Doctors could be told to stop wearing political badges at work and not to attend political protests in work uniforms, after a national review.Strengthened official guidance on uniform and workwear for NHS staff is expected after a government commissioned review on tackling antisemitism and other forms of racism across the NHS.1However, doctors' leaders labelled some of the proposals as “deeply concerning.”They said having a “blanket ban” on all symbols being worn as a step too far and there are questions over who decides what is “political.”The review, carried out by the Labour peer and UK government adviser on antisemitism John Mann, was commissioned after an attack at Heaton Park Synagogue in Manchester in October 2025 and reports of doctors being struck off the medical register because of antisemitic comments.2Mann heard from Jewish people who said they experienced “routine ostracism” in the NHS.Jewish staff were also the only religious group in...

McNally correctly identifies that many of the challenges affecting parents who are doctors are compounded for trainees with frequent rotations and often long commutes.1 Being a dual doctor couple, which has become increasingly common, further compounds the problem. The degree of influence that trainees have over their rotations varies considerably across grade, region, and training programme. We started a family during higher specialty training, but there are many parents in foundation or early specialty training who are even more vulnerable to these problems, with shorter rotations and even less agency. Most trusts lack an on-site nursery, which is of limited use when both parents are working in different places. Our friends and colleagues who rely on family might seem to have a better deal, but these arrangements often strain personal relationships and can be vulnerable to changes of health or circumstance.2Less than full time (LTFT) working has allowed my wife...

bmj;393/jun05_11/e491185/VS1F1vs1Eric was born in Liverpool in 1925, was educated at Liverpool College, and went on to Liverpool University to study medicine.He qualified as a urologist and started his career at Sefton General, where he met his wife, Rosemary, who was working there as a physiotherapist. Most of his career was spent at the Manchester Royal Infirmary, where he became head of urology surgery.Eric was very involved in kidney research, and he spent his early career in the US at the Mayo Clinic, studying the artificial kidney. On his return to the UK, he developed and performed the first cadaver transplant. He was a leading force in Kidney Research Northwest and much involved in raising funds through the rugby sevens team. This was recognised by the Queen, and he attended one of her garden parties in the late 1970s.Eric became chair of the British Association of Urological Surgeons and was also...

A new drug to treat resistant ovarian cancer, and the first to be approved in over two decades, has been approved for patients in the NHS in England.What is the new drug?Mirvetuximab soravtansine (marketed as Elahere), developed by AbbVie, is an advanced, targeted treatment that combines a “homing” antibody with a cancer destroying drug.Often described by scientists as a “biological missile” or “trojan horse” therapy, the drug is already available in the US and Europe.It costs £4950 per 100 mg vial at list prices, excluding VAT.1 However, for the health service it is being made available subject to a confidential commercial arrangement between AbbVie and NHS England.How does it work?In contrast to chemotherapy, it uses a targeted therapy that seeks out a specific protein found on the surface of cancer cells called folate receptor alpha (FR?) and delivers a molecule that destroys the cancer cell from within.The drug is given...

While the growth rate of the world's population has declined to 0.86% per year, the rate of mortality has also slowed down. Part of the decline in mortality can be attributed to considerable efforts on young infant and child survival, which have been successful. But the message from a linked series of papers on neonatal, child, and adolescent mortality published in The BMJ (doi:10.1136/bmj-2025-088684; doi:10.1136/bmj-2025-088685; doi:10.1136/bmj-2025-088686; doi:10.1136/bmj-2025-088687) is clear: since 2015, the rate of decline in mortality rates in newborn babies, children under 5 years old, older children, and adolescents has slowed substantially.1234 Although the number of deaths among children under 5 has decreased over the past two decades, 4.9 million children in this age group died in 2024, with almost half of the deaths occurring in newborn babies. While the mortality rate among children under 5 declined by 3.9% in 2000-15, the rate of decline was only 1.5% in...

AbstractObjectiveTo estimate cause specific mortality among neonates and children under 5 for 195 countries from 2000 to 2024.DesignSecondary data analysis using a Bayesian multinomial logistic regression model to estimate cause specific mortality fractions.Data sourcesPubMed, Embase, Web of Science, SCOPUS, Cochrane, Global Health Index Medicus, PAHO, Global Health OVID, Africa-Wide Information, IndMed, WHO Mortality Database, Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), and Health and Demographic and Surveillance Systems (HDSS).Inclusion criteriaStudies in the general population reporting empirical cause specific mortality for at least two causes in the age groups of interest, with a specified method for cause ascertainment. For studies identifying causes of mortality with verbal autopsy, ?25 deaths reported with ?25% of these deaths with unknown cause. For vital registration, ?80% population completeness and ?10% deaths assigned to ill defined causes determined by the international classification of diseases, 10th revision.ResultsCause specific mortality for countries with adequate quality vital registration was estimated with their own data with minor adjustments. For countries with low mortality without adequate quality vital registration, cause specific mortality was modeled by age group and based on vital registration. For high mortality areas, cause specific mortality was modeled primarily on the basis of verbal autopsy data identified in a systematic review. Estimated cause distributions were applied to all cause mortality rates and death counts estimated by the United Nations Inter-agency Group for Child Mortality Estimation. Among 4.9 million estimated global deaths in under 5s in 2024, the most important cause of death was preterm birth complications, with 0.82 (90% uncertainty interval 0.76 to 0.88) million deaths and 6.17 (5.93 to 6.42) deaths for every 1000 live births. This was followed closely by lower respiratory infections at 0.66 (0.60 to 0.71) million deaths, intrapartum related events (0.48 (0.43 to 0.52) million), and malaria (0.45 (0.39 to 0.51) million). Analysis for trends over time showed that the decline in most causes has slowed since 2016.ConclusionWith the recent slowed pace of decline in under 5 mortality for most primary causes of death, many high mortality countries are at risk of missing the sustainable development goal targets of ?12 neonatal deaths and ?25 under 5 deaths per 1000 live births without acceleration. Estimates presented here can help countries to determine the most appropriate course of action to reduce under 5 mortality and achieve these targets.

bmj;393/may28_11/s953/FAF1faThe zenith of Joseph Ana’s passion to improve healthcare in Africa, particularly in his native Nigeria, came in 2004, when he was appointed health commissioner of Cross River State in the south east of the country. Donald Duke, the state governor, was impressed when Ana, a GP in the UK at the time, made clear that “medicine was not about buildings and equipment but love and care.” Duke had “gone through two health commissioners already without the satisfaction of making progress.”When Ana took up his post, the state had to serve more than three million people with only 72 doctors, no psychiatrist, radiologist, or pathologist, and just over 1000 nurses and midwives, with most practitioners concentrated in the cities. Maternal mortality was over 1% and child mortality over 20%. Only a fifth of the population were immunised, and—although hardly acknowledged because of the stigma—12% of the population were HIV positive.Ana...

Resident doctors in England will return to the picket lines next month in their 16th walkout over pay and conditions, the doctors' union has announced.The strike will run from 7 am on Monday 15 June to 6 59 am on Friday 19 June, and the BMA has threatened “more strike dates in July” if no further progress is made.The announcement comes after talks broke down between the new health and social care secretary, James Murray, and the BMA's Resident Doctors Committee (RDC). BMA officials said Murray had made it clear that he would not put any more money on the table beyond what his predecessor, Wes Streeting, had previously offered. Murray expressed disappointment that the BMA had “rushed once again to unnecessary and unreasonable strike action.”On 27 May the RDC chair, Jack Fletcher, said he had hoped that a change in health secretary “would lead to a change in approach.”“Sadly,...

In this article (BMJ 2026;393:e629407; doi:10.1136/bmj-2026-629407) the first initial of D Gareth Evans was omitted. The online version has been corrected.

Various media outlets have described the current Ebola outbreak affecting eastern Democratic Republic of the Congo (DRC) and Uganda as “a perfect storm.”1 A convergence of critical factors has made the outbreak difficult to control: a rare virus for which there are no licensed vaccines or therapeutics, combined with transmission occurring in conflict affected areas characterised by high population mobility, weak health infrastructure, and longstanding challenges around community trust and engagement.The outbreak is caused by Bundibugyo, a rare Ebola-causing virus identified in two previous outbreaks, Uganda in 2007 and DRC in 2012. Unlike Ebola virus (formerly Zaire ebolavirus), which caused the devastating West African epidemic of 2014-16, there are currently no approved vaccines or therapeutics for Bundibugyo virus disease. This raises a difficult question: if Ebola has been recognised for decades, why do we still not have vaccines for all Ebola viruses?The answer reflects an uncomfortable reality about how the...

Wes Streeting's time as health and social care secretary has been a missed opportunity. Instead of using Labour's overwhelming majority to fix the fundamental problems of the NHS he embarked on the unnecessary abolition of NHS England while failing to put in place a credible plan for reform.Labour's 2024 general election manifesto promised not just to improve NHS performance but ensure its long term success through three shifts: hospital to community, treatment and prevention, and analogue to digital.1 This was supposed to be part of a pan-government “health mission” to help people to live longer healthier lives, which was quietly ditched.It took 12 months to publish the 10 Year Health Plan for England.2 It was well received, but Streeting failed to set out how it would be delivered. By the time he resigned almost a year later he had still not published either the delivery plan or the workforce plan,...

AbstractObjectivesTo study the prevalence and characteristics of outcome switching, the completeness of outcome prespecification, and factors associated with outcome switching in observational cohort studies of interventions.DesignLongitudinal meta-epidemiological study.SettingRegistry records and journal publications.ParticipantsControlled cohort studies investigating the effects of interventions. Eligible studies were registered on ClinicalTrials.gov within one month of their start date (2014-16) and had published results in peer reviewed journals by 2024.Main outcomes measuresFirstly, proportion of studies with outcome switching identified by comparing the prespecified outcomes in the registry and those reported in the journal publication of results. Discrepancies were categorised as omission (prespecified primary outcomes not reported), downgrading (prespecified primary outcomes reported as non-primary), upgrading (prespecified non-primary outcomes reported as primary), and introduction of new primary outcomes (not registered as an outcome). Secondly, proportion of studies with completely prespecified primary outcomes, defined as registry entries that include the measurement variable, analysis metric, method of aggregation (the statistic summarising the outcome within each study group), and time point.ResultsOf 9965 registration records screened, 124 eligible studies with results published between 2015 and 2024 were included. Only 30 studies (24%) completely prespecified their primary outcomes. Outcome switching occurred in 60 (48%) studies, but only two provided an explanation. The most common types of switching were omission (n=32, 26%) and downgrading (n=32, 26%), followed by the introduction of new primary outcomes (n=25, 20%), and upgrading (n=2, 2%). Among 57 studies with outcome switching other than omission (ie, outcome results were reported), statistically significant results were favoured in 77% (44/57) by introducing or upgrading a new significant primary outcome or downgrading a non-significant one. No study characteristics were significantly associated with outcome switching in multivariable logistic regression.ConclusionsOutcome switching and inadequate outcome prespecification were common in cohort studies of interventions. Most changes were unexplained and favoured statistically significant results, raising concerns about potential selective reporting and highlighting the need for improved transparency in outcome reporting.Study registrationOpen Science Framework (https://osf.io/xn5zt/).

UK government plans to increase the price the NHS pays for drugs will face a legal challenge from a patient campaign group.The changes, announced in December 2025, formed a key part of a trade deal aimed at avoiding tariffs being imposed by the US president, Donald Trump.1These new regulations would allow ministers to increase the cost threshold that the National Institute for Health and Care Excellence (NICE) uses to determine which drugs are made routinely available in the health service from a range of £20 000-£30 000 per quality adjusted life year to £25 000-£35 000. The change is expected to cost the NHS billions, which critics say could be better spent improving services.But these plans are now being challenged by Just Treatment, a patient led campaign group working alongside Global Justice Now, a social justice organisation. The two groups have written to the secretary of state for health and...

Regulations for handling “vexatious” patients must be toughened to protect GPs and their staff against the growing threat of harassment and abuse, general practice leaders say.The UK conference of local medical committees (LMCs) in Belfast heard distressing accounts from GPs about doctors, staff, and their families being harassed, stalked, and targeted by patients.Delegates said that current rules on handling patients who engage in repeated harassment, stalking, or abuse did not adequately protect doctors and staff against what was a growing problem.Claire Barnsley, of Wakefield LMC, who proposed the motion, said, “Harassment and stalking are patterned based forms of abuse, not single instance. They escalate over time, and in modern general practice they are increasingly enabled by our own systems.“Police thresholds are high and inconsistently applied. NHS systems compel repeated engagement with patients demonstrating vexatious behaviours, even after abusive or threatening behaviours.”GPs have consistently highlighted the need to deal with abuse...

Davies provides a salutary reminder of the harm that can be caused by the diagnoses we make.1 Most melanoma in situ is biologically indolent and will never progress, and the dramatic rise in incidence is largely a marker of diagnostic scrutiny. The absence of a corresponding fall in invasive melanomas is the hallmark of overdiagnosis.2 I hope she will take consolation from the fact that a diagnosis of melanoma in situ is associated with an overall reduced risk of death from any cause over the 15 years after diagnosis, which greatly exceeds any (exceedingly small) risk of death from melanoma.3Overdiagnosis of melanoma is being recognised as a major problem in dermatology.45 Several factors have contributed, including social media messaging; government cancer targets with increased melanoma awareness; and for-profit “mole screening” shops on high streets, open to anyone despite the absence of any evidence that undirected mole screening reduces melanoma mortality....

A new outbreak of Ebola virus disease in central Africa, caused by the rare Bundibugyo version of the virus, has caused more than 300 suspected cases and killed 100 people, health officials have said.The World Health Organization (WHO) has declared the situation a public health emergency of international concern.1The Africa Centres for Disease Control and Prevention (Africa CDC) has so far identified 336 suspected and 10 confirmed cases in the Democratic Republic of the Congo (DRC).2 There have been 87 deaths in the DRC to date. Uganda has had two confirmed cases and one additional death.3In response WHO has sent five tonnes of medical supplies to the DRC, and $500 000 (£374 000; €430 000) has been released from the agency's contingency fund for emergencies.This Ebola outbreak is causing particular concern because it has been caused by the Bundibugyo strain, which has been detected in only two previous outbreaks, in...

Screening with a PSA (prostate specific antigen) blood test reduces prostate cancer deaths by two for every 1000 men screened, though the risk of overdiagnosis remains high, an updated Cochrane review says.1The evidence of a “modest” benefit is a shift from a 2013 Cochrane review that concluded there was not enough evidence that screening reduced prostate cancer deaths.In the UK, more than 64 000 men are given a prostate cancer diagnosis every year, and one in eight will receive a diagnosis in their lifetime.The merits of routine screening for prostate cancer have long been debated. In recent years there has been high profile campaigning for PSA testing to be rolled out more widely, including by former prime ministers Rishi Sunak and David Cameron and the Olympic cyclist Chris Hoy.However, last year the UK National Screening Committee advised against routine screening for prostate cancer, saying the harms outweighed the benefits.2 Instead...

I want to take a career break—what do I need to know?Considering why you want to take a break and what you want to achieve can be a great place to start.Lucy Henshall—founder of Welcome Back to Work (https://www.welcomebacktowork.co.uk/), which provides support for GPs returning to work after a break—says: “You need to decide what is important to you.“People take career breaks for many different reasons, and there is no right or wrong path. It is a very personal decision that needs careful thought to minimise the hurdles and mitigate the risks when you do return to medicine.”Henshall, a retired GP, says that taking breaks was not the norm when she qualified back in 1987 but that “times have changed.”“Life is much more complicated for young medics now—and student debts are higher than ever,” she says. “The heady combination of excessive workloads, financial pressures, social isolation due to frequent geographic...

One French woman and one US national who disembarked from the cruise ship MV Hondius have now tested positive for hantavirus.Another US national was also reported as showing symptoms of possible infection. The fresh wave of cases came as passengers disembarking the ship were repatriated after the MV Hondius docked in the Canary Islands on the morning of 10 May.The World Health Organization (WHO) has confirmed that the hantavirus outbreak on the ship1 was caused by the Andes strain of the virus, which has been known to spread between people. As of 8 May eight cases were confirmed or suspected on board, of which three had proved fatal. By 10 May this had risen to 10 cases, said US and Spanish officials.Giulia Gallo, postdoctoral scientist in the viral glycoproteins group at the UK’s Pirbright Institute, said that the potentially new cases derived from the same cluster of exposed people on...

A risky gamble?It’s certainly a controversial one. But the practice of staking money on the likelihood of disease outbreaks or future pandemics is a growing trend, with gamblers flocking to online prediction market platforms like Polymarket to lay down their money.1High stakes?You bet. In the wake of the hantavirus outbreak on a cruise ship, traders are placing wagers on whether it will escalate into a pandemic1 (as defined by the World Health Organization) before the end of 2026. As of 11 May, a whopping $6m has been staked.What are prediction markets?Essentially, they allow people to bet on the outcomes of future events. Online platforms like Polymarket and Kalshi allow users to stake money on all manner of events such as elections, sports results, and major global events.Dead pool?The hantavirus market is the latest controversial market to emerge. Recently, gamblers started placing bets on how many people would be infected with...