Six pragmatic steps to separate medical GenAI's promise from its inherent dangers.

GenAI and agentic systems in medicine bring real opportunities for better diagnosis and therapy and for the development of better diagnoses and therapies. It is now increasingly being recognised that the power of these systems for good is inseparable from their power to be used for harm. Systems optimised for biomedical research are unfortunately being harnessed by malign human masters to help develop bioweapons to be targeted at humanity. Agentic systems are autonomously, unknown to their human masters, carrying out cybersecurity attacks. Frontier models are increasing anxiety and stress of medical students and threaten to reshape medical professional roles, not always for the better. Although  there may currently be some over emphasis of risk by BigTech foundation model developers, and these may even be attempts at ‘regulatory capture’, there are also genuine reasons for concern. We set out actionable measures that are needed to control medical frontier models to maximise human benefits and control risks.