# Thomas F. Heston, MD

> Academic physician (family medicine, nuclear medicine) at the University of Washington and Washington State University. Research on statistical fragility and robustness in clinical trials (the p fr nb framework), large language models in clinical medicine and medical education, and blockchain in health care. Editor, Internet Medical Journal (ISSN 1093-7935). ORCID: https://orcid.org/0000-0002-5655-2512

Full-text repository with per-paper records and citation metadata: https://faculty.washington.edu/theston/repository/
Chinese-language summary of this research and these papers: https://tomheston.com/zh.html

## Statistical fragility and robustness

- [The Robustness Index: Going Beyond Statistical Significance by Quantifying Fragility](https://doi.org/10.7759/cureus.44397): Heston, T. F. (2023). Cureus, 15(8), e44397. PMID 37791215. The metric it introduced is now named the sample-size fragility multiplier (SFM).
- [The Percent Fragility Index](https://doi.org/10.36106/ijsr/1830060): Heston, T. F. (2023). International Journal of Scientific Research, 12(7), 9-10.
- [From Fragility Index to Fragility Distance in Clinical Trials](https://doi.org/10.5281/zenodo.22072163): Heston, T. F. (2026). Internet Medical Journal, 1, e22072163. Defines the Fragility Distance (FD).
- [The Global Fragility Index: A Path-Independent Measure of Statistical Fragility](https://doi.org/10.2139/ssrn.5709162): Heston, T. F. (2025). SSRN. Defines the Global Fragility Index (GFI).
- [Fragility Distance definition page](https://fragilitymetrics.org/fragility-distance.php): canonical definition and citation.
- [Global Fragility Index definition page](https://fragilitymetrics.org/global-fragility-index.php): canonical definition and citation.

## Large language models in medicine

- [ChatGPT provides inconsistent risk-stratification of patients with atraumatic chest pain](https://doi.org/10.1371/journal.pone.0301854): Heston, T. F., & Lewis, L. M. (2024). PLOS ONE, 19(4), e0301854.
- [Large Language Models Demonstrate Distinct Personality Profiles](https://doi.org/10.7759/cureus.84706): Heston, T. F., & Gillette, J. (2025). Cureus, 17(5), e84706. PMID 40551914.

## Blockchain in health care and society

- [Why Blockchain Technology Is Important for Healthcare Professionals](https://doi.org/10.2139/ssrn.3006389): Heston, T. F. (2017). SSRN.
- [The blockchain-based scientific study](https://doi.org/10.4103/digm.digm_17_17): Heston, T. F. (2017). Digital Medicine, 3(2), 66-68.
- [A blockchain solution to gun control](https://doi.org/10.5281/zenodo.8117806): Heston, T. F. (2018). International Journal of Scientific Research, 7(3), 81-83.
- [A blockchain AI solution to climate change](https://doi.org/10.30574/ijsra.2024.11.2.0471): Heston, T. F. (2024). International Journal of Science and Research Archive, 11(2), 450-454.

## Clinical medicine

- [Myocardial infarction](https://faculty.washington.edu/theston/repository/paper.php?file=1993%20Myocardial%20Infarction.pdf): Heston, T. F., & Lewis, L. M. (1993). Journal of Family Practice, 37(1), 13-14.
- [Moral injury or burnout?](https://sma.org/southern-medical-journal/article/moral-injury-or-burnout/): Heston, T. F., & Pahang, J. A. (2019). Southern Medical Journal, 112(9), 483.