BMJ - British Medical Journal

This week is National Public Health Week in the United States and perhaps the saddest one in the 70 years of this celebration. Last week, President Donald Trump’s administration enacted mass firings of staff, or a “reduction in force,” at agencies that form the scaffolding of public health in the US.1 This action continued the attacks on science and health that have quickly become a signature of the new presidency.2The scope and depth of the cuts to staff are vast, including the Centers for Disease Control and Prevention, the National Institutes of Health, the US Food and Drug Administration (FDA), Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, Centers for Medicare and Medicaid Services, and many other offices.Collectively, these cuts impair government functions that are vital to society, including (but not limited to) the ability to ensure the safety of new medications, devices, food, and other...

Patients in hospital emergency departments are being put at risk because they are not getting time critical medication (TCM) for chronic conditions such as diabetes and Parkinson’s disease on time, says a report by the Royal College of Emergency Medicine.1Analysis of data from 136 UK emergency departments on patients with diabetes or Parkinson’s disease who take certain TCM such as insulin injections and levodopa found that two thirds did not receive their drugs around the expected time. This could potentially exacerbate symptoms or complications and lead to deterioration and increased mortality.Just over half (7197) of the 13 478 eligible patients were not identified within 30 minutes of their arrival in the emergency department, the analysis showed, and just 32% of 10 850 doses that patients should have had were administered within 30 minutes of their scheduled time. This proportion was 39% for levodopa and 22% for insulinIn light of the...

My name is Biotic. Andi Biotic.The UK Health Security Agency (UKHSA) has a new superhero in the form of a pill shaped cartoon character known as Andi Biotic. He’s heading up a campaign to tackle misconceptions about antibiotics among 18 to 34 year olds, as part of the ongoing “Keep Antibiotics Working” programme.A dose of good messaging?The agency is piloting this new six week digital campaign, which is being promoted across YouTube,1 Instagram, and Facebook, and by GP practices and pharmacies, to test its “potential to capture people’s attention and imagination” in order to “help raise awareness of good antibiotic stewardship.”A hard pill to swallowIndeed. An Ipsos survey of nearly 6000 UK residents aged 16 and older, commissioned by the UKHSA last year, found that over half of respondents incorrectly believed they either could not do anything personally to prevent antibiotics becoming less effective at treating infections (26%, 1535) or...

bmj;389/apr08_4/r697/FAF1faSheila Bhattacharya (née Burns) was born in St Leonards-on-Sea, East Sussex, in 1924. Her father, Robert Burns, a classics scholar, had been a colonial administrator in St Kitts and West Africa, while her mother, a highly independent Glaswegian woman, had served as a nurse in the first world war.Sheila had a passion for literature and had intended to study English at university, but the onset of the second world war while she was finishing school was the great event of her life, changing her outlook. Encouraged by her mother, she decided to study medicine and got a place at Newnham College, Cambridge, in 1942. She then decided instead to volunteer for war work and was sent to an explosives research laboratory at Woolwich Arsenal where she learnt about life beyond her privileged upbringing. It was dangerous work handling unstable chemicals, and more so during the V1 and V2 missile attacks....

The UK government should train and employ more health visitors and school nurses as part of a package of measures to tackle the rise in mental health problems among children and young people, a charity has urged.1The Centre for Mental Health, a charity that aims to tackle mental health inequalities, noted that one in five 8 to 25 year olds are now affected by mental health problems. It urged the government to invest in evidence based preventative strategies to reverse the trend, spanning the perinatal period and early years to schools and colleges, through to adulthood and employment.Cuts to health visitors and school nurses under successive governments have led to more children falling through the gaps of early support and going on to need specialist care, the report said.Increasing health visitor and school nurse numbers will benefit babies, children, and families for decades to come, alongside other interventions such as...

In January 2025, the UK government announced that an independent commission is to be set up on social care in England led by Louise Casey, a crossbench peer. The commission will explore problems facing social care and provide recommendations for creating a “national care service.”1 The announcement has elicited considerable (tending towards negative) response.2 Some query the basis for a commission, calling it a “cop out” in light of the urgent need for funding and reform.3 Others decry the long duration, with the commission expected to finally report by 2028, and point to a field already crowded with many similar exercises.4I view things somewhat differently. I agree that social care cannot afford to wait but suggest that the necessary change must be profound and that the commission can be justified as a way of proceeding. The organisational and funding issues are substantial, but we must recognise that reform in complex...

The US has reported 6600 cases of whooping cough (pertussis) in the first three months of 2025, more than four times the number at the same point last year and 25 times as many as had been reported at the same point in 2023.If the current trend continues, the country will be on course for the highest number of infections since vaccination was introduced in 1948.The state of Louisiana last week reported that two people had died from pertussis in the past six months. Both were infants, who are most at risk of serious complications. Two other US deaths have been reported this year: a school age child in North Dakota and an adult in Idaho.Pertussis remains one of the world’s deadliest infectious diseases. The World Health Organization estimated that in 2014 there were 24.1 million cases and 160 700 deaths in children under 5 worldwide.The number of cases typically...

A consultant surgeon who sexually harassed junior female colleagues has been suspended from the medical register for 12 months after a High Court judge ruled that his original eight months suspension had been too lenient.1James Gilbert was regarded as the “golden boy” of his department at the Oxford Transplant Centre, one of the women who gave evidence against him told the medical practitioners tribunal that suspended him last August. The tribunal found that he had touched female colleagues inappropriately without consent, including squeezing one woman’s thigh between his own thighs under the operating table, and made sexually motivated and racist remarks.2Gilbert had told the tribunal that he was a “different person and a fundamentally changed practitioner from the doctor whose conduct led to complaints being raised.”The tribunal noted that “these incidents did not give rise to concerns about risks to patient safety and that there was evidence that Mr Gilbert...

How are AI tools being evaluated?So far, the UK National Institute for Health and Care Excellence (NICE) has evaluated and published reports on five AI technologies. The sixth evaluation, on the first autonomous AI tool, is due to be published later this year.“Most of the AI tech that we have evaluated has been in the diagnostic space and are imaging based technologies,” said NICE’s HealthTech programme director Anastasia Chalkidou. “It’s still a med tech fundamentally.”Chalkidou told NICE’s annual conference on 27 March that most AI tools are currently being evaluated through its early value assessment (EVA) process.1 To be considered for this pathway, technologies with evidence uncertainties must aim to meet an unmet need. If they are conditionally recommended for “early use in the NHS,” an evidence generation plan must then be followed to produce the “evidence that needs to be gathered while it’s in use.” Once this evidence is...

DC and 23 states sue Trump governmentThe District of Columbia and 23 US states have launched legal action against President Donald Trump’s administration after the cancellation of $11bn (£8.54bn; €10bn) in public health funding left over from the covid pandemic.1 The funding was being used in programmes tracking the spread of disease and vaccine rollouts, as well as addiction and mental health services and others.The lawsuit, which asks the court to immediately block the funding cut, says that the federal government did not provide a “rational basis” or facts to support the cuts. The attorney generals representing these states said that the move would lead to “serious harm to public health” and would put states “at greater risk for future pandemics and the spread of otherwise preventable disease and cutting off vital public health services.”California’s attorney general, Rob Bonta, said that Trump and the health secretary, Robert F Kennedy Jr,...

The inequalities in outcomes for pregnant women and babies from black and Asian backgrounds have been improving, but they still persist in Scotland.1A short life working group on racialised health inequalities in maternity care was established in Scotland in January 2023. It took a co-production approach, underpinned by data and evidence, and identified three key deliverables2: an action plan, a best practice toolkit for working with interpreters in maternity and neonatal services, and scoping of data and evidence.Across Scotland, we are fortunate to have organisations—such as Amma Birth Companions (a Glasgow charity that supports women and birthing people from migrant backgrounds; https://ammabirthcompanions.org) and KWISA, Women of African Descent in Scotland (an African women led organisation based in Edinburgh; https://kwisa.org.uk)—advocating for and amplifying the voices of women and families from racialised and marginalised communities.We must continue to listen carefully to those with living expertise and create and maintain the conditions for...

Concerted global efforts to improve maternal healthcare mean that women are far less likely to die in childbirth than they were two decades ago, a new UN report says. But agencies have warned that the gains are already at risk because of to the recent unprecedented cuts to international aid funding.“In the year 2000 nearly half a million women died from giving birth. The figure now in 2023 is just over a quarter of a million,” said Jenny Cresswell, a researcher at WHO’s Department of Sexual and Reproductive Health and Research and the report’s lead author. “This report presents the first time that no countries were estimated to have extremely high levels of maternal mortality.”The report, published by the UN Maternal Mortality Estimation Inter-Agency Group, is the first to assess the global effect of the covid-19 pandemic on maternal health.The 40% decrease in maternal deaths was largely due to better...

Smith is right to acknowledge the admiration that many of us hold for those who make huge personal (and in Patrick Hart’s case, professional) sacrifices by acting in line with their conscience.1But we must avoid framing climate activists as merely acting on “their beliefs.” Hart and others who have been imprisoned for engaging in non-violent climate action are not acting based on beliefs or personal opinions, but rather in the name of decades of well established climate science that evidences the need for urgent action.2 The narrative that such actions are based on personal convictions and opinions has been exploited by the General Medical Council as part of its justification for suspending doctors who have been imprisoned for climate related offences.3Smith also expresses scepticism about the effectiveness of civil disobedience, but research has shown that it leads to greater support for more moderate climate organisations.4 Moreover, even in health circles,...

On 13 February 2025, a few hours after the US Senate confirmed Robert F. Kennedy, Jr as Secretary of Health and Human Services, President Trump issued an executive order establishing a “Make America Healthy Again” (MAHA) Commission. That same day the US House Budget Committee voted to progress a budget bill that targets Medicaid with the biggest share of cuts to finance Trump’s agenda of border security and tax cuts. The House budget proposal includes at least $880 billion in Medicaid cuts—approximately 11 percent of federal Medicaid funding over the 10 year period.1Medicaid is the largest publicly funded source of health insurance coverage, covering 79 million people.2 By comparison Medicare covers 68 million people.3 Medicaid is a federal-state matching programme with the majority of funding (69%) coming from the federal government. States run the programme with federal rules and options. Medicaid is the only source of public financing for long...

A UK government advisory committee has said that food and drink sweetened with non-sugar sweeteners (NSS) can help people lose a small amount of weight, contrasting with a previous conclusion from the World Health Organization.But younger children should not be given any drinks or foods containing NSS, the UK’s Scientific Advisory Committee on Nutrition (SACN) concluded.The updated advice has been published in response to 2023 WHO guidelines which concluded that NSS and foods that contain them should not be used to control body weight or reduce the risk of non-communicable diseases as there is no evidence of any long term benefit.12 WHO also warned that their long term use is associated with increased risk of type 2 diabetes, cardiovascular diseases, and mortality, although it said the evidence for this was of low certainty overall.In its response the SACN states that the WHO guideline prioritises evidence from prospective cohort studies rather...

bmj;389/apr07_1/r626/FAF1faDespite blazing a trail as one of the few female medical students of her day, Rosamond Gruer did not expect to work as a doctor after she married. As a mother of four her duties were as a housewife and practice receptionist. She became an expert knitter and dressmaker and hosted increasingly elaborate dinner parties based on recipes by the celebrity chef Robert Carrier.However, when her GP husband, Kenneth, failed to find a replacement partner for his practice in the Aberdeenshire quarry village of Kemnay, Rosamond became his assistant and then partner. She was reluctant at first, feeling untrained and out of touch with medicine, as well as still doing most of the child rearing and household running. But she soon grew in confidence and discovered she had the resilience and capability to cope.Kenneth became ill a few years later and, seeking a less stressful life, the family moved to...

The debate over rising numbers of people claiming disability benefits in the United Kingdom, particularly relating to mental health, has become increasingly highly charged over recent months, especially in the context of an underperforming UK economy.1 The UK is an outlier among the G7 countries in terms of economic inactivity.2 These countries also saw a post-pandemic rise in disability benefit claims, but, unlike the UK, they are now seeing a return to normal. Why is the UK different?Could it be a problem of overdiagnosis, as the health secretary, Wes Streeting, controversially stated recently?3 Or is it related to the medicalisation of everyday worries, as previous prime minister Rishi Sunak speculated?4 Or is it a sickness problem that can only be resolved once NHS waiting lists reduce and people have improved access to support?5Opinions remain divided. It’s not straightforward, however, to get through a benefits assessment and be awarded payments on...

On 27 March the US health secretary Robert F Kennedy Jr, abruptly announced the termination of 10 000 jobs at the Department of Health and Human Services (HHS), with 10 000 more cut through early retirement and buyouts.1 The repercussions became clearer this week as employees received their notice on 1 April—or turned up to work to find their security passes had been deactivated.Kennedy said that HHS was being “recalibrated to emphasize prevention, not just sick care.” On X he wrote, “The reality is clear: what we’ve been doing isn’t working.2Two senators, Bill Cassidy and Bernie Sanders, invited Kennedy to a 10 April hearing to explain the restructuring. A HHS spokesperson told Politico that Kennedy had yet to accept the invitation.Senior figures reassigned and relocatedAs employees were served notice by email early on 1 April, many staff in high ranking posts found themselves reassigned and facing relocation or put on...

Since the passage of the US Administrative Procedures Act of 1946, public commentary has remained a cornerstone of US policy making, establishing transparent procedures with which federal agencies must comply.1 Public comment is not a bureaucratic formality: it’s part of a deliberate process designed to ensure accountability in policy making. These mechanisms are foundational to a democratic government reliant on public trust derived from careful and transparent decision making.That’s why a proposal by the new US health secretary, Robert F Kennedy Jr, to eliminate public comment requirements for key decisions in the US Department of Health and Human Services (HHS) is so alarming.2 If implemented, this change would strip away a critical mechanism that invites patients, care partners, healthcare professionals, and advocacy organisations to weigh in on policies that directly affect them. Removing the formal mechanism for public comment would set a dangerous precedent by permitting policies to be formulated...

The US Supreme Court unanimously upheld the decision by the Food and Drug Administration (FDA) to reject an application for approval of flavoured liquids used in vapes, also called e-cigarettes, on 2 April.12However, the Supreme Court’s decision was not a clear win for the FDA.Yolanda Richardson, president of the Campaign for Tobacco-Free Kids, said in a statement, “While the FDA has authorized the sale of 34 e-cigarette products, manufacturers continue to flood the market with thousands of illegal, unauthorized products. To end this crisis, the FDA must deny marketing applications for flavoured e-cigarettes and step up enforcement efforts to clear the market of illegal products. Today’s ruling should spur the FDA to act quickly to do so.”3The Supreme Court overturned a ruling by a lower court, the conservative US Court of Appeals for the Fifth Circuit. That court had decided that the FDA had changed the rules for companies applying...