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...

The UK’s statistics watchdog has warned NHS England and the Department of Health and Social Care over their claims about the benefits of Palantir’s federated data platform (FDP).1The Office for Statistical Regulation (OSR) examined how NHSE was using statistics to support claims about the success of the FDP, after several members of the public contacted the watchdog to express concern about how data were being presented.It identified that statistical teams at NHS England did not clear the FDP statistical data for public use before it was published. The watchdog recommended that these statistical teams should have a bigger role in overseeing claims made about the benefits of the platform.It also advised NHSE and ministers that all communications about Palantir’s software that include before-and-after data comparisons must be “clearly and appropriately labelled” and that any figures cited about its effectiveness “are communicated in a clear, accurate manner.”Members of the public expressed...

Thick smoke from Canadian wildfires has blanketed Toronto, Detroit, Minneapolis, Chicago, New York, and Washington, DC, in July. At points, Detroit, Toronto, and other North American cities ranked among the worst in the world for air quality.1In several cities, monitors recorded fine particle pollution at or above levels the US Environmental Protection Agency (EPA) classifies as “hazardous” on its air quality index.2 EPA’s updated particulate matter of 2.5 ?m diameter or smaller (PM2.5) breakpoints put the hazardous category at 225.5 µg/m3 and above. During July, Reuters reported hazardous readings in Minneapolis, Milwaukee, and Toronto, while state and local monitors recorded PM2.5 concentrations above 600 µg/m3 in parts of Minnesota and Wisconsin.3Some US politicians took to social media, blaming Canada as summer activities were curtailed and residents were warned to stay indoors. And in a reversal, wildfires in the US west are now sending smoke north across the border into British...

NHS England’s announcement of an accelerated rollout of AI1 promises a beguiling future of shorter waiting times and better care for millions of patients. With a £10bn investment over three years, this is a major programme intended to deliver around half of the commitments in the 10 year plan and to generate £41bn in total benefits. Much of the gain is expected to be delivered through a new AI triage tool on the NHS app and through AI tools based on ambient voice technology.When taxpayers’ money is committed on this scale, decisions should be made transparently and based on evidence. For new medicines, we have machinery to do exactly that: regulatory approval, health technology assessment through the National Institute for Health and Care Excellence (NICE), the expectation of randomised trial evidence before widespread adoption, and a clear separation of private and public interests. For digital technology and AI, the evidential...

An expensive and recently banned neck operation for Alzheimer’s disease spread rapidly through China and is now being tested in the US and other countries, despite a lack of randomised evidence to demonstrate its efficacy.Qingping Xie, a microsurgeon and president at Hangzhou Qiushi Hospital in the city of Hangzhou, China, performed the first ever deep cervical lymphatic-venous anastomosis (dcLVA) on a patient with Alzheimer’s disease six years ago after receiving ethical approval from his hospital for the highly experimental procedure. The procedure became popular1 in China and was featured in articles published in Science in 20252 and in Nature in 2026.3But the rapid expansion of the procedure ignited criticism about its lack of standardisation, high price, and potential complications,4 as well as the ethics5 of performing experimental surgery on such vulnerable patients. It was banned6 by Chinese authorities in July 2025 because of a lack of robust clinical evidence to...

Medical students face official accusations of “unprofessionalism” to manage dissent or in retaliation for providing feedback about their education, a report warns.Students shared how they had been reported as being unprofessional for going home while sick, while others faced similar sanctions for legitimate complaints about their placement.These experiences were detailed in a report by the BMA, with the union warning that the practice left students afraid to raise concerns, including on patient safety, as doing so could harm their future careers.1This increasingly “punitive” and inconsistent enforcement of professionalism standards in UK medical schools is having a silencing effect across medical education and damaging trust in university leadership, the BMA warned.The report drew on survey data from 2573 UK medical students and data gathered from freedom of information (FoI) requests to medical schools.Nearly half (45%) of the students surveyed said they would feel uncomfortable raising concerns within their medical school, while...

The Edinburgh Medical School, the first in the English-speaking world, was founded 300 years ago. Its prehistory included the establishment of several important institutions:a College of Surgeons in 1505;the University of Edinburgh in 1582;a physic garden in 1670;a College of Physicians in 1680;In the 1680s the Edinburgh physicians began work on the Pharmacopoeia Edinburgensis, which was finally published in 1699, and from 1685 onwards many university professorial appointments were made in subjects such as physic, anatomy, chemistry, and the institutes and practice of medicine. Although not associated with chairs in the first instance, materia medica and botany were also being taught. Then, in 1726, following a petition presented to the Edinburgh Town Council by four physicians, a Faculty of Medicine was established. This was followed three years later by the foundation of a teaching hospital, completing all the requirements for a fully functioning medical school. The school was successful in...

The unrest over physician assistants continues to drag on, more than a year after Gillian Leng’s independent review was published. On 17 July 2026 the High Court dismissed a legal challenge to the Leng review’s recommendations brought by the physician assistants’ trade union, United Medical Associate Professionals. Importantly, the judge dismissed the unfounded claim that Leng had produced the review to appease certain quarters of the medical profession, including the BMA.The handling of the controversy around physician assistants has been damaging to the health system—including the royal colleges, the General Medical Council (GMC), and NHS England. Many concerns about physician assistants raised by frontline staff were dismissed by leaders as “social media noise.” Doctors were accused of elitism and being protective of their role. Delayed and soft touch regulation of physician assistants by the GMC added to the problems around undefined scope of practice and patient safety risks.The former health...

Thousands of people with multiple sclerosis (MS) in England will be offered a new drug on the NHS to help them walk more easily.Fampridine (Fampyra)—the first medicine to help improve walking for adults with MS—will be routinely available on the NHS in England from today.The twice daily pill acts as a “signalled booster” for nerves damaged by MS, helping electrical messages to travel to muscles more effectively. This will make it easier for some patients to walk, which could make everyday tasks easier and help them maintain their independence, said NHS England (NHSE).MS is a lifelong neurological condition caused by damage to nerves in the brain and spinal cord. Symptoms can include weakness, fatigue, loss of sensation, problems with balance and coordination, and difficulty walking.Existing treatment options for helping people with MS to walk include physiotherapy and exercises, walking aids, devices to support the feet, and treatments to manage muscle...