In late June, over 50 grant recipients of the US’s Teen Pregnancy Prevention Program received notice that their funding, used to implement sexual health education initiatives, was being terminated because their programmes didn’t align with the Trump administration’s values. This came just days after the US Department of Health and Human Services released new notices of funding opportunities and laid out guidelines for new applications.12 The new guidelines emphasise abstinence-only education, “parental rights” (a conservative movement that uses the concept as a pretext for restricting young people’s autonomy), and themes of fertility tracking and hormone production favoured by the “Make America Healthy Again” movement.34A federal judge temporarily blocked the new guidelines on 19 August, but terminated funding will not be restored to grant recipients. Although this ruling prevents the new guidelines from being implemented while litigation is ongoing, these actions are yet another threat to evidence based sexual and reproductive...

In 2007 The BMJ’s readers voted vaccination as one of the most important medical milestones since the journal began in 1840. Vaccines are estimated to have saved hundreds of millions of lives worldwide, primarily among children. A robust evidence base has shown vaccines to be safe and effective.1 Who would want to undermine one of the greatest public health achievements?Last week the US president, Donald Trump, and his health secretary, Robert F Kennedy Jr—both long term vaccine sceptics—did just that by signing an executive order to reduce the vaccinations US children receive and to deliver MMR vaccination as separate doses (doi:10.1136/bmj-2026-100549).2 This shows “an ambivalence towards vaccines and the evidence base that supports them,” write Tiago Correia and colleagues, and will reduce uptake and trust in vaccines that won’t be easy to recover, making outbreaks of vaccine preventable diseases certain (doi:10.1136/bmj-2026-100562).3The executive order was issued shortly after a US Senate...

News reports in recent weeks highlight several potential missteps in the implementation of artificial intelligence in healthcare.A patient sued Open AI claiming that ChatGPT gave him harmful medical advice, a whistleblower claimed a major academic medical centre cut corners in evaluating patient facing AI tools, and a large insurer was accused of using reckless algorithms to prematurely discharge patients from postacute care.1Reports like these are likely to continue as healthcare organisations race to implement new AI tools.At the same time, public scepticism about AI is growing, which further raises the stakes of getting AI implementation wrong, particularly where patients are directly affected.2 Trustworthy AI implementation in healthcare entails not only ensuring outputs are accurate and reliable, but also that the processes by which healthcare organisations adopt, implement, evaluate, govern, and communicate about their AI efforts maintain their integrity, including proactively detecting and responding to problems.3As health systems pursue AI integration,...

The UK has entered a new era of climate volatility, in which record breaking temperatures and droughts are expected rather than exceptional events.1On 14 August, 71.3% of England was declared to be in drought, following the driest July on record, with some regions receiving only 10% of their average annual rainfall. Reservoir storage fell to 69% of capacity, 11.6% below seasonal norms, while 78% of England’s rivers are below normal levels, and more than 27 million people face water restrictions.2 It will take more than a few days of rain to bring water levels back to what they should be.The drought has been accompanied by heatwaves to create “compound extreme events” with substantial public health implications. As a result, what is often framed as a water management problem is now a warning that climate change is becoming a food and public health emergency.Droughts progress through four stages: a meteorological drought...

Stroke is a leading cause of death and disability worldwide. Despite improving patient outcomes, reperfusion treatments are time dependent and not universally available. Head positioning is a simple, low cost intervention with a compelling physiological rationale,1 but randomised trials have not demonstrated functional benefit.234 Current guidelines recommend head position based on the individual, rather than routinely keeping patients in either flat or upright head positions.567 However, earlier trials focused on optimising head position to improve cerebral perfusion before reperfusion of the ischaemic penumbra. Whether there is a preferred head position after successful reperfusion remains unclear, especially in those with major strokes where head elevation may attenuate oedema progression.In a linked study (doi:10.1136/bmj-2026-100363), Yuan and colleagues report the HeadSOAR trial, which aimed to determine optimal head position after successful reperfusion.8 HeadSOAR was an investigator led, multicentre, randomised, open label trial with blinded endpoint assessment conducted across 67 stroke centres in China....

A woman in her 30s presented with a two month history of painless, non-itchy reddish purple plaques and nodules which first appeared on her abdomen and gradually spread to her upper body and thighs (fig 1). She had no relevant medical history and was not taking any medication.bmj;394/aug20_5/e100277/F1F1f1Fig 1On examination, there were multiple violaceous patches and nodules on her abdomen, chest, back, upper arms, and thighs. The lesions were indurated and non-tender on palpation.Differential diagnoses included cutaneous metastases from a solid tumour or cutaneous involvement of a haematological malignancy. Given the lack of tenderness, ulceration, discharge, or signs of systemic inflammation, infective and inflammatory dermatoses were considered less likely.Full blood count showed a white blood cell count of 3.06×109/L (reference range, 3.5 to 9.5×109/L). Liver and renal function, coagulation, autoimmune, and immunodeficiency profiles were within normal limits.An abdominal skin biopsy was done. Histopathological examination and immunophenotyping were consistent with a...

ObesityRates in England double in 30 yearsObesity rates in England have doubled in three decades, with 14.3 million people now classed as obese. The increase has come despite 14 government strategies in that time aiming to cut obesity levels, said a King’s Fund analysis. At least 7.2 million more adults now have obesity than in 1993, the year after the first obesity strategy was published by John Major’s Conservative government. The rise in obesity rates among young people is particularly stark: in 1993 only 6% of 16-24 year olds were obese or severely obese, but in 2024 the rate was 18%. (Full story doi:10.1136/bmj-2026-100531)Cosmetic surgeryCampaigners decry lack of action to protect patientsA coalition of royal colleges, specialist surgical associations, and patient safety organisations criticised a lack of progress on changing the law to protect cosmetic surgery patients. An open letter to ministers sent to the UK health secretary, Yvette Cooper,...

AbstractObjectiveTo evaluate the effects of intravenous iron on red cell transfusion and recovery after cardiac surgery.DesignInternational, multicentre, double blind, placebo controlled randomised trial (ITACS).Setting33 hospitals across 10 countries. Participants were enrolled between July 2016 and December 2023.Participants955 adults with anaemia undergoing elective cardiac surgery. Exclusion criteria included haemoglobinopathy or iron storage disorder, renal dialysis, and erythropoietin or intravenous iron given in the previous four weeks.InterventionA computer generated program randomised participants to intravenous iron 1000 mg or placebo 1-26 weeks before surgery. Participants, clinicians, and data collectors were masked to the intervention.Main outcome measuresThe number of days alive and at home up to 90 days after surgery (primary outcome), red cell transfusion requirements and complications (secondary outcomes).ResultsOf 2993 screened participants, 955 were enrolled and 921 of the eligible 939 modified intention-to-treat participants were assessed for the primary outcome. The median number of days alive and at home up to 90 days after surgery was 81.1 (interquartile range 74.8-83.7) in patients assigned to intravenous iron and 80.0 (69.5-83.6) in those receiving placebo (adjusted median difference 1.0 day, 95.4% confidence interval 0.0 to 2.1 days, P=0.041). Red cell transfusions were given to 262 patients (61.1%) in the iron group and 302 (68.2%) in the placebo group during their hospital stay (relative risk 0.90, 95% confidence interval 0.82 to 0.99, P=0.027). No differences were observed for major complications or length of hospital stay.ConclusionAmong patients with anaemia undergoing elective cardiac surgery, preoperative intravenous iron was associated with a reduction in red cell transfusion and a small improvement in the number of days alive and at home in the first 90 days after surgery. Intravenous iron is an effective component of patient blood management in this setting.Trial registrationClinicalTrials.gov NCT02632760.

An unprecedented summer surge in cases of cyclosporiasis, a foodborne, diarrhoea causing disease, has now affected almost every US state, according to health authorities in the country.More than 15 700 laboratory confirmed cases have been counted to date, said the US Centers for Disease Control and Prevention (CDC), far higher than the annual average of roughly 3000.12 A further 11 841 cases of cyclosporiasis may require further investigation, the CDC said.Only Delaware, New Mexico, and Hawaii are yet to report any cases of the illness, which has emerged across the US and Puerto Rico. There have been 828 people admitted to hospitals and two deaths.The latest states to have been affected are Maine and Massachusetts in the northeastern US.Democratic Senator Elizabeth Warren has blasted the current US administration’s “calamitous” and “botched” response to the cyclosporiasis boom. In a letter sent to US health secretary Robert F Kennedy Jr on 16...

Senior doctors in Scotland may take industrial action, as a formal dispute has been triggered between the BMA and Holyrood.Leaders of the union’s Consultants Committee and its SAS (specialist, associate specialist, and specialty doctors) committee announced that they were now in formal dispute with the government over pay and conditions.The BMA said that the decision reflected the “scale of anger and frustration that senior doctors are feeling over the failure to address longstanding issues affecting the profession,” adding that it was considering holding a ballot to allow industrial action.The Scottish health secretary, Angela Constance, announced on 12 August that consultants, GPs, SAS doctors, and dentists would receive a 3.5% pay increase for 2026-27 and that this would be backdated to 1 April 2026. This was despite the BMA rejecting these pay increases, which came from recommendations by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB).At the time of the...

McCartney highlights the risks of overdiagnosis, overtreatment, and resource diversion associated with prostate cancer screening.1 These concerns remain central to policy decisions. One methodological issue, however, deserves attention.The UK National Screening Committee’s recommendation is often interpreted as “screening versus no screening”—an important comparison for establishing effectiveness. Yet this no longer reflects contemporary UK practice. English primary care data from over 2.8 million men showed that over 410 000 men underwent opportunistic prostate specific antigen (PSA) testing between 1998 and 2017, with cumulative uptake reaching 44%.2 Analyses indicate that almost 40% of UK men aged 45-69 years have at least one PSA test in a decade.3 Consequently, the comparator is not “no screening” but widespread opportunistic PSA testing.From a health economics perspective, interventions should be evaluated against current practice. The policy question is whether an organised, risk stratified programme could deliver greater benefit, fewer harms, and better equity than the unstructured...

One person has died and 207 have become ill in a UK outbreak of salmonella, health authorities have said.The UK Health Security Agency (UKHSA) has launched an investigation into the recent spike in confirmed cases, most of which have occurred since the beginning of July.1 The contamination is genetically linked to a previous outbreak last year, which was traced to imported eggs.Almost all cases (199) in the current outbreak were reported in England, and the two regions worst affected are Yorkshire and the Humber, and London. A further six cases were reported in Scotland, one in Wales, and one in Northern Ireland.Of the people currently known to have become ill, 38% were admitted to hospital because of their salmonellosis symptoms and two people developed a bloodstream infection. Common symptoms of salmonella poisoning include cramps, vomiting, diarrhoea, and fever.2Salmonella samples from all confirmed cases were very closely related, suggesting a “common...

Four members of the Darwin family were students at the Edinburgh Medical School, three of them in the second half of the 18th century—Erasmus and his two sons, Charles and Robert, and one in the early 19th century—Robert’s son Charles. The younger Charles found the study of medicine boring and didn’t qualify, but became more famous than all the others. The older Charles, the younger Charles’s uncle, would have qualified, but died before he could submit his graduation dissertation; he may have developed meningococcal septicaemia after dissecting the body of a child with hydrocephalus. Erasmus and Robert pursued successful careers in medicine.The Edinburgh Medical SchoolThe Edinburgh Medical School was founded as a Faculty of Medicine within Edinburgh University in 1726, 300 years ago this year.1 It was the first such in the English-speaking world, at a time when medical training in the UK was largely achieved through apprenticeships to apothecaries,...

A next generation glucagon-like peptide-1 (GLP-1) drug for obesity, retatrutide, will now be available to some patients before it is approved by the US Food and Drug Administration (FDA) through an expanded access programme (also known as compassionate use).The announcement, from the drug’s manufacturer Eli Lilly,1 comes amid speculation that the then 79 year old Donald Trump was given access to the drug.That story, from the online news website STAT, describes the patient as a man 79 years of age with refractory obesity, obstructive sleep apnoea, and pulmonary hypertension.2A notice issued to the US government website ClinicalTrials.gov (which details clinical studies on humans) includes a notice to “provide pre-approval single patient expanded access of retatrutide,” submitted on 1 June.3However, White House spokesperson Kush Desai has firmly denied speculation that this patient was the US president.4Trump has previously accessed medications that at the time were unapproved through an expanded access programme.In...

Each year millions of students sit India’s National Eligibility cum Entrance Test (NEET), to determine whether they will be admitted to medical, dental, and AYUSH (Ayurveda, yoga, Unani, Siddha, and homeopathy) schools as an undergraduate.After a single exam taking three hours, each student receives a score that forms a ranking from which medical and other healthcare related teaching institutions choose who to accept for their limited places.The standardised test has been controversial since it was first launched (box 1). But the 2026 exam has left a scar not just on Indian medicine but also on Indian politics.Box 1A history of controversyThe NEET was first conducted for the 2013-14 admissions cycle and initially lasted just three months.It was formed with good intentions. The government wanted to replace the patchwork of entrance exams used by government and private medical colleges. The NEET would, it said, reduce costs and pressure on students, who...

At last week’s Senate committee hearing, Anthony Fauci, former director of the US National Institute of Allergy and Infectious Diseases (NIAID), faced hours of hostile questioning from Republican Senators.1 They accused the 85 year old physician-scientist of lying, covering up evidence, and misleading the American public during the covid pandemic.1 Republican members of the Senate committee have now voted to hold Fauci in contempt of Congress. The hearing, including Fauci pleading the fifth amendment, fuelled anger among the MAGA political base and conservative influencers, energising them ahead of the upcoming midterm elections2—but a more lasting harm from the hearing will be damage to science and trust in public health.Fauci has devoted more than 50 years to public service, leading NIAID and the US through the HIV/AIDS epidemic, the 2001 anthrax attacks, SARS, pandemic influenza, Ebola, Zika, and other infectious disease threats.3 Beyond the White House briefing room, he helped transform...

War metaphors have been used in healthcare and medicine for decades.1 However, for almost as long, commentators have pointed out how this language risks positioning not just the condition as a problem, but the person with the condition, which increases stigma.2 For certain conditions, such as HIV and cancer, messaging has become noticeably more person centred and informative.2 Yet in diabetes advocacy, the use of “battle” language is still common.3 Militaristic messaging indicates that we need to “fight,” “combat,” “beat,” and, ultimately, “defeat” diabetes. In recent years, the American Diabetes Association, Diabetes Australia, the Danish Diabetes Association, and Diabetes UK have all had campaigns involving a fight: “We fight to end diabetes,” “Unite in the fight for change,” and “Know diabetes, fight diabetes.”Such messaging is often well intentioned—it seeks to unite and galvanise the public and diabetes community in pursuit of policy changes, improved access to healthcare, and increased funding...

A former chief medical officer has criticised a lack of progress on changing the law to protect cosmetic surgery patients.Bruce Keogh has joined several surgical and medical bodies as 13 signatories in an open letter to ministers decrying a lack of action to regulate high risk cosmetic procedures, despite the government promising to do so a year ago.1This lack of action means patients are still facing unnecessary risk, say the signatories, because cosmetic surgery in England can still legally be performed by doctors without specialist surgical qualifications.Sent to health and social care secretary Yvette Cooper on 6 August, the letter comes from a coalition of royal colleges, specialist surgical associations, and patient safety organisations, led by the Royal College of Surgeons of England.It calls on the government to publish a promised consultation and use it to strengthen protections for patients undergoing cosmetic surgery, warning that there is a “serious regulatory...

This Viewpoint discusses policies the Biden administration can enact to reduce costs, including benchmarking Medicare Part B drug payments to the lowest price paid in similar countries, preventing Part D plans from negotiating confidential rebates with manufacturers, and patent reform to promote generic drug use.

This Viewpoint reviews evidence that higher hospital prices reflect greater market power more than higher-quality services and proposes that backstop price caps can mitigate harms from the most excessive prices without constraining or distorting competitive health care markets.