Doctors’ leaders have reacted strongly to the government’s proposed 2.5% pay rise for clinicians next year, suggesting it’s “neglect dressed up as restraint.”The Department of Health and Social Care (DHSC) submitted its annual evidence1 to the pay review body, the Doctors’ and Dentists’ Remuneration Body (DDRB), calling for a 2.5% uplift in 2026-27. It warned that anything higher would hamper the NHS’s ability to deliver services and could mean cuts to staffing levels.The BMA has condemned the proposal, however, calling it “indefensible” and one which is likely to worsen already strained relations between the union and government.The union is already in dispute with the government over the online GP consultation rules introduced from 1 October, and its resident doctor members are set to hold a five day strike from 14 November.23In its 103 page submission to the DDRB, the DHSC said it has only planned for a 2.5% pay uplift...

Mention China to a medical journal editor, and their mind will leap to studies on irrelevant research questions drawn from the UK Biobank. It might also jump to numerous analyses of Global Burden of Disease study data. It will inevitably dwell on risks of research misconduct and ethical breaches. The overriding sentiment, however, might be: how do we get through an avalanche of substandard submissions seeking an international journal with an impact factor?On a recent trip to China I championed the advice of Doug Altman, The BMJ’s former chief statistician who not only led the field of medical statistics but helped establish it. In a landmark editorial in The BMJ in 1994 describing the “scandal of poor medical research,” Altman wrote, “We need less research, better research, and research done for the right reasons” (doi:10.1136/bmj.308.6924.283).1 Good advice travels slowly, in time and place. Urging China’s researchers to abide by Altman’s...

Doctors have urged Florida policymakers to reject plans to end childhood vaccine mandates, with others claiming they are being silenced on the matter by their institutions.On 3 September, Florida Surgeon General Joseph Ladapo announced that “the Florida health department is going to be working to end all vaccine mandates in Florida law.” He said, “Who am I, as a government or anyone else, to tell you what you should put in your body?”The announcement builds on the decision by Florida Governor Ron DeSantis during the covid-19 pandemic to reject vaccine and mask mandates for schools and workplaces.Florida is scheduled to end mandates for the hepatitis B, chickenpox, haemophilus influenza type b, and pneumococcal conjugate vaccines in December. The state’s health department said this will go into effect 90 days after the 3 September announcement.But before mandates can be removed for other vaccines, including those for measles, the change must be...

A long criticised study on antidepressant use in adolescents has been flagged with an “expression of concern” by a leading academic journal after the launch of legal action.12George Murgatroyd III, a lawyer, is suing the publishing giant Elsevier, as well as the American Academy of Child and Adolescent Psychiatry, demanding the retraction of the 24 year old randomised trial.3Concerns about the widely cited article—including numerous demands for retraction456—have been circulating for almost as long as the paper itself, and the trial, known as Study 329, is regularly referred to as one of the best examples of spin, misreporting, and ghostwriting in industry funded medical research.In 2012 paroxetine’s manufacturer, GlaxoSmithKline (GSK), was fined a record $3bn (£2.27bn; €2.58bn), in part for illegally promoting paroxetine using the journal article.7 Published by the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) in 2001, the article declared paroxetine “generally well tolerated...

Older people are systematically excluded from research, particularly clinical trials, despite having the highest health and care needs.1 The joint statement from research funders calls for a renewed commitment to ensuring better inclusion of older adults, particularly those with multiple long term health conditions.2But the statement doesn’t mention the growing number of older people with cognitive impairment who are often excluded altogether.3 This is primarily owing to the ethical, legal, and methodological complexities around involving participants who lack capacity to consent. A researcher we interviewed described this as “an insurmountable black box of horrendousness that I dare not go into” fearing that, if they get it wrong, they will be “illegal . . . and the ethics police will come for you.”4 This urgently needs to be tackled if we are to ensure better inclusion.Hope comes in the form of trials methodology research, which provides evidence based strategies to improve...

McNally raises the very important point of reversing silent osteoporosis.1 As a gynaecologist with a special interest in menopause care, I want to highlight the importance of hormone replacement therapy (HRT) for the prevention of osteoporosis in women.As McNally quotes, the prevalence of osteoporosis in women increases significantly from 2% at age 50 to 50% at 80. The average age of menopause in the UK is 51.2 Oestrogen has a profound effect on bone, and replacement of oestrogen in women has been seen to improve bone health in numerous studies—so much so that the British Menopause Society states that it should be considered a first line therapeutic intervention for the prevention of osteoporosis.34 This is especially true for women with premature ovarian insufficiency (whether iatrogenic or non-iatrogenic).5 Alongside discussions about balanced diet, vitamin D and calcium supplementation, reducing smoking, and improving exercise, HRT should be part of the consultation for...

Analogies and analoguesThe words “analogy” and “analogue” come from the Greek word ????????, which had several different meanings, including mathematical proportion, proportion in general, correspondence, and resemblance. The meanings that dominate English today are reasoning on the basis of parallel cases (analogy) and forms of technology other than digital (analogue).Although “analogy” entered English in the 15th century, via the Latin analogia and the French analogie, with the now obsolete meaning of proportion or mathematical agreement of ratios, most of its other meanings did not emerge until the 16th century or slightly later, including “a thing which (or occasionally person who) corresponds to or resembles another; a parallel, an equivalent ….”1Here, for example, is the Elizabethan physician Philip Barrough in The Methode of Physicke in 1583: “Therefore by the example and analogie of one difference of tumours, which are caused thorough defluxion (for here we mind to intreate only of them)...

Bodies of Palestinians returned by Israel as part of a ceasefire deal show signs of torture, execution, and being run over by tanks, hospital workers have said.Sources at Nasser Hospital in Khan Younis, which received the remains, told Middle East Eye (MEE) that several bodies bore strangulation marks, broken bones, and mutilation, while others were missing limbs.1The news comes as UN leaders called for a “massive surge” in aid as doctors in Gaza report that “nothing has changed on the ground” and there is still a huge shortage of aid and medical supplies.Speaking to MEE, the source said that some 45 bodies returned on 14 October were recently killed, while others arrived in a decomposed state or as partial remains.The ceasefire agreement between Israel and Hamas, brokered by the US, included an exchange deal that has seen Hamas release all 20 living hostages taken during the 7 October 2023 attack...

How far will you go to promote your medical invention? This is a question for clinical innovators. How far will you go to market the invention? This is a question for corporations whose primary purpose is to keep pleasing their shareholders. The limits of promotion, of course, should be reached when the balance of benefits and harms is no longer favourable. That balance is a judgment, made by people capable of deciphering the evidence and seeking to protect the public—drug and device regulators, for example.What happens when an intervention seems innocuous, the data are equivocal, and the benefits are more theoretical than demonstrable? Again, it depends. There is no free good; every intervention is a vector of harm—trivial, minor, major, or yet to be determined. It is in these grey areas, where judgment is required, that the peddlers of a new product show their true colours and the vigilance of...

American pharmaceutical giant Eli Lilly has said it will crack down on suppliers who are selling fake versions of its unapproved weight loss drug retatrutide.Social media companies TikTok and Meta have also intervened against black market sellers operating on their platforms.The decision comes after a Channel 4 investigation found that patients have been able to buy fake versions of retatrutide on social media.1 The triple glucagon hormone receptor agonist drug is currently in phase 3 clinical trials, set to conclude in May 2026.2As a glucagon-like peptide-1 receptor agonist, it is similar to other weight loss drugs such as tirzepatide (Mounjaro) and semaglutide (Ozempic, Wegovy). It is also an agonist for glucagon receptors and gastric inhibitory polypeptide.Undercover journalists from Channel 4 were able to buy a fake version of the unapproved weight loss injection online, and find members of the public who had bought the drug from TikTok.A spokesperson for Eli...

The prime minister, Keir Starmer, has ordered a rapid review of how healthcare regulators such as the General Medical Council deal with allegations of racist or antisemitic behaviour in the NHS. The government will also roll out mandatory antisemitism and antiracism training for all 1.5 million NHS staff and has promised a “zero tolerance” approach to discrimination in healthcare.The move follows a case in which a British-Palestinian trainee doctor, Rahmeh Aladwan, was allowed to continue practising pending a full Medical Practitioners Tribunal Service hearing into allegations that she made antisemitic remarks.1Aladwan, who has continued to comment on social media, has been referred for a new interim orders tribunal hearing, set for 23 October.In another recent case, a former consultant surgeon, Manoj Sen, was struck off the UK medical register for antisemitic comments in social media, including calling a Jewish man “vermin” and “rodent.”2The rapid review will be led by John...

A long acting injection given every two months to reduce the risk of contracting HIV is to be made available in England for people who are unable to have a daily prophylaxis tablet.The National Institute for Health and Care Excellence (NICE) said its approval1 of the “groundbreaking” preventative therapy would support the government’s target of eliminating HIV transmissions by 2030.Latest data from the UK Health and Security Agency show that new HIV diagnoses fell by 2% in England from 2838 in 2023 to 2773 in 2024.2“This breakthrough preventative therapy is another powerful tool in our arsenal to reach that crucial goal,” said health secretary Wes Streeting.NICE’s final draft guidance recommends cabotegravir (Apretude, made by ViiV Healthcare) as an option for pre-exposure prophylaxis (PrEP) alongside safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults and young people who weigh at least 35 kg.It is only recommended...

bmj;391/oct16_10/r2181/FAF1faUntil her untimely death aged 44, Scottish born Vicky Johnson, associate professor of neurosurgery at Perelman School of Medicine, University of Pennsylvania, led landmark international research exploring the biology and pathology of traumatic brain injury (TBI), with projects spanning complex pre-clinical models to human pathology studies. She established herself as one of the leaders in TBI research, directing multiple programmes and mentoring many students and postdoctoral researchers.“Traumatic brain injury is a common and often devastating health problem,” she said on the Johnson Laboratory website, highlighting how it affected 2.5 million people a year in the US.1 Johnson’s research focused largely on links between TBI and neurodegenerative diseases such as Alzheimer’s and chronic traumatic encephalopathy, including the short and long term outcomes of sports concussions. Her work advanced understanding of the mechanisms by which acute brain trauma leads to long term neurological decline. She contributed to more than 120 published research...

Healthcare in low and middle income countries in Africa and elsewhere is being “hijacked” by commercial surrogacy companies, experts have warned.At a session at the European women’s rights conference FiLia in Brighton on 12 October, former surrogates and women’s rights campaigners from France, the US, and Germany argued that pregnancy complications such as sepsis, postpartum haemorrhage, and pre-eclampsia are higher in surrogate pregnancies and that the industry is distorting healthcare provision in commercial surrogacy destinations.Marie Josephe Devilliers, president of the feminist organisation International Coalition Against Surrogate Motherhood, presented evidence of such practice in Uganda, where a medical sector has been developed for in vitro fertilisatoin (IVF) and reproductive surrogacy but where local women cannot access obstetric care. The situation is similar in South Africa, where “ordinary citizens have little access to medical care for their own pregnancies, but the most sophisticated clinics are available for surrogate pregnancies,” Devilliers said.Lexi Ellingsworth,...

Almost a quarter of children needing community care services in England are waiting over a year for treatment, with 1 in 15 waiting two years, an analysis by two healthcare think tanks has found.1The Nuffield Trust and the Health Foundation said the “unacceptable” figures were placing children’s health and life chances at risk and should serve as a “wake-up call” for the government. The think tanks said their findings, published on 16 October, showed that many young people with disabilities and developmental problems faced potentially damaging delays to treatment.Failing to tackle the problem could derail ambitions laid out in the NHS’s 10 year plan to move more care out of hospitals into the community, they warned.2Community health services see and treat more than two million patients each month in England, with more than eight million care contacts, accounting for around 13% of all daily activity in the NHS.In July 2025...

The report on surrogacy presented to the United Nations General Assembly in October by special rapporteur Reem Alsalem concludes that “The practice of surrogacy is characterized by exploitation and violence against women and children, including girls”.1 Its key recommendation is to eradicate all forms of surrogacy around the world. Alsalem’s report has, predictably, prompted highly polarised responses, with some commentators welcoming its conclusions, and others responding with outrage.234Two things need to be said here. Firstly, Alsalem is the UN special rapporteur on violence against women and girls, and the report is entitled “The different manifestations of violence against women and girls in the context of surrogacy.” The report therefore takes a particular viewpoint and is not intended as an objective survey of the global surrogacy landscape. Secondly, although the special rapporteur can make recommendations, the UN is under no obligation to accept them. This report is therefore a prompt for...

The World Health Organization has been forced to cut dozens of staff in Europe over the past few weeks, as the US withdrawal continues to hit the agency hard.Speaking at the World Vaccine Congress Europe in Amsterdam on 15 October, Robb Butler, WHO Europe’s director of the division of communicable diseases, environment, and health, said 32 staff had been cut from his division in the past three weeks. “We’ve taken a very heavy hit. The politicisation of health is a very raw and real thing in the WHO European region at the moment,” he said.The Trump administration withdrew from WHO in January,1 saying that the UN agency had mishandled major international health crises. The US had previously contributed around 18% of WHO’s funding.Between January and July this year WHO reduced its staff by 221, according to Health Policy Watch, from 9452 to 9231.2 In March WHO said it would have...

The BMJ editorial on declining childhood vaccine uptake in England is both sobering and timely.1 The authors rightly highlight fragmentation, austerity, and service delivery barriers, but they linger within the boundaries of traditional paradigms. I urge a more radical, systemic response—one that dares to reframe the entire vaccine ecosystem in the UK.First, it is time to recognise that our current model—a patchwork of institutional silos, short term funding, and legacy outreach—is not simply strained but obsolete. Instead of incremental tweaks, let’s pilot “vaccine broker” hubs: hyperlocal, interdisciplinary teams embedded in schools, community centres, and pharmacies. These hubs would not just deliver immunisations but also build authentic relationships with families—leveraging data science to predict hesitancy, tailor outreach, and triage barriers in real time.2Second, digital transformation remains underused. Although reminders and portals exist, the future lies in intelligent scheduling and artificial intelligence (AI) driven nudges embedded into the everyday digital footprint of...

F. Gordo Vidal
Med Intensiva. 2023;47:191-2

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Francisco Álvarez-Lerma, Mercedes Catalán-González, Joaquín Álvarez, Miguel Sánchez-García, Mercedes Palomar-Martínez, Inmaculada Fernández-Moreno, José Garnacho-Montero, Fernando Barcenilla-Gaite, Rosa García, Jesús Aranaz-Andrés, Francisco J. Lozano-García, Paula Ramírez-Galleymore, Montserrat Martínez-Alonso
Med Intensiva. 2023;47:193-202

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