In 1788, the Birmingham physician William Withering was consulted by an apothecary in Wellington, Shropshire, about the case of a woman, Mrs Houlston, whom Erasmus Darwin’s son, Robert Darwin, a medical practitioner in Shrewsbury, had attended the day before. Withering thought that Darwin’s prescription had been inappropriate and changed it. Robert reacted angrily, and a vituperative correspondence followed. Erasmus, Robert’s father, also medically qualified, may have been involved in the affair, by urging his son to attack Withering and by helping him to write his letters. Erasmus may have had good reason for wanting to damage Withering’s reputation. Although all three of them were alumni of the Edinburgh Medical School in the latter half of the 18th century, albeit at different times, and although Erasmus had recommended Withering to both a post in Birmingham and membership of the Lunar Society, he may have become jealous of Withering’s success as a physician and botanist. The enmity between them had culminated in a dispute over the treatment of a patient in Staffordshire, whom Withering was asked to see after Erasmus had attended her, with little therapeutic success. Withering recommended digitalis, which seemed to have saved her life. Darwin reported the case in 1780, anonymously including it in a posthumous publication credited to another medical son, Charles, and without crediting Withering. In turn, Withering responded by criticising Darwin in his 1785 monograph An Account of the Foxglove. The rift between the two seems to have been irreparable.

Any NHS staff member suspected of improperly and unlawfully accessing patients’ medical records will be immediately suspended, NHS England has announced.Staff under suspicion will also have their access to NHS computer systems cut off, under a “zero tolerance crackdown on snooping staff,” NHS England said.Jim Mackey, NHS England chief executive, has written to every NHS trust demanding they immediately implement the new approach.Staff suspected of accessing patient records without proper justification will be suspended pending investigation and have their access to NHS systems paused.It comes after several cases of staff being caught accessing patient records when they should not have.In May, Nottingham University Hospitals NHS Trust fired 11 staff members and issued warnings to 14 others for inappropriately accessing the medical records of three people killed by Valdo Calocane.1NHS systems keep records on who has accessed patient information, and suspicious activity can be identified through routine monitoring and audits.When inappropriate...

The Galleri multicancer detection blood test has been recommended by the US drug regulator’s expert advisory panel, despite concerns over its effectiveness.The decision by the US Food and Drug Administration (FDA) came a day after results from the NHS-Galleri trial, published in the New England Journal of Medicine, showed that the test had failed to meet its primary endpoint: lowering the incidence of stage 3 or 4 cancers across 12 cancers after three screening rounds.1The FDA panel was split on whether it thought the blood test, which retails for $949, was effective, with six members voting in favour of it being effective and four voting against.2Stanley Lipkowitz, senior investigator at the National Institutes of Health (NIH), who voted no when asked about effectiveness, said that when it came to patient outcomes “we don’t have that data.” He also warned that approving the test without data to prove effectiveness would set...

BiographyCatherine Wang, 23, medical student at Oxford University became The BMJ editorial scholar in August 2026. At medical school, she is the captain of the medics football team, editor in chief of the Oxford Medical School Gazette, and producer for podcast The OxStu Supplement. She is excited, and slightly apprehensive, to be moving from behind the scenes of podcast production to the hosting seat for the podcast Sharp Scratch. This year, she looks forward to giving a platform to a diverse range of perspectives in BMJ Student that she hopes will give everybody something to relate to.What was your earliest ambition?Winning sports day.How is your work-life balance?Pretty good. I’ve started planning more activities into my day, so I’m forced to work in short bursts between. It has done wonders for my motivation.To whom would you most like to apologise?To my brothers, for treating them like my personal search engine.What do...

Every day, clinicians working with young children meet parents worried about paying the rent, buying food, covering childcare costs, and keeping the lights on. Financial hardship affects the health and wellbeing of children and their families.12 Yet many health professionals feel uncertainty about how they should respond, whether talking about money is beyond the remit of healthcare, and what difference they can realistically make.Following Scotland’s pioneering lead in 2010, countries including Australia, Sweden, and England have developed initiatives known as Healthier Wealthier Families. The programmes use healthcare contacts to identify families experiencing financial hardship and connect them with community based financial wellbeing services. Financial wellbeing services are known variously as money advice, financial counselling, budget and debt counselling, or welfare and benefits support.345 By focusing on hardship, they differ from financial advice or planning services, which build wealth.Families consistently report that conversations about money are acceptable in healthcare settings and...

Scotland saw a spike in deaths related to drug use last year—with a fifth of deaths linked to a group of highly potent synthetic opioids called nitazenes.Drug use deaths in Scotland rose by 11% (116 deaths) to 1133 in 2025, figures from National Records of Scotland (NRS) show.1 This means that Scotland continues to have the highest rate of deaths from drug use in Europe.However, the substances responsible for the deaths are changing.In 2025 more than a fifth of deaths (247, 22%) were linked to nitazenes, a class of synthetic opioids that can be hundreds of times more potent than heroin. This was more than triple the number of deaths linked to these drugs in 2024.The NRS noted that etonitazene—the most common of the nitazenes, linked to 215 deaths in 2025—was incorporated into routine testing in postmortem examinations only in May 2025, which may explain the increase.However, the government and...

The proportion of young children in Gaza affected by wasting—a form of severe malnutrition—fell sharply in the months after a ceasefire was announced, a study has indicated.But the nutritional gain documented since more food trucks have been allowed into Gaza “remains fragile,” warned the UN Relief and Works Agency for Palestinian Refugees (UNRWA), which carried out the research.Medical relief organisations on the ground in Gaza said that they were still seeing widespread malnutrition and that much of the food getting in was of poor nutritional value.The study estimated that nearly 16% of children aged 6 months to 5 years in Gaza—more than 54 600 children—were affected by wasting in August 2025.This fell to around 8% in October 2025 when a ceasefire was declared and the number of food aid trucks entering the territory increased.The proportion affected by wasting fell further to about 3% in February 2026 and stayed at this...

In systematic reviews of randomised controlled trials, the established steps are to identify all eligible trials, to appraise them using risk of bias tools, and to synthesise the results to reach a conclusion about the effectiveness and harms of an intervention. This paradigm is threatened by the presence of problematic studies in the literature. As defined by Cochrane, these are studies “where there are serious questions about the trustworthiness of the data or findings.”1 A study could be problematic due to research misconduct (including plagiarism, falsification, and fabrication of data or methods) or due to critical errors in study conduct that would not be flagged by risk of bias tools. If these studies are not identified as untrustworthy, they may inadvertently be included in evidence synthesis, potentially leading to treatment recommendations that are misleading or even actively harmful.234 Because many of these studies are not easily identifiable, it is difficult...

Electric scooters and head injuryA three year retrospective study of emergency departments in Helsinki identified 184 traumatic brain injuries associated with riding electric scooters (J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2026-338835). Most occurred at night or at weekends. Eighty-two per cent of patients were intoxicated and only 9% were known to have worn a helmet. Sixteen per cent had intracranial abnormalities on imaging and four required surgery.TicklishnessAmong 448 young adults from Chinese, Dutch, and Greek cultural groups, body maps of the most ticklish areas were remarkably similar (Nat Hum Behav doi:10.1038/s41562-026-02535-z). The neck, axillae, abdomen, and soles of the feet were the most sensitive areas. Charles Darwin’s suggestion that parts of the body that are touched least often are the most ticklish looks right, but why ticklishness evolved is still a mystery.The Edinburgh Postnatal Depression ScaleThe 10 item Edinburgh Postnatal Depression Scale has remained unchanged for 40 years and has been translated...

A girl presented with a two day history of bilateral eye irritation and frequent blinking. She had a history of autism spectrum disorder and growth restriction.On examination, her conjunctivae appeared dry (fig 1, top) and there were whitish, foamy lesions in keeping with Bitot’s spots (fig 1, bottom). Visual acuity was normal in both eyes. Retinal appearances were normal on funduscopy.bmj;394/sep24_6/e100205/F1F1f1Fig 1On further questioning, the mother reported that the patient followed a restrictive diet consisting mainly of rice, bread, potato chips, and crisps. Results of serological testing confirmed vitamin A deficiency (<0.35 µmol/L; reference range 1.05 to 3.84 µmol/L).Xerophthalmia is the spectrum of eye disease caused by vitamin A deficiency and can lead to blindness. It typically presents with difficulty seeing in dim lighting conditions. Other typical signs include conjunctival dryness and Bitot’s spots.1Children with autism spectrum disorder are at higher risk of nutrient deficiencies because they may have restrictive...

Over the past 14 years, I’ve been asked to review four major errors in high stakes medical exams: three for UK medical royal colleges and one for the UK Foundation Programme Office.1234 In each of these cases, candidates were given the wrong exam result, with some applicants even receiving an incorrect pass or fail. All the organisations involved responded to me with full cooperation and disclosure and expressed genuine regret and contrition. Nevertheless, some people were severely affected by the errors, and I’ve heard many distressing stories about the personal and professional consequences it has had.These exam errors all shared a few common features, and understanding these can help avoid the same mistakes being repeated. Although almost all the errors were the result of human error; they all happened under conditions where mistakes are more likely.The first vulnerability is information moving between systems, from one software platform to another. Each...

A balanced study of septic shock in childrenProtocols for using sodium chloride 0.9% solution, often called “normal saline,” have changed over the past two decades. In part because of its not so normal levels of chloride that are associated with acute kidney injury. A pragmatic trial across five countries assessed balanced crystalloids (Ringer’s solution, Plasma-Lyte, or Hartmann’s solution) versus 0.9% saline in children treated for septic shock. Despite finding higher rates of hyperchloraemia in the 0.9% saline group, there was no difference between groups in the primary outcome of major adverse kidney events after 30 days.N Engl J Med 2026 doi:10.1056/NEJMoa2601969Extraordinary claims for new stroke treatmentIn theory, neuroprotective and neuroreparative drugs such as loberamisal could improve outcomes from acute ischaemic stroke. Trials of potential neuroprotective drugs, however, have repeatedly failed to find any benefit. “Hundreds of promising agents were tested. The result: failure over and over again” writes an editorial...

An online memorial wall for health and care workers who have died by suicide has been launched by NHS Practitioner Health.Since 2011 more than 2500 healthcare workers in the UK have died by suicide, an average of four a week.1According to some estimates one doctor dies by suicide every three weeks in the UK.2The online memorial wall aims to serve as a permanent space for colleagues, friends, and families to share photographs and memories of health and care workers who have taken their own lives. 3NHS Practitioner Health is a specialist mental health and addiction service for doctors. In addition to the memorial wall it has launched a new webpage dedicated to providing messages of hope.Helen Garr, medical director at NHS Practitioner Health, said she believed the online memorial wall—launched on the third annual National Suicide Memorial Day for Health and Care Workers—is the first of its kind.“Through our work...

The cost implications of the US-UK drug pricing deal must be rapidly investigated by the UK’s public spending watchdog, the heads of six different parliamentary committees have urged.The UK signed a drug trade deal with the US in December 2025 to reduce the effect of tariffs put in place by US president Donald Trump.1As part of the deal, ministers agreed to raise the cost effectiveness thresholds used by the National Institute for Health and Care Excellence (NICE). These thresholds will rise from £20 000 to £30 000 per quality adjusted life year (QALY) to £25 000 to £35 000 per QALY.But the deal has proved controversial, with an analysis published in The BMJ calculating that changes implemented as part of the deal could lead to 229 000 excess deaths over the next decade, as around £45bn in NHS funding would be diverted from existing services by 2036 to cover the...

Corfield and colleagues point out that undetected fetal growth restriction is both an ultrasonography problem and a maternity safety problem.1 The issue is not only the growth chart but also whether maternity services recognise possible placental failure early enough, respond, and learn from near misses.Fetal growth trajectory needs more attention. Size at a single scan can be misleading. Larsen et al studied 5319 pregnancies, finding that a fall of at least 50 centiles in the second half of pregnancy was associated with four times the adjusted odds of perinatal mortality.2 This was seen even when the final estimated fetal weight or abdominal circumference remained at or above the 10th centile. When reduced growth and smallness were both present, the adjusted odds rose to 7.71. A fetus can therefore look “not small” but still be at risk. Electronic alerts for slowing growth should be part of routine care.Risk is not limited...

AbstractObjectiveTo compare the risk of renal deterioration under treatment with glucagon-like peptide-1 (GLP-1) receptor agonists or sodium-glucose contransporter-2 (SGLT-2) inhibitors versus other second line treatments in people with type 2 diabetes with and without albuminuria (albumin to creatinine ratio ?30 mg/g).DesignTarget trial emulation.SettingsLinkage of electronic health records and claims data from 10 health systems and two national health insurance plans—data from BESTMED (observational evaluation of second line therapy medications in diabetes) study.ParticipantsPeople with type 2 diabetes and moderate cardiovascular risk and estimated glomerular filtration rate ?45 mL/min/1.73 m2 on metformin monotherapy who started treatment with a GLP-1 receptor agonist or SGLT-2 inhibitor, a sulfonylurea, or a dipeptidyl peptidase-4 (DPP-4) inhibitor after metformin between 2014 and 2022.Main outcome measureDeterioration of kidney function defined as doubling of serum creatinine or estimated glomerular filtration rate <15 mL/min/1.73 m2.ResultsAmong 75 455 eligible people (61 583 (81.76%) without albuminuria), median age was 60 years (interquartile range 51-68), 36 231 (48%) were women, median haemoglobin A1c was 7.8% (interquartile range 7.3-8.5%), and median estimated glomerular filtration rate was 92 mL/min/1.73 m2 (interquartile range 77-102). People were followed for a median of 32 months (interquartile range 18-57). The estimated five year risk of the renal outcome was 2.4% (95% confidence interval 2.1% to 2.7%) for people taking GLP-1 receptor agonists or SGLT-2 inhibitors versus 2.1% (1.8% to 2.6%) for people taking DPP-4 inhibitors among those without albuminuria; and 3.2% (2.3% to 4.1%) versus 5.4% (4.2% to 6.7%), respectively, among people with albuminuria. The estimated five year risk ratio comparing the GLP-1 receptor agonist or SGLT-2 inhibitor group with the DPP-4 inhibitor group was 1.10 (95% confidence interval 0.90 to 1.38) among people without albuminuria and 0.60 (0.42 to 0.82) among people with albuminuria.ConclusionsCompared with DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors reduce the risk of deterioration of renal function in people with albuminuria. Little evidence of renal benefit among people without albuminuria was observed over the study follow-up period.

More than half of integrated care systems (ICSs) in England don’t have enough capacity to accurately diagnose childhood asthma in line with current guidelines, a survey has found.National clinical guidelines emphasise that doctors should not make a diagnosis of asthma in children based on symptoms alone.The 2024 joint guidelines, published by the National Institute for Health and Care Excellence (NICE), the British Thoracic Society, and the Scottish Intercollegiate Guidelines Network, recommended that the measurement of fractional exhaled nitric oxide (FeNO) levels should be the first line diagnostic test in children with a history of asthma.12Asthma should be diagnosed if the FeNO level is 35 parts per billion or more, the guidelines state.However, the charity Asthma + Lung UK has found that the availability of FeNO testing is “patchy,” with many areas either not commissioning enough to cover the whole area or not enough to meet demand.The charity surveyed all of...

A saliva based diagnostic test, called Endotest, can be used in primary care when endometriosis is suspected, the UK National Institute of Health and Care Excellence (NICE) has recommended in updated draft guidance.1An original version of the draft guidance, published in July, recommended two non-invasive tests to speed up the diagnosis of endometriosis, Endotest and Endosure.2However, after consideration of consultation responses alongside the original evidence base, the committee has now concluded that the evidence for Endosure remains too limited to be recommended.Endosure attempts to detect endometriosis by using sensor pads on the abdomen to measure electrical signals in the gut.More research is also needed before two blood tests, DotEndo and Endomkit, can be considered for NHS funding, NICE added.Endotest is a test that detects a biomarker signature of endometriosis in saliva. The saliva sample must be sent to a lab for analysis. NICE recommends its use in primary care when...

A scalable programme of additional psychological support for NHS workers will be rolled out in the event of a future pandemic, the government says. Officials made the commitment in its response to module 3 of the UK Covid-19 inquiry.1In the third phase of the national inquiry, published in March, its chair Heather Hallett said that the NHS “teetered on the brink of collapse” but was saved by the “superhuman” efforts of doctors and other healthcare staff.2 But this enormous effort came at great personal cost to healthcare workers and their families as they were obliged to work under “intolerable pressure for months on end,” Hallett said.Her report found that the mental health of healthcare staff “was severely impacted, with many exhibiting signs of post-traumatic stress disorder, while burnout was common.”One of Hallett’s recommendations was that the government should put in place plans to deliver effective support for healthcare workers at...

The group UK Lawyers for Israel (UKLFI) has urged the government to investigate and potentially proscribe the medical charity Doctors Without Borders (Médecins Sans Frontières, or MSF) under terrorism laws, according to media reports.UKLFI, a group of lawyers who campaign for Israel, reportedly wrote to the Home Office, Charity Commission, and the Fundraising Regulator alleging that MSF had previously employed people with ties to Palestinian terrorist organisations.It further alleged that the charity did not have adequate safeguards in place to ensure charitable resources were not “exploited by terrorist organisations.”A UKLFI spokesperson told the Telegraph, “We are not questioning legitimate humanitarian medical work. But humanitarian status cannot place an organisation beyond proper scrutiny.“We have therefore asked the Charity Commission and Fundraising Regulator to investigate MSF UK and have submitted our evidence to the home secretary for consideration under the Terrorism Act.”1MSF has strongly denied the allegations and claimed it is the...