BMJ - British Medical Journal

The new US health secretary, Robert F Kennedy Jr, has ordered the Centers for Disease Control and Prevention (CDC) to halt its publicity campaign encouraging uptake of this year’s seasonal flu vaccine.Kennedy has also indefinitely postponed the meeting of CDC’s advisory committee on immunisation practices (ACIP), a key event in the agency’s calendar, stirring alarm in the public health community.The moves by the incoming health secretary, who made his career as a professional anti-vaccine activist, appeared at odds with assurances given during his confirmation hearing in which he promised not to undermine Americans’ faith in vaccines.1CDC’s “wild to mild” ad campaign, running since 2023, aimed to promote flu vaccination by highlighting its ability to prevent severe complications even when it doesn’t stop infection. The US is currently in the grip of an unusually fierce flu season.According to the US website Stat News, CDC staff were told by the health department’s...

Israel’s attacks on the Gaza Strip since October 2023 have left its healthcare system in ruins, with nearly all hospitals partly or completely destroyed, along with much of their medical equipment.1 More than 1000 healthcare workers have been killed.2A temporary ceasefire agreement between Hamas and Israel came into effect on 19 January, 470 days after Hamas’s 7 October 2023 attack on Israel, which resulted in around 1200 people being killed and more than 200, including children, being taken hostage. Over the next 16 months Israel has bombarded Gaza, raided hospitals, and carried out ground offensives across the strip. An estimated 47 000 Palestinians have been killed and 111 000 injured, and around 10 000 people are believed to be beneath rubble.3The effects of the war go far beyond these numbers, says Mohammed Abu Mughaiseeb, deputy medical coordinator for Gaza for the charity Médecins Sans Frontières (MSF). “We don’t count the...

Tests using blood based biomarkers for the concurrent detection of multiple types of cancer in asymptomatic people are currently being trialled in the UK and elsewhere.1 This has raised the possibility of their adoption in population screening programmes. Multicancer testing has the potential to improve cancer survival, particularly for rarer cancers, through early detection. But this benefit has to be balanced against possible harms from false positive results; overdiagnosis; inaccurate predictions of, or indeed inability to, predict the cancer site; and cases where a cancer detected by testing is too small to be seen on imaging.23Most discussion has considered the overall—aggregate—benefits and harms of screening programmes using multicancer tests. However, cancers behave remarkably differently between both individuals and cancer types. Differences in the natural history of disease have an important influence on the potential for one potential harm—overdiagnosis—when screening for multiple cancers simultaneously. The example of overdiagnosis illustrates why differences...

The trial of the French surgeon Joël Le Scouarnec, which opened on 24 February and is thought to be France’s biggest ever paedophilia case, raises the question of how he was allowed to continue practising after being given a suspended sentence of four months in 2005 for possessing indecent images of children.Le Scouarnec, aged 74, whose trial is being held in the Brittany town of Vannes and will last four months, is accused of sexually abusing 299 children over nearly 30 years in hospitals in western France. He was arrested in 2017 and risks a 20 year prison sentence. He has been serving a 15 year term since 2020, when the court in Saintes, in the département of Charente-Maritime, found him guilty of rape and sexual abuse of four minors, including two nieces.The Conseil National de l’Ordre de Médecins (CNOM), which regulates doctors in France, declined to answer this and...

The editorial emphasising that “adult social care reform cannot wait” covers the finance and policy issues clearly but fails to mention that it is essential—and possible—to reduce the need for social care by preventing problems such as falls, isolation, frailty, stroke, and dementia, which create the need.1The science is now clear that the normal biological process of ageing is not a cause of major problems until people reach their late 90s.23 The problems develop because of three inter-related causes: loss of fitness, social pressures (notably deprivation and ageism), and disease, much of which can be prevented or delayed. At Live Longer Better, we are tackling all these, but we need to turn the theory into action.One of our programmes is to create a new generation of social care professionals, whose mission will be partly focused on enabling people to maintain and regain function, based on the principle of social pedagogy...

John Mulinga started working in mental health after meeting the first consultant in his career who was truly welcoming.“This consultant wanted to know a bit about me before we started the training, which was quite different to the other roles I’d had,” says Mulinga, who works as a consultant psychiatrist for Lancashire and South Cumbria NHS Foundation Trust.“I’d never had a time before that when the consultant said, ‘Sit here and let’s just have a chat about who you are, what you want, or how we can best help you.’ But that’s exactly what happened when I started with that psychiatric consultant. At the end of my three month placement my mind was made up to stay.”Mulinga had wanted to be a doctor ever since being rushed to hospital as a child after drinking from a bottle of what he thought was water—but which turned out to be paraffin. Watching...

The figures in this Feature (BMJ 2025;388:q2759, doi:10.1136/bmj.q2759, 9 January 2025) mistakenly stated that smoking prevalence in France was 4.6% instead of 34.6%. This has now been corrected.

Canada has bought half a million vaccines designed to prevent H5N1 avian influenza in humans.The vaccines are intended to stamp out any potential human transmission of the disease by immunising those most at risk, such as farm workers, medical staff, and veterinarians.1 Some 60% of the doses will be distributed to the provinces, while the remaining 200 000 are held in a federal reserve.The vaccine, GSK’s Arepanrix H5N1 A/American wigeon clade 2.3.4.4b, is based on existing seasonal flu vaccine technology. It was approved in Canada on 19 February, the day the order was placed.In December the UK ordered five million doses of human H5 influenza vaccine from Seqirus UK.2Experts fear that Canada is entering a dangerous period as migratory birds return from their southern winter grounds—almost certainly carrying new mutations of H5N1 virus—while the human H1N1 flu season is still in full swing. The swapping of viral genetic material in...

bmj;388/feb24_6/r359/FAF1faMichael King (standing) with Elspeth and colleaguesMichael King had been working as a surgeon in a day care ward in Worthing for two years when he began to get itchy feet. While “the work was rewarding and I was my own boss within limits,” he was yearning for a greater challenge. His wife, Elspeth, and two pre-teen daughters, Fiona and Sheenagh, “would welcome a more adventurous life,” he wrote in his unpublished memoirs.Elspeth spotted an advertisement in The BMJ for a surgeon at the Queen Elizabeth Central Hospital in Blantyre, the industrial and commercial capital of Malawi. King spoke to the chief surgeon in post, Jan Borgstein. He then consulted Sam Bhima, the first black doctor in Nyasaland, as Malawi was called before independence, who happened to be working at Worthing Hospital. Bhima had been forced to flee his homeland because of his links to Malawi’s opposition and told King...

The 24 February 2025 marks the third anniversary of Russia’s full scale invasion of Ukraine. This grim milestone coincides with a radical shift in American policy towards Ukraine and the rest of Europe that challenges the country’s sovereignty and capacity to recover. It is an appropriate time to reflect on the impact the invasion has had on Ukrainians and the resilience they have demonstrated in their response.In the last three years, while international attention to the crisis waned, the attempted destruction of Ukraine’s health and healthcare system intensified. Between February 2022 and January 2025, 12 605 Ukrainian civilians have been killed by the war and 29 178 have been injured.1 The World Health Organization (WHO) has verified 2,236 attacks on healthcare facilities in Ukraine since 24 February 2022, the most ever recorded by WHO in a conflict.2 The agency reports that these attacks have increased in the past year, and...

Since the US Supreme Court issued the Dobbs decision, which rolled back the constitutional right to abortion, public health experts have focused mainly on the harm to health caused by abortion bans, as more states moved to restrict when abortion was legal.12 While this is a legitimate focus, there has been another, stealthier legal trend that threatens reproductive healthcare and bodily autonomy more broadly. The rise of laws and state high court opinions granting fertilized eggs, embryos, or fetuses separate legal rights from the person carrying the pregnancy are equally nefarious.At first glance, it may seem that the movement to recognise a fetus as a legal person has only recently gained momentum, as evidenced by lawmakers in Idaho, Indiana, North Dakota, Oklahoma, South Carolina, and Texas introducing or working to introduce bills to allow homicide charges to be brought against people suspected of having an abortion.345 Or in Montana where...

The most beautiful English wordsIn a 1955 lecture titled English and Welsh, inaugurating the O'Donnell Lectures, J R R Tolkien asserted that “most English-speaking people ... will admit that cellar door is ‘beautiful’, especially if dissociated from its sense (and from its spelling). More beautiful than, say, sky, and far more beautiful than beautiful.” The O'Donnell Lectures were established to promote interest in how the English language had been influenced by Celtic languages, and the phrase “cellar door” contains elements that are common in Welsh phonology.1This observation, however, was not novel to Tolkien. It had been expounded in the 1903 novel Gee Boy by Cyrus Hooper, where it was attributed to an earlier, albeit unidentified, author: “He even grew to like sounds unassociated with the meaning, and once made a list of the words he loved most, as doubloon, squadron, thatch, fanfare (he never did know the meaning of this...

What has been announced?NHS England has said that it is actively working with GPs’ leaders to prepare for sharing of GP patient data, through the OpenSAFELY system, with select researchers. This could potentially happen within months.Do researchers currently have access to GP data?Deidentified patient data from general practices in Scotland and Wales are available for research, but this is largely not the case in England. However, an exception has been made in recent years in relation to covid-19. Early in the pandemic the government issued a “control of patient information” (COPI) notice, which gave researchers access to deidentified patient data, but only for covid-19 research.1What is OpenSAFELY?OpenSAFELY is a software platform that enables researchers to analyse electronic health record data in England, including GP patient records for the whole population of 58 million—but currently only for covid related work. Developed in the early months of the pandemic,2 it is a...

The National Institute for Health and Care Excellence (NICE) has approved fenfluramine (Fintepla) for the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in people aged 2 years and over, following an appeal by the manufacturer.1Fenfluramine will be an alternative for people who cannot tolerate existing cannabis based treatment. The treatment has already been made available in Scotland following a decision by the Scottish Medicines Consortium earlier this month.2LGS is a severe form of epilepsy that begins between the ages of 2 and 7 and is characterised by frequent seizures of different types. These include drop seizures which can result in sudden falling and may lead to severe injuries and hospital admissions. LGS is also associated with severe learning and behavioural disorders.People with the condition need constant care and help with most aspects of daily life. Patient carers who gave evidence to the NICE committee noted that the currently available...

Doctors’ leaders have condemned a “catastrophic” error in the marking of a high stakes medical exam that left almost 300 candidates with an incorrect result.The error affected nearly a fifth (283 of 1451) of the doctors who took the second written component of the membership of the Royal Colleges of Physicians of the United Kingdom exam in September 2023. Some 61 candidates who were originally told that they failed the MRCP(UK) exam have now been informed that they passed, and 222 candidates who were originally told they passed have now been told that they failed and will need to resit.The exam is a major hurdle for doctors wishing to enter higher specialty training in medical subspecialties such as cardiology, geriatrics, and haematology. It is administered by the Federation of the Royal Colleges of Physicians of the UK, representing the colleges in London, Edinburgh, and Glasgow.Doctors affected by the error who...

The BMA recently published survey data that found 43% of UK medical students out of 3500 surveyed have considered taking a break or leaving their course entirely because of financial difficulties.1 As a graduate entry medical student who has taken time out of my course due to financial pressures, I think it is clearer than ever that increased financial investment is necessary to support the future of our NHS workforce.With the rising cost of living, both student finance and the NHS bursary are proving to be insufficient to meet students’ everyday expenses, but the latter is particularly meagre. In the second year of medical school, graduate entry students transition from being funded by Student Finance England to an NHS bursary. For students on standard entry medical courses, this switch happens in their fifth year of study. This change was introduced so that the NHS could directly fund healthcare students, a...

A senior GP partner who made false allegations to the General Medical Council about a colleague has been struck off the UK medical register after the GMC accused him of serious dishonesty and attempting to abuse the regulatory process.Chandubhai Patel “manipulated the regulatory process for his own benefit” when he “dishonestly made repeated allegations about a fellow doctor to the GMC, which he knew to be untrue,” said Nessa Sharkett, who chaired the medical practitioners tribunal that struck off Patel.Several details remain confidential, including the identity of the doctor whom Patel reported to the GMC, named only as Dr A. Patel did not attend his own hearing, although in a signed witness statement he had agreed to testify at a potential hearing against Dr A.The tribunal heard that in January 2021 Patel, the senior partner at the Hayes Medical Centre in west London, asked Dr A to sign an agreement,...