An invasive species of mosquito that can transmit viral diseases such as dengue, Zika, and chikungunya has been discovered breeding in the UK for the first time.The UK Health Security Agency (UKHSA) has increased surveillance and trapping activities after invasive Aedes aegypti mosquitoes and larvae were detected at residential properties in east London.The agency said that the risk to the public remained low, as—despite recent heatwaves—the UK climate is too cold for the species to survive long term.It is the fourth time Aedes aegypti has been detected in the UK in recent years, but this is the first time that it has been identified breeding, health officials said.The species is typically found in tropical and subtropical regions and can transmit diseases including dengue, chikungunya, yellow fever, and Zika. It is not a vector for malaria.It has previously been known to “hitchhike” from its native range in vehicles, baggage, and imported...

A doctor in Guernsey revealed sensitive confidential medical information about one patient by taking a phone call while examining another patient, it has emerged.The breach of confidentiality was outlined in the latest report from Guernsey’s Office of the Data Protection Authority.1This case came to light after the healthcare provider that employed the doctor reported the breach to the data protection regulator.The doctor remained in the examination room throughout the conversation, where the identifying details of the patient on the phone and sensitive details of their health were heard by the patient being examined and by others in the room.“The information was heard by people who had no legitimate reason to receive it and who were unconnected to the care of the patient on the phone,” the Data Protection Authority’s report reads.“The breach involved the unauthorised disclosure of special category data and created a risk of distress and loss of privacy...

Global health is entering an era of financial retrenchment and fragmented leadership. Development assistance for health fell sharply in 2025, driven largely by cuts in US funding, and is at its lowest level since 2008.1 This has encouraged speculation that China might fill the financial gap. That illusion should be rejected. Such substitution would be financially implausible, politically inconsistent with China’s approach to development cooperation, and undesirable for regions seeking more national sovereignty, such as that envisioned in the Africa-led Accra reset to reform the global health architecture.2China nevertheless has compelling reasons to engage more deeply in global health and governance. The 2003 SARS outbreak exposed weaknesses in domestic surveillance, reporting, and emergency response, while disrupting trade, travel, and economic growth; covid-19 reinforced the lesson on an unprecedented scale.3 China’s engagement reflects overlapping motivations: national risk management, international commitments and responsibilities, south-south solidarity, and economic and technological interests.34 More importantly...

The potential benefits of sharing clinical trial data are broadly recognised by researchers, policy makers, and the public. Notably, US clinical trial participants express high levels of support for secondary use of their individual participant data (IPD), especially by academic scientists.1 The US National Institutes of Health and other research sponsors have adopted policies to expand IPD sharing among investigators they fund.23 However, as a result of uneven data sharing practices, the vision of a scientific commons in which data are accessible to all qualified researchers to accelerate discovery remains elusive.4A linked special paper by Taherifard and colleagues (doi:10.1136/bmj-2026-100460) illuminates a strategy that could overcome some barriers to data sharing: repositories.5 So that data requestors need not beg other investigators to spend time and resources preparing datasets and metadata, repositories provide a mechanism for deposition of clinical trial artefacts in a centralised structure staffed by people who evaluate requests, secure...

AbstractObjectiveTo assess the number, timing, characteristics, and scholarly impact of secondary publications generated using individual participant level data (IPD) from a portfolio of clinical trials shared with external investigators through a data sharing platform.DesignCross sectional study.SettingYale University Open Data Access (YODA) Project platform.ParticipantsJohnson 91%), most obtained access through data sharing platforms (n=161; 85%), primarily the YODA Project (n=157; 83%). Over time, the proportion of external publications increased steadily, exceeding 50% of all secondary publications by year 11 and thereafter. Compared with internal publications, external publications were more frequently pooled analyses (151/209 (72%) v 534/958 (55.7%); P<0.001) and involved predictive or prognostic modelling (108/209 (51.7%) v 322/958 (33.6%); P<0.001), development of statistical models or algorithms (60/209 (29%) v 114/958 (11.9%); P<0.001), and validation of existing methods, models, or risk scores (32/209 (15%) v 66/958 (6.9%); P<0.001). Compared with internal publications, external publications were published in journals with higher impact factors (median 6.7 (interquartile range 3.4-16.6) v 4.6 (2.9-10.2); P=0.002) and had higher annual Altmetric Attention Scores (median 2.1 (0.7-7.1) v 0.6 (0.3-2.3); P<0.001) but had lower annual citation counts (median 2.7 (1.1-5.6) v 3.4 (1.6-7.5); P<0.001) and were less likely to be cited in clinical guidelines (21/184 (11%) v 235/805 (29.2%); P<0.001) or policy documents (14/184 (8%) v 206/805 (25.6%); P<0.001).ConclusionsMost trials in this portfolio of clinical trials, for which IPD were available through a data sharing platform, generated secondary research by both original trial investigators and external investigators. External investigators most often accessed data through the data sharing platform, and their publications accounted for an increasingly larger proportion of secondary publications over time. These findings suggest that structured data sharing mechanisms may support additional secondary use of clinical trial data and further enhance the scientific value of clinical trials.

The General Medical Council (GMC), like many institutions today, faces a clash of values. Doctors’ freedom of speech must be protected from punitive or bad faith referrals1: if doctors fear that ethical, humanitarian, or political speech about Israel, Palestine, or Gaza will trigger regulatory scrutiny, professional witness will be constrained at the very moment moral clarity is most needed.Yet a second trust problem must be held alongside the first. If the debate is framed only as “antisemitism is being used to silence doctors,” we should not be surprised when Jewish staff and patients hear something else: that their recognition of antisemitism is itself suspect or politically motivated. That too damages trust.The task for medical institutions is not to choose between protecting speech and recognising antisemitism, but to build processes that differentiate between legitimate criticism of Israeli policy, humanitarian advocacy for Palestinians, offensive but lawful speech, professional misconduct, discrimination, and hostility...

Neurosurgeons in London have successfully carried out a live artificial intelligence assisted operation to remove a brain tumour, described as a world first for such surgery.Rhys Hibbert, a 48 year old patient, could have lost his sight without the surgery at the National Hospital for Neurology and Neurosurgery (NHNN) in London earlier this year.During the operation the AI system analysed the live surgical video feed in real time, rather than using presurgery scans. The surgeons remained in full control, but the technology helped the team make more precise decisions by highlighting critical structures at the base of the brain.The procedure represented the first time the technology has been used on a patient this way.Because blood vessels and nerves controlling vision are so tightly packed together in the pituitary gland, and going a millimetre wrong can make a critical difference leading to death, blindness, or stroke, the surgical team used AI...

Pennsylvania has recorded the first two deaths from measles in the US state for more than three decades.These are also the first fatalities from measles recorded in the US this year. In 2025 there were three deaths from measles, which were the first measles associated fatalities in the country since 2015.The most recent fatalities occurred in Lancaster County, where 185 of Pennsylvania’s 393 cases this year have been recorded.No further details about the two individuals were released by health officials owing to privacy concerns, though the Pennsylvania Department of Health confirmed that they were unvaccinated.Jeffrey Martin, a GP at Penn Medicine Lancaster General Health, told a press briefing, “These tragic deaths remind us that measles is not a harmless illness. It’s appropriate that we’re having this press conference at our Women and Babies Hospital. Pregnant women and children are vulnerable to measles if they are not vaccinated.”The US Centers for...

Women in southwest England have voiced alarm that the temporary closure of a town’s maternity unit means riskier, longer journeys to give birth.But media reports that expectant women are now being coached on “how to give birth in the back of a car” have led to clarification and pushback.1Royal Devon University Healthcare NHS Foundation Trust, which suspended births at North Devon District Hospital in Barnstaple because of a lack of medical cover, confirmed that the birthing advice discussed in the media was not theirs.Rather, it had come from Devon Antenatal Family Centre. The centre’s founder and chief executive, Catherine Mchomvu, told The BMJ that press reports of the advice to women, which she had updated to enhance their safety and wellbeing, had produced “sensationalist” headlines.Births at North Devon District Hospital were controversially suspended earlier this month owing to shortages of consultants and obstetricians.23 But safety concerns were raised over the...

Taking the shingles vaccine Shingrix could reduce the risk of cardiovascular events including heart disease, heart failure, and stroke, a study has suggested.1Shingles, a viral infection that can lead to a painful rash, is caused when the varicella zoster virus (which causes chickenpox) reactivates, often decades after initial infection. It typically lasts two to four weeks.An estimated one in five people develop the condition in their lifetime.2Shingrix, a recombinant vaccine targeting the infection, has been available widely on the NHS since 2023 and is now offered to people aged 65-79 and immunosuppressed people aged over 18.Previously, the live attenuated Zostavax vaccine against shingles was used in many parts of the world, including the UK from 2006. But many countries, including the US and the UK, switched to Shingrix, which is more effective and—unlike the live vaccine—is suitable for people with weakened immune systems. The US switched from Zostavax to Shingrix...

In January 2021 Anthony Fauci, then director of the US National Institute of Allergy and Infectious Diseases, sent a text message stating that the second dose of covid vaccine “theoretically could be associated with miscarriage in the 1st trimester.”1This was one of a chain of messages, later in which he highlighted the risks of covid infection in pregnancy and stated that no issues had arisen in more than 10 000 pregnant women who had been vaccinated. But, hot on the heels of President Donald Trump’s latest executive order advising a reduction in childhood vaccines, antivaccination Republicans in the US have seized on the first statement, along with misinterpretation of data from an early study, to falsely assert that vaccination against covid-19 causes miscarriage.That early study, published soon after the mass rollout of the vaccine began, used data from a small number of pregnant women who had received the vaccine.2 The...

Just before noon local time on 21 October 2013,1 a car entering an intersection in Nashville, Tennessee, crashed into an SUV. Sitting in the passenger seat of that SUV was Dolly Parton.2 Thankfully, no one was seriously hurt, and the legendary country singer experienced only minor injuries.What happened next arguably changed the course of her life and, quite likely, helped to save the lives of many others. Because it was later that day, during treatment for her injuries at Vanderbilt University Medical Centre (VUMC), that Parton met the surgeon Naji Abumrad. They became friends, and when the covid-19 pandemic erupted roughly seven years later, Parton donated $1m towards the development of Moderna’s mRNA based vaccine, in honour of her medical pal.3 VUMC researchers were involved in the jab’s development.4Parton died this week at the age of 80, after a cancer diagnosis.5 She leaves a broad legacy in music and the...

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.