BMJ - British Medical Journal

Campaigners who are taking the General Medical Council (GMC) to court alleging failure to properly regulate physician associates (PAs) and anaesthesia associates (AAs) have been cleared to submit new patient safety evidence.A judge has granted Anaesthetists United’s bid to submit two reports that were published after it began its legal case, and which the GMC had argued were inadmissible, for a judicial review in the High Court on 13 and 14 May.One report is a systematic review published in The BMJ in March 2025, which found little evidence supporting the safety and efficacy of PAs and AAs in the UK.1The other is a coroner’s regulation 28 “prevention of future deaths” report published in February 2025, regarding the death in 2024 of Pamela Marking, who was seen by a PA and died after having a nosebleed misdiagnosed. The coroner highlighted a lack of national and local guidelines and regulation of the...

The global conversation is locked into trade deficits. While tariffs can be temporary, as we’re seeing, debt has a longer term impact. The question is, if we truly believe that people and countries should have an opportunity to flourish and prosper, how do our finance systems—that hardwire debt—support those ambitions? Debt is the deficit that requires some serious thinking and an enlightened response.A medical student in the UK can end up with debt of £100 000 before earning a penny as a qualified doctor. Is this fair? Is it how we want young people to start their working lives? From the US to India, a medical career is once more the domain of rich and privileged people. Many countries are unable to widen access to a medical career despite championing it. Some countries don’t care. They should. A diverse workforce delivers better care. A diverse workforce also offers greater prospects...

If health really is part of all policies,1 then we in the public health community can’t ignore what might seem like arcane and complex discussions in other policy areas. A pertinent example is the recent dispute over a proposal to tackle potential inequalities in sentencing by the courts in England and Wales.2 The lord chancellor and justice secretary, Shabana Mahmood, has intervened,3 raising issues that have potential consequences for those working to reduce health inequalities. This sentencing guideline dispute is a concerning example of government interference in what should be an independent expert process.The dispute concerned the Sentencing Council, an independent body with a majority of judicial members and a remit to promote greater transparency and consistency in sentencing.4 It arose when the council published guidance on pre-sentence reports prepared by the probation service to give the courts additional information on people being sentenced. These pre-sentence reports should be requested...

Throughout my time as Children’s Commissioner, I have heard from a million children and young people about their hopes, ambitions, and concerns. An issue which frequently comes up in these conversations is how they can spend time online safely and protect themselves from distressing or harmful content. Children are digital pioneers, and the adults in charge of online platforms should put the protection of children before profit.As a former teacher and headteacher, I have witnessed the spike in children’s time spent online during the past 20 years. Research conducted by Ofcom in 2021 found that by the age of eight, a child would typically spend 2 hours and 45 minutes online a day. The figure rises to more than four hours a day by age 11-12.1 Just this week, my own nationally representative poll of children aged eight to 15 backed these findings—25% of children spent two or three hours...

Academic medicine is in urgent need of a revolution,1 now more than ever following recent attacks on it in the United States.23 Academic medicine brings together science, humanities, social science, health, and social care to improve the health and wellbeing of people and planet in an equitable manner. For decades, its role has been to train doctors who have led on generating research and provide services to improve health outcomes in a growing global population.4 Some countries such as France, Germany, and India offer domestic students free or minimal tuition fees. However, the past decade of rising costs of publicly and privately funded medical education in many countries disproportionately favours a minority of students who can fund themselves through medical training.5 For example, current total costs (excluding living expenses) for private medical education for international students to the US, UK, and Australia or domestic students who do not qualify for...

Last month the UK government announced that it planned to abolish NHS England and move many of its functions back into the Department of Health and Social Care.12 An estimated 20 000-30 000 jobs are expected to be lost in the restructuring.Appearing before MPs on the Health and Social Care Committee on 8 April, the health secretary, Wes Streeting, was asked whether he recognised a figure first reported in the Observer3 that the total cost of redundancy payouts could reach £1bn. He said that it was too early to know the precise numbers but that £1bn was not an “unreasonable ballpark figure.”Streeting faced a series of other questions from MPs.Why abolish NHS England before the 10 year plan?The government had acted because “we know where we’re headed” in terms of the upcoming 10 year plan for the NHS, Streeting told MPs. “Abolishing an arm’s length body of this size and...

AbstractObjectiveTo investigate the reporting and evolution of patient and public involvement (PPI) in randomised controlled trials published over time in major medical journals and in their trial protocols.DesignMeta-epidemiological evaluation.Data sourcePubMed was searched for articles reporting randomised controlled trials published since 2015 in four major medical journals and their corresponding peer reviewed protocols.Eligibility criteria for selecting studiesThe first 10 randomised controlled trials published each year in each journal were included.Data extractionData extraction focused on involved stakeholders, description and extent of PPI activities/processes, and recognition of PPI contributions. Published articles and protocols were assessed for consistency of the reported PPI in both.ResultsOf the 360 published articles reporting randomised controlled trials and 299 respective protocols, PPI was only reported in 64 (18%) articles and 56 (19%) protocols. When PPI was reported, patients and their representatives were mainly involved, with the most common PPI activity being participation in trial committees (44/64 PPI reporting articles; 39/56 protocols). PPI primarily occurred during the trial development phase, including feedback on study design, review of study materials, and assessment of feasibility. Protocols occasionally had more detailed information than the published articles, but in most cases the PPI contributions were often vague without detailed information on specific outcomes and the effect on decision making within the randomised controlled trial. Recognition of PPI contributions was more frequent in published articles (n=37; 58%) than in protocols (n=18; 32%), mainly in the acknowledgment section.ConclusionThis study found limited PPI reported in randomised controlled trials published in major medical journals and in their respective protocols, underscoring the need for consistent, detailed, and transparent PPI reporting practices in clinical research.Study registrationhttps://doi.org/10.17605/OSF.IO/4EQG2.

Patient and public involvement (PPI) has become a key part of health and social care research in many countries with a focus on working with or by patients rather than to, about, or for them, aiming to coproduce knowledge that is relevant, appropriate, and acceptable for patients.12 Patient and public contributors can and should be included at all stages of research, including identifying key questions, designing, recruiting, selecting outcomes, and implementing findings.1Patient involvement in a study should be reported within a paper to ensure that this knowledge contributes to building the PPI evidence base for practice. While reporting PPI might seem obvious, the reporting of PPI in research remains more elusive than we might expect. Past studies have identified poor and inconsistent reporting,34 which resulted in development of the GRIPP2 reporting guidance specifically for PPI.56 GRIPP2 is supported by journals that request authors to report PPI, including The BMJ and...

bmj;389/apr10_1/r708/FAF1faStephen was born in Bristol in 1933, the son of a carpenter. He won a scholarship to Queen Elizabeth’s Hospital School before studying medicine at Bristol University. After graduation he worked at Leeds General Hospital and then as a registrar at the National Heart Hospital in London.He moved back to Bristol, became a paediatric cardiologist at the Bristol Royal Hospital for Children, and was instrumental in making it a hub for paediatric cardiology in the West Country and South Wales. As well as his patient work Stephen was active in fundraising for the hospital, especially in the then emerging areas of echocardiography through the Bristol Heart Circle. Of note during his tenure was the expansion of the special care baby unit in Bristol and the visit of Diana, Princess of Wales, to open the new facility in 1983.He also pioneered the use of computers for helping with clinical record keeping...

Almost 700 medical students in the UK have been given “placeholder” jobs, meaning that they know the deanery they will be in when they start foundation training in August but not the hospital where they will work.Some deaneries cover huge geographical locations, or even nations, as in Wales, Scotland, and Northern Ireland—leaving new doctors little time to plan where they will live, the BMA said.Phil Banfield, BMA chair of council, and officers from its Medical Students Committee have written to the health and social care secretary, Wes Streeting, calling on him to meet the contractual obligations of hiring these doctors and certainty for the placements to be provided at least eight weeks before the start of the foundation programme.The UK Foundation Programme Office (UKFPO) introduced “placeholder jobs” in 2023 after 800 new doctors were placed on the reserve list for jobs in 2022, up from just 25 in 2017. A...

The movement to dismantle diversity, equity, and inclusion (DEI) initiatives in healthcare threatens to reverse decades of progress towards tackling systemic inequities that harm marginalised patients and providers. Critiques of bureaucratic or performative DEI efforts should not justify abandoning the mission altogether. Instead, the solution lies in reforming DEI to prioritise evidence based strategies. Studies show that racial concordance between patients and physicians improves trust, communication, and adherence to treatment plans, directly enhancing clinical outcomes.1 Yet, as Hopkins-Kotb notes,2 only 2.8% of physicians are black women, a stark under-representation that perpetuates inequities.Too often, DEI initiatives rely on superficial workshops led by facilitators lacking clinical expertise. These programmes fail to tackle the realities of healthcare, such as racial disparities in pain management or diagnostic delays. Effective DEI requires clinician-educators with dual expertise in anti-racist pedagogy and medical practice. Workshops led by physicians, for example, can show how implicit biases affect treatment...

Children born in 2008 in the UK have not yet hit their 18th birthday but have already lived through a global financial crisis, a period of austerity, a pandemic, and now a cost-of-living crisis. Inequality has widened in that time, and local authority budgets have been dramatically cut.Before last year’s election the Labour Party set out its health mission, where it acknowledged that much of what made people healthy sat outside the remit of the NHS. It set out plans for jobs, housing, and policies around unhealthy food, alcohol, and tobacco.1 But with a laser focus on fiscal policy, many public health experts believe that the government is simply not being ambitious enough.Since gaining power the Labour government has announced a ban later this year on TV advertising of unhealthy food before the 9 pm watershed,2 as well as £125m for trailblazer programmes to help people with long term chronic...

The US measles outbreak that began in Texas in late January is now spreading more widely, with 505 cases in Texas and 56 in nearby New Mexico, making a national total of more than 600 cases in 21 states.Two school age children died of measles complications in Texas. Both had been previously healthy, and neither one had been vaccinated. A third person probably died of measles in the neighbouring state of New Mexico, although the cause of death has not yet been confirmed. The Texas cases have been concentrated in a Mennonite community in Gaines County where vaccination rates are low.Robert F Kennedy Jr, the recently appointed head of the US Department of Health and Human Services, who has long denied the benefits of vaccines, has now urged people to get vaccinated. “The most effective way to prevent the spread of measles is the MMR vaccine,” he wrote on X...

The Royal College of Surgeons of England (RCS England) is calling for urgent reforms to tackle sexual harassment in the NHS after a High Court judge ruled that a surgeon who harassed junior colleagues over more than a decade should not be struck off the medical register.1Mr Justice Calver decided that erasure from the register would be a “disproportionate” sanction for James Gilbert, a leading transplant surgeon and supervisor of surgical trainees at the Oxford Transplant Centre who touched women “inappropriately” without their consent, including in the operating theatre, and made sexually suggestive comments.2A medical practitioners tribunal decided last August to suspend him from the register for eight months without review, allowing him to return to unrestricted practice at the end of the period. The General Medical Council appealed to the High Court, arguing that he should be struck off. But the judge instead extended his suspension to 12 months,...

Vaccination for shingles could be linked to a reduction in the risk of developing dementia, a study published in Nature has reported.1Researchers at Stanford University in California analysed cases of dementia in Wales, based on the health records of more than 280 000 adults born in 1925 to 1942. Over a seven year follow-up period the results showed that dementia diagnoses were 3.5 percentage points lower in people who received the live attenuated herpes zoster vaccine (Zostavax) than in those who did not receive it.Pascal Geldsetzer, lead author of the study and assistant professor of medicine at Stanford University, said, “For the first time, we have evidence for a cause-and-effect relationship between live attenuated shingles vaccination and dementia. The effect sizes appear to be large and, if truly causal, would have profound implications for population health and dementia research.”The study took advantage of a public health policy in Wales that...

US health secretary Robert F Kennedy Jr said he will order the Centers for Disease Control and Prevention (CDC) to revise its recommendation, which has stood for seven decades, that fluoride be added to drinking water.The public health agency said on 7 April that it would re-examine the scientific evidence on fluoride’s safety and effectiveness after Kennedy said he will ask it to drop the guidance.1The CDC currently suggests that 0.7 mg of fluoride be added per litre of water, the equivalent of three drops of water in a 55 gallon barrel. States generally follow that advice. Kennedy said he will instruct the CDC to drop that advice. He added that he was creating a task force to study fluoride in drinking water.The announcements have caused concern in dental and scientific communities who say there is no evidence that fluoride is harmful but plenty of evidence that it delivers dental...

Babies and children aged three months to 11 years with uncomplicated community acquired pneumonia should be offered a three day rather than five day course of antibiotics, the National Institute for Health and Care Excellence (NICE) has said in a draft guideline.1The recommendation follows evidence that for this group of patients a three day course of antibiotics was as effective as a five day course. It is also in line with shorter antibiotic courses for many common infections, such as urinary tract infections and acute bronchitis.Jonathan Benger, chief medical officer and interim director of the centre for guidelines at NICE, said that shorter courses of treatment also reduce the risk of antimicrobial resistance and save NHS resources.The draft guideline includes children for the first time and combines previous guidance on community acquired pneumonia and hospital acquired pneumonia published in 2019.It recommends using steroids in addition to antibiotics for adults with...

Lobbying by the advertising industry is thwarting plans that aim to protect public health by banning junk food advertisements from bus stops and billboards, The BMJ has found.Advertising companies and their representatives are warning local authorities in financial crisis that the councils’ advertising revenues will plummet if they restrict the promotion of food products high in fat, salt, or sugar (HFSS). These warnings have led some local authorities in England to shelve their plans despite the potential benefits to public health, The BMJ’s investigation discovered.media-1vid1Video 1Deny, dilute, delay—how advertisers are fighting billboard bansbmj.r667-vid1Those councils who push ahead with their plans despite such lobbying are facing delays of up to eight years to enforce the bans, because of their existing contracts with the advertising firms. Even when the bans come into effect they allow adverts for products such as McDonald’s chicken nuggets and KFC burgers to continue to be displayed (box...

In this paper by Gao C and colleagues (BMJ 2025;399:e082945, doi:10.1136/bmj-2024-082945, published), in the pdf, figure 2 had missing data for number censored at days 365, the HTML live figure was unaffected. Additionally, in figure 3, the number in the hierarchical component for death in the Ties box, should have been 929 398.

Last month NHS England issued a press release announcing a “nationwide rollout” of an “artificial intelligence tool that predicts falls and viruses.”1 It said that the tool, developed by the care provider Cera, was being “rolled out across the NHS” and “can predict a patient’s risk of falling with 97% accuracy, preventing as many as 2000 falls and hospital admissions each day.”The press release quoted senior government officials backing the tool as a “perfect example of how the NHS can use the latest tech to keep more patients safe at home and out of hospital.” The announcement was covered across several media outlets, including ITV News, the Independent, and the London Standard.23 The NHS Confederation issued a response, welcoming the rollout of the technology, but warning of the need for robust evaluation of AI in the health service.4How will the NHS roll out the AI?The BMJ approached Cera and NHS...