences between the two groups. There were 4059 hospital admissions with COVID-19 in the study period. Of the 3288 White, 789 (24%) required intensive care unit (ICU) admission in comparison to 187 (24.3%) of the 770 Hispanics. Unadjusted mortality was higher in Whites than Hispanics (17.1% vs. 10.7%; p < 0.001). After adjusting for confounding variables, in-hospital mortality was not statistically different for Whites in comparison to Hispanics (hazard ratio [HR]: 0.96, 95% confidence interval [CI]: 0.76-1.21, p = 0.73). The adjusted rates of ICU transfers were significantly higher in Hispanics (HR: 1.34, 95% CI: 1.11-1.61, p = 0.002). Hispanics had significantly higher C-reactive protein, lactate dehydrogenase, and fibrinogen when compared to Whites. Hispanics as compared to Whites with COVID-19 require higher rates of ICU admission but have a similar mortality. Hispanics as compared to Whites with COVID-19 require higher rates of ICU admission but have a similar mortality.

Genetic Polymorphisms in Pharmaceuticals and Chemotherapy.

The study of genetic polymorphisms has significantly advanced the field of personalized medicine. Polymorphism of genes influence the efficacy of drugs used for treating medical conditions such as depression, cardiac diseases, thromboembolic disorders, oncological diseases, etc. The study of genetic polymorphism is beneficial for drug safety as well as for assessing therapeutic outcomes. Understanding and detecting genetic polymorphisms early on in patients can be useful in selecting the correct chemotherapeutic agent and appropriate dosage for a patient. Knowing the genetic profile of a patient and the interindividual response to various drugs significantly influences the proper selection of medication - a key step towards personalized medicine. Polymorphisms also make patients susceptible to certain cancers and identification of these polymorphisms early can be useful for a personalized treatment plan. The Genome-Wide Association Studies (GWAS) project where millions of genetic variants in the genomes of many individuals are studied to identify connections between what is present on the gene and the phenotype of the patient has enhanced the prospect of personalized medicine. GWAS has been used to identify hundreds of diseases associated to genetic polymorphisms. Individual pharmacokinetic profiles of patients to drugs enable the development of early surveillance protocols to prophylactically prevent patients from having adverse reactions. Furthermore, patient-derived cellular organoids are another advancement that allows researchers to screen for polymorphisms of the patient for adverse reactions from chemotherapy and will allow for the development of new medications that are specific to the profile of the patient's tumor. These advances have led to significant progress towards personalized medicine. The functional consequences of genetic polymorphism on cancer drugs and treatment are studied here.

Analysis of Race and Gender Disparities in Mortality Trends from Patients Diagnosed with Nasopharyngeal, Oropharyngeal and Hypopharyngeal Cancer from 2000 to 2017.

BACKGROUND: Squamous cell carcinoma of the nasopharynx, oropharynx and hypopharynx constitutes a majority of head neck malignancies. The incidence-based mortality across different races has been noted to be divergent. This study analyzes the trend in incidence-based mortality from the years 2000 to 2017 amongst both the genders in Caucasian/White and African American/Black patients. METHODS: The Surveillance, Epidemiology, and End Results (SEER) Database was queried to conduct a nation-wide analysis for the years 2000 to 2017. Incidence-based mortality for all stages of nasopharyngeal, oropharyngeal and hypopharyngeal cancer was queried and the results were grouped by race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander) and gender. All stages and ages were included in the analysis. t-test was used to determine statistically significant differences between various subgroups. Linearized trend lines were used to visualize the mortality trends of all sub groups. RESULTS: Across all races, the male to female gender disparity in mortality was ~1:3 in patients with nasopharynx and became worse to ~1:4 and ~1:5 for patients with oropharyngeal and hypopharyngeal cancers, respectively. Notably, the highest incidence-based mortality for nasopharyngeal cancers is seen in Asian/pacific Islander males and a similar peak is noted for hypopharyngeal cancers in African American/Black males. Incidence-based mortality rates (per 1000) for nasopharyngeal, oropharyngeal and hypopharyngeal cancer of all races and both the genders was noted to be divergent. CONCLUSION: A significant gender disparity exists in all three pharyngeal cancers across all races. It is unclear if female gender is protective but further study is warranted in a stage-specific and age-specific manner to better understand this disparity.

Analysis of Trends in Mortality in Patients with Lymphoepithelial Carcinoma of the Head and Neck.

BACKGROUND: Squamous cell carcinoma is the most common subtype of malignancy found in patients with head and neck malignancy. There are other rare subtypes which are not adequately reported in medical literature. Lymphoepithelial carcinoma consists of lymphocytic infiltration in a background of undifferentiated carcinoma. They are most often seen in salivary glands but can also be found in other structures of the head and neck region. This analysis reports the nation-wide mortality of patients diagnosed with lymphoepithelial carcinoma of the head and neck. METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) Database from the years 2000 to 2014. Incidence-based mortality for all stages was queried and results were grouped by gender and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). Paired T-test was used to determine statistically significance difference between various subgroups. RESULTS: Incidence-based mortality has been improving for African American/Black patients and has been worsening for Caucasian/White, American Indian/Alaskan native and Asian/Pacific Islander for the period of 2000 to 2014. The differences in mortality trends were statistically different (P < 0.05). The highest mortality rate per 1000 patients was seen in Asian/Pacific Islander population, followed by African American/Black, American Indian/Alaskan native and the least mortality was noted in Caucasian/White patients. When a similar analysis with linearized trend lines on gender was conducted, only African American/Black males and Asian/Pacific Islander females showed an improving trend in mortality. The sample size was a major limitation of this study (Caucasian/White - 134, African American/Black - 30, American Indian/Alaskan native - 5 and Asian/Pacific Islander - 87). CONCLUSION: Lymphoepithelial carcinoma is a rare subtype of head and neck malignancies whose incidence-based mortality showed a worsening trend. This study showed significant race and gender disparity amongst patients with lymphoepithelial carcinoma. Due to its rarity, this subtype warrants further study, especially with regards to its etiology, clinical course and cure rates.

Cancer stem cells in head and neck cancer.

Cancer stem cells (CSCs) are a unique population of cells found within tumors that are able to self-renew, restore the original heterogeneity of a tumor following treatment, and show increased tumorigenic potential when compared to other cancer cells. It is thought that they are responsible for the recurrence of tumors as well as the resistance to treatment that is seen clinically. CSCs are known to be involved in head and neck cancer (HNCs) specifically, as evidence for their existence can be found in head and neck squamous cell carcinoma (HNSCC), mucoepidermoid carcinoma (MEC), and adenoid cystic carcinoma (ACC), among others. Here, findings from various approaches to identifying and targeting CSCs and their downstream effectors in HNC are summarized, with an emphasis on recent advancements. Prognostic and therapeutic markers are discussed for each specific type of HNC, and novel treatment strategies and current clinical trials involving CSCs are detailed as well. The information provided here is intended to further the research on this important topic and lead to clinical impact in the battle against HNC.

Incidence of Venous Thromboembolism and Effect of Anticoagulant Dosing in Hospitalized COVID-19 Patients.

Background: Coronavirus disease 2019 (COVID-19) is characterized by coagulopathy and thrombotic events. We examined factors associated with development of venous thromboembolism (VTE) in COVID-19 and to discern if higher dose of anticoagulation was beneficial in these patients. Methods: This study involves an observational study of prospectively collected data in the setting of a large community hospital in a rural setting in Northeast Georgia with COVID-19 between March 1, 2020 and February 5, 2021. Anticoagulation dose (none, standard, intermediate, and therapeutic dosages) was studied in adult patients (≥ 18 years). We constructed multivariable logistic regression model to examine the association of clinical characteristics with VTE. To examine the effect of dose of anticoagulation in preventing VTE, we used inverse probability weighted regression adjustment. Results: Of the 4,645 patients with COVID-19, 251 (5.4%) patients were found to have VTE. Of these, 91 had pulmonary embolism, 148 had deep venous thrombosis (DVT) and 12 had both. A total of 129 of VTE cases were diagnosed at admission. Of all admissions, 12.9% did not receive any DVT prophylaxis, 70.4% received prophylactic dose, 1.3% received intermediate dose and 15.5% received therapeutic dose. Male gender (odds ratio (OR): 1.55, 95% confidence interval (CI): 1.0 - 2.4, P = 0.04) and Black race (OR: 2.0, 95% CI: 1.2 - 3.4, P = 0.01), along with higher levels of lactate dehydrogenase (LDH) and D-dimer were associated with higher odds of developing VTE. Patients receiving steroids had lower rates of VTE (3.9% vs. 8.3%, P < 0.001). Use of intermediate or therapeutic anticoagulation was not associated with lower odds of developing VTE. However, patients on therapeutic anticoagulation had lower odds of in hospital mortality when compared to standard dose (OR: 0.47, 95% CI: 0.27 - 0.80, P = 0.006). Conclusions: In COVID-19, D-dimer and LDH can be useful in predicting VTE. Steroids appear to have some protective role in development of VTE. Therapeutic anticoagulation did not result in lower rates of VTE but was associated with in-hospital mortality.

Management of hepatotoxicity of chemotherapy and targeted agents.

Hepatotoxicity of chemotherapeutic agents such as methotrexate, oxaliplatin, and irinotecan have been well documented and characterized allowing for careful management by oncologists during administration. However, the rapid advance of the field of oncology and introduction of new classes of therapies such as small molecule inhibitors and immunotherapies have introduced new hepatotoxicity challenges and management strategies. This work is a compilation of the hepatotoxicity and recommended management of various chemotherapies and targeted agents, with a focus on the newer classes of targeted anticancer agents.

Unequal allotment of patients in phase III oncology clinical trials.

Patient enrollment in cancer clinical trials has traditionally been limited to an equal distribution between cases and controls, however recently some clinical trials have utilized an unequal distribution between the case and control arms. Trends and proportion of phase 3 cancer clinical trials that have an unequal allocation between the years 2010 and 2019 were studied from data extracted from clinicaltrials.gov. 323 trials with two arms and 35 trials with 3 arms were identified as randomized control trials with the primary purpose of a cancer-related treatment that provided allocation data. Amongst the trials with two arms, 238 trials had equal allocation and 85 trials had unequal allocation. Therefore, cancer clinical trials with unequal allocation represent about one in four 2-arm phase 3 trials. Amongst the eligible trials with three arms, 26 trials had equal allocation and 9 trials had unequal allocation. There was no significant difference in the annual proportion of trials with unequal allocation from 2010 to 2019. The categories of cancer which had the highest number of unequally allotted two-arm clinical trials were: gastrointestinal, breast, and genitourinary malignancies. This shift may represent a new trend in clinical trial design to help enhance closer monitoring of adverse events despite higher costs and lower statistical power attached to this method.

Nation-Wide Trends in Incidence-Based Mortality of Patients with Ocular Melanoma in USA: 2000 to 2018.

BACKGROUND: Ocular and orbit melanoma is a rare subtype of melanoma for which outcomes have not been adequately reported. We have analyzed the incidence-based mortality trends of ocular and orbit melanoma over 15 years in USA. Most ocular melanomas originate from the uvea and, to a lesser extent, from the conjunctiva. Primary orbital melanoma is exceedingly rare. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was queried to find the incidence-based mortality for all patients diagnosed with ocular and orbit melanoma for the years 2000 to 2018. Results were grouped by gender and race (Caucasian/White, African American/Black, American Indian/Alaskan Native, and Asian/Pacific Islanders). A paired t-test was used to determine the statistically significant difference between various subgroups (p < 0.05). RESULTS: Incidence-based mortality has been the highest in Caucasian/White patients from 2000 to 2018, followed by African American/Black and Asian/Pacific Islander patients. American Indian/Alaskan native patients appear to have the least mortality. There was a statistically significant difference (p<0.05) in mortality between Caucasian/White patients from 2000 to 2018, and African American/Black and Asian/Pacific Islander patients. The sample size for African American/Black and American Indian/Alaskan native patients was too low to discern a meaningful trend in mortality. Overall, it appears that Caucasian males and females have a far higher and worsening incidence-based mortality compared to other races. CONCLUSION: Ocular melanoma and orbit melanoma are rare entities that are predominantly seen in Caucasian/White patients. This study shows that incidence-based mortality has been worsening for these patients in the past two decades. These entities have a poor prognosis and have not been studied extensively in immunotherapy trials. There is a need for new clinical trials to help improve mortality rates.

Does ABO Blood Groups Affect Outcomes in Hospitalized COVID-19 Patients?

BACKGROUND: Blood group type A has been associated with increased susceptibility for coronavirus disease 2019 (COVID-19) infection when compared to group O. The aim of our study was to examine outcomes in hospitalized COVID-19 patients among blood groups A and O. METHODS: This is an observational study. Kruskal-Wallis and Chi-square tests were used to compare continuous and categorical variables. Multivariable logistic regression models were used to examine association of blood groups with rates of mortality and severity of disease. All adult patients (> 18 years) admitted with COVID-19 infection between March 1, 2020 and March 10, 2021 at a large community hospital in Northeast Georgia were included. We compared mortality, severity of disease (use of mechanical ventilation, vasopressor, and acute renal failure), rates of venous thromboembolism and inflammatory markers between the blood groups. We used multivariable logistic regression model to adjust for demographical and clinical characteristics, use of COVID-19 medications and severity. RESULTS: A total of 3,563 of 5,204 admitted patients had information on blood groups. Of these, 1,301 (36.5%) were group A, 377 (10.6 %) were group B, 133 (3.7%) were group AB and 1,752 (49.2%) were group O. On adjusted analysis, there were no significant differences in rates of intensive care unit (ICU) admissions, mechanical ventilation, vasopressors, acute renal failure, venous thromboembolism and readmission rate between the blood groups A and O. In-hospital mortality was also not statistically different among the blood groups A and O (17.5% vs. 20.1%; P = 0.07). On adjusted analysis, in-hospital mortality was not lower in blood groups O (odds ratio (OR): 1.06; 95% confidence interval (CI): 0.80 - 1.40, P = 0.70). CONCLUSIONS: Once hospitalized with COVID-19 infection, blood groups A and O are not associated with increased severity or in-hospital mortality.

Cyberspace and Libel: A Dangerous Balance for Physicians.

Freedom of speech and expression is one of the core tenets of modern societies. It was deemed to be so fundamentally essential to early American life that it was inscribed as the First Amendment of the United States Constitution. Over the past century, the rise of modern life also marked the rise of the digital era and age of social media. Freedom of speech thus transitioned from print to electronic media. Access to such content is almost instantaneous and available to a vast audience. From social media to online rating websites, online defamation may cause irreparable damage to a physician's reputation and practice. It is especially relevant in these times of political turbulence where the battle to separate facts from misinformation has started a debate about the responsibility of social media. The historical context of libel and its applicability in the age of increasing online presence is important for physicians since they are also bound by duty to protect the privacy of their patients. The use of public rating sites and social media will continue to be important for physicians, as online presence and incidents of defamation impact the practice of medicine.

Clinical endpoints in oncology - a primer.

Clinical endpoints are essential for assessing the safety and efficacy of new cancer therapies. They are used by oncologists to help guide clinical decision making. While overall survival (OS) has frequently been regarded as the "gold standard" primary clinical endpoint, it's utility is constrained by several disadvantages. The time-consuming nature of trials using OS has led to a recent push to explore surrogate clinical endpoints and their potential to serve as primary clinical endpoints in lieu of OS. Additionally, it is becoming evident that other endpoints add valuable information about quality of life and treatment failure as their use is becoming increasingly prevalent in oncology clinical trials. Without a doubt, the use of clinical endpoints will continue to expand and evolve as new cancer therapies are developed and novel treatments, including immunotherapy, draw interest. This review explores the roles of primary and surrogate clinical endpoints as well as the benefits and drawbacks of each specific endpoint. In addition, it directly compares the unique features of each suggesting some of the specific uses each one fulfills.

Cardiotoxicity of chemotherapy and targeted agents.

The evolution of cancer treatment and development of new classes of anticancer therapies have continued to revolutionize the field of oncology. New therapies including targeted agents, immunotherapies, and adoptive cell transfer have allowed for exciting survival benefit progress for patients. However, the novel nature of these therapies as well as the longer survival periods of patients receiving them has highlighted the various side effects of anticancer therapies. Cardiotoxicity has emerged as a major side effect of anticancer treatment and can present both acutely during treatment and chronically even years after treatment has been completed. This work compiles the cardiotoxic side effects of various chemotherapeutic and targeted anticancer therapies and their management.

Ethical Issues in Patient Data Ownership.

Patient data have conventionally been thought to be well protected by the privacy laws outlined in the United States. The increasing interest of for-profit companies in acquiring the databases of large health care systems poses new challenges to the protection of patients' privacy. It also raises ethical concerns of sharing patient data with entities that may exploit it for commercial interests and even target vulnerable populations. Recognizing that every breach in the confidentiality of large databases exposes millions of patients to the potential of being exploited is important in framing new rules for governing the sharing of patient data. Similarly, the ethical aspects of data voluntarily and altruistically provided by patients for research, which may be exploited for commercial interests due to patient data sharing between health care entities and third-party companies, need to be addressed. The rise of technologies such as artificial intelligence and the availability of personal data gleaned by data vendor companies place American patients at risk of being exploited both intentionally and inadvertently because of the sharing of their data by their health care provider institutions and third-party entities.