There are at least 996 shisha cafes in the UK, an increase of 33% in the past five years, and London has more shisha cafes than branches of McDonald’s.1 Yet the smoking of shisha tobacco (see box 1) continues to be overlooked as a public health matter, contributing to the widening of existing inequalities.Box 1What is shisha?Shisha, also known as hookah, narghile, and hubble bubble, is a waterpipe that is used to smoke a charcoal heated tobacco mix. Smoke passes through water before being inhaled through a hose-like pipe. The origin of shisha dates back centuries and it is especially common across the Middle East and South Asia.Shisha tobacco is generally flavoured and has become increasingly popular in the UK,2 especially among young people and those from Middle Eastern, North African, and South Asian backgrounds. It is primarily smoked socially and, though it can be smoked in homes, it is...

Just a few weeks apart, parliaments in Scotland and Jersey voted on assisted dying legislation with very different outcomes. The Assisted Dying for Terminally Ill Adults Bill was rejected in Scotland, while a draft law on assisted dying was approved in Jersey.12 The Terminally Ill Adults (End of Life) Bill for England and Wales is likely to fall in the House of Lords despite being approved by the House of Commons, and the prospect of it returning in the future is uncertain.34 It is important to consider the factors contributing to varying outcomes and reflect on what can be learnt from Jersey and Scotland.The legislative proposals in Scotland and Jersey have key differences.12 The Scottish bill bears greater similarity to the one going through the Westminster parliament. Two doctors must assess eligibility, approve the assisted dying decision, and then one doctor prescribes the medication that the patient self-administers. The Jersey...

A Colorado state ban on conversion therapy for minors likely violates constitutional protections of free speech, the US Supreme Court has ruled.The decision—widely criticised by LGBTQ+ advocacy groups—will send the case to the lower courts to determine whether therapists can resume offering gender conversion therapy to minors.This could have implications for similar laws in states across the US.The case was brought by Kaley Chiles, a counsellor from Colorado Springs, who argued that the state’s 2019 ban on licensed doctors or mental health professionals “converting” lesbian, gay, or transgender people unlawfully restricted her ability to provide talk therapy to clients who sought to change their sexual orientation or gender identity.The court voted 8-1 to side with Chiles, with liberal justices Elena Kagan and Sonia Sotomayor joining the conservative majority.Justice Neil Gorsuch said in his written decision, “While the First Amendment protects many and varied forms of expression, the spoken word is...

If you ask any doctor how their day is going, they’ll almost certainly reply “busy.” It’s an almost universal state of being in medicine, and we declare it like a kind of tic. But what if being perpetually busy isn’t just a symptom of being under pressure but one of its principal causes? Bob Klaber—a paediatrician at Imperial College Healthcare NHS Trust and its director of strategy, research, and innovation—argues that our collective busy-ness is a barrier to all the changes we say we want. When every minute is ridiculously full there’s no space for reflection, human connection, or the careful conversations from which better care emerges—and no time for teaching the next generation.Klaber invites us to adopt a different attitude to our work, one that de-emphasises frantic activity and multitasking and gives priority to being available for people and listening. As a clinician, he seems to practise what he...

Social media use makes it hard to separate a genuine rise from diagnostic inflation, but blaming it is an oversimplification—Annabeth P Groenman, Tessa Copp, Kirsten McCaffery, and Jesse JansenThe Lancet Psychiatry commission on youth mental health has called for action on a global “youth mental health crisis.”1 Rates of diagnosed mental health conditions have been rising in young people. For example, 11.4% of children in the US currently have a classification of attention deficit/hyperactivity disorder (ADHD). In specific groups this figure is even higher: around 22% of 17 year old boys in the US have received an ADHD classification at some point in their life.2This raises the question of whether young people’s mental health is actually worse than in the past, or whether we’re simply recognising and labelling what was always there.Many academics point to social media as a key driver for the rise in mental health conditions among young...

Yamey and Shaffer discuss how Trump and Robert F Kennedy Jr have promoted misinformation.1 Vaccine scepticism in the US is long standing, but recent revisions to the childhood immunisation schedule and other vaccine policy shifts risk intensifying public confusion and reinforcing discredited safety claims.2345Misinformation provided by the government heightens physicians’ responsibility to counter vaccine myths and misunderstandings. Fact based counselling remains vital. But innovative communication strategies are also needed to rebuild trust in routine childhood immunisations to prevent avoidable illness and restore population level immunity.Physicians can reclaim the narrative by pairing rigorous epidemiological data with human stories, translating statistics into tangible outcomes. A de-identified clinical vignette, for example, might describe a young adult with swollen lymph nodes, fatigue, and jaundice whose advanced cirrhosis from chronic hepatitis B necessitates a liver transplant. Timely vaccination could have prevented this condition.Physicians can use visual aids, displaying lifetime risks of vaccine preventable illnesses with...

A Kent hospital has admitted to being too slow to alert the UK Health Security Agency (UKHSA) to a suspected case of meningitis.There is a legal requirement for suspected cases of acute meningitis to be reported to the UKHSA immediately without waiting for laboratory confirmation of the disease.1 However, it has now emerged that this did not happen for the first known case of the Kent outbreak, which eventually included dozens of cases and the deaths of two young people.2The hospital’s delay in reporting meant that the UKHSA did not start investigating a potential outbreak as soon as it could have. It also led to delays in contacting and treating any close contacts of the patient.The Kent outbreak of meningitis B now seems to have passed its peak, with no new cases reported for the past five days. As of 24 March the confirmed number of cases of invasive meningococcal...

The scandal over student loan debt and interest has rightly dominated headlines in the past few weeks.12 The plan from chancellor Rachel Reeves to freeze loan repayment thresholds represents yet another burden placed on a financially beleaguered generation. For doctors, this new hit to our income feels like two steps back in the ongoing struggle for pay restoration. Something needs to change to relieve the financial strain on doctors.Last month I made the brave decision to check my student loan balance. I should have prepared myself more for the shock. Over my six year degree in medicine, I borrowed £44 000 but by my graduation I had accrued an additional £11 000 of interest before I had even started earning. My current balance sits at £63 500 and I’m only now close to paying off as much per month as I’m being charged in interest. I suspect most younger doctors...

The UK government must set out clear national standards to tackle “serious inadequacies” and staff shortages in children’s palliative care services, a group of MPs has urged.The House of Commons Health and Social Care Committee’s report on palliative care in England1 says that people enter a “postcode lottery” of care in their most vulnerable moments at the end of life. This variability is compounded by a workforce declining in numbers, the MPs warned.The report calls for a plan to increase the numbers of specialist doctors, nurses, and other healthcare professionals working across the palliative care sector. It emphasises that action is most urgently needed in children and young people’s palliative care, and it urges the government to include specific standards in its upcoming modern service framework later this year.The charity Together for Short Lives has estimated that 99 000 UK children were seriously ill in 2025.2 The committee’s report says...

Campaigners have criticised a midwifery journal for sending out an “inappropriate” prize survey targeting health professionals that was sponsored by a formula milk company.The survey of midwives and health visitors was shared by the British Journal of Midwifery in February. It is sponsored by SMA infant formula, owned by food and beverage giant Nestlé.Healthcare professionals who completed the survey and provided their personal details were entered into a prize draw for £100 of Amazon gift vouchers.Although the British Journal of Midwifery states at the beginning of the survey they “firmly believe that breastfeeding is always the best option for a baby,” all the questions relate to formula feeding and infant gut health.Victoria Thomas, a consultant paediatrician and co-chair of the Hospital Infant Feeding Network, said the survey reads as “a thinly veiled marketing exercise.”“I do not think it is appropriate for a scientific journal to send out a survey such...

After the creation of Bangladesh in 1971, the entire political, economic, and medical system was in disarray: the UK General Medical Council withdrew its recognition of medical graduates and the country faced a severe shortage of doctors. Ali Ashraf played a pivotal role in restoring standards of medical education, particularly in the surgical specialties. He was one of the prime movers in the establishment of the Bangladesh College of Physicians and Surgeons (BCPS) in 1972, a postgraduate medical institute modelled on the royal colleges in the UK. He held key positions in the BCPS and served as its vice president and president for 10 years.Ashraf and the founding president of Bangladesh, Sheikh Mujibur Rahman, had known each other as students in Calcutta and when Ashraf treated the president’s wife in the early days of the new country he seized the opportunity to highlight the severe shortage of trained doctors.In June...

AbstractObjectiveTo evaluate the efficacy of a clinical decision support system (CDSS) on stroke care quality and clinical outcomes among patients with acute ischaemic stroke.DesignMulticentre, cluster randomised clinical trial.Setting77 hospitals across China.Participants77 hospitals (38 randomised to intervention group, 39 to control group) enrolled 21?603 patients with acute ischaemic stroke admitted to hospital within seven days after symptom onset.InterventionsHospitals in the intervention group received stroke CDSS support including artificial intelligence assisted imaging analysis, classification of stroke causes, and evidence based treatment recommendations. Hospitals in the control group provided usual care.Main outcomes measuresThe primary outcome was a new vascular event (composite of ischaemic stroke, haemorrhagic stroke, myocardial infarction, and vascular death) within three months after initial symptom onset. Secondary outcomes included the composite measure and all-or-none measure of evidence based performance measures for acute ischaemic stroke care quality, a new vascular event at six and 12 months, and disability (modified Rankin Scale score 3-6) and all cause mortality at three, six, and 12 months. Safety outcomes were moderate or severe bleeding events and all bleeding events at three, six, and 12 months.Results11?054 patients in the intervention group and 10?549 patients in the control group were enrolled from January 2021 to June 2023. New vascular events at three months occurred in 2.9% (320/11?054) in the intervention group compared with 3.9% (416/10?549) in the control group (adjusted hazard ratio 0.74, 95% confidence interval (CI) 0.58 to 0.93, P=0.01). The CDSS intervention effect remained significant in the cluster level analysis (?0.01, ?0.02 to ?0.004, P=0.003). Patients in the intervention group were more likely to have a higher composite measure (91.4% (77?049/84?276) v 89.8% (70?794/78?834), adjusted odds ratio 1.21, 95% CI 1.17 to 1.26, P<0.001). New vascular events were significantly lower in the intervention group at 12 months (4.0% (440/11?054) v 5.5% (576/10?549), adjusted hazard ratio 0.73, 95% CI 0.56 to 0.95, P=0.02). No significant differences were found in disability and all cause mortality. Moderate or severe bleeding, and all bleeding did not differ significantly between the two groups.ConclusionsUse of the stroke CDSS in patients with acute ischaemic stroke in China led to a significant decrease in new vascular events at three months. The stroke CDSS intervention was also effective in improving stroke care quality and decreasing long term vascular events.Trial registrationClinicalTrials.gov NCT04524624

William Blake, George Russell, and Aldous HuxleyAldous Huxley (1894?1963) is best known as a novelist, particularly for his futuristic science fiction novel Brave New World (1932), although most of his other well known novels were social satires.However, Huxley was also a poet and essayist, his best known essays being two that are often published together: The Doors of Perception (1954) and Heaven and Hell (1956). In the former, Huxley described his disappointing experience with mescaline:“I swallowed four-tenths of a gram of mescalin dissolved in half a glass of water and sat down to wait for the results. … From what I had read of the mescalin experience I was convinced in advance that the drug would admit me, at least for a few hours, into the kind of inner world described by Blake and AE. But what I had expected did not happen. I had expected to lie with my...

NHS watchdogs will re-evaluate their decision not to fund two new Alzheimer’s treatments on the health service after appeals from the drugs’ manufacturers.The National Institute for Health and Care Excellence (NICE) has also confirmed that the reassessment will take place under new, and controversial, cost effectiveness thresholds that were agreed as part of a trade deal with the US.1NICE previously concluded in June234 that lecanemab and donanemab should not be provided on the NHS for treating mild cognitive impairment or mild dementia caused by Alzheimer’s disease.Despite substantial interest in the drugs from patient representative groups NICE determined that neither was a cost effective use of NHS resources.The treatments were estimated to cost five to six times more than the threshold NICE can normally recommend, with high rollout costs including both regular infusions and monitoring of side effects such as swelling and brain bleeds.But NICE has now said it will review...

What has led to such a large spike in cases when compared with previous outbreaks?“This is the most fascinating question that has arisen from this outbreak,” says Emma Wall, clinical professor of infectious diseases at Queen Mary University of London. She tells The BMJ, “Meningitis A outbreaks in the Sahel [semi-arid region extending from Senegal in West Africa to Sudan and Eritrea in East Africa] can comprise thousands of cases, but MenB has never caused an outbreak of this size before.”While the UK has previously seen meningitis outbreaks caused by the bacterial strain B of meningitis (MenB), case numbers have been small—as with the two cases seen in nursery in 20231—or have occurred over many years, as happened in Gloucestershire in the 1980s.2“It’s speculation, but whether this strain has acquired the ability to spread more rapidly is something under investigation,” Wall explains. “Otherwise, I suspect this is due more to...

At the time of writing, the outbreak of invasive meningococcal disease in Kent includes 18 confirmed cases, 13 of which have been identified as type B (MenB), plus 11 suspected cases.1 Sadly, this has included two fatal infections. This outbreak is notable for its large number of cases in a short period, described as “unprecedented” by the UK Health Security Agency (UKHSA),2 and for the response, with extensive media coverage and widespread public anxiety about the perceived risk nationwide.The acquisition of Neisseria meningitidis requires close contact, with transmission occurring through saliva or respiratory droplets from a person carrying the organism.3 Most transmission events result in carriage, and around 10% of the population carry N meningitidis at any time.4 In the pre-vaccination era this rate was as high as 33% in adolescents with additional risk factors, which included attendance at pubs or clubs and cigarette smoking—echoing the discussion about the current...

Rules regarding ways doctors must keep their personal beliefs in check when treating patients are being updated by the General Medical Council.The regulator has launched a consultation1 on proposed changes to its personal beliefs and medical practice guidance,2 which was last fully updated in 2013.The GMC said it was updating the guidance to reflect legal, social, and cultural changes. Examples include the government’s recently published guidance on defining “anti-Muslim hostility”3 and debates over assisted dying legislation.The regulator said it wanted to allow doctors to practise in line with their beliefs and values, while respecting patients’ own beliefs and “maintaining good and safe care.”It follows cases such as that of Kent GP Richard Scott, who was given a formal warning by a medical practitioners tribunal in 2023 after telling a vulnerable young patient seeking mental health treatment that he needed to reconnect with God.4The GMC clarified that the guidance does not...

bmj;392/mar20_2/s520/FAF1faRalph Ross Russell—or R3, as he was affectionately known—became a neurologist at a time when strokes were not deemed worthy of academic attention. He was one of the first to make study of the condition into a research and clinical specialty, paving the way for better understanding and care, and playing a pivotal role in turning the treatment of stroke into the medical success story that it often is today.From the outset of his career Ross Russell was at the forefront of academic research in neurology. His first senior position was as a research scholar and lecturer in medicine in Oxford under George Pickering, regius professor of medicine, at the time of much debate on the nature of hypertension and when vasospasm as the cause of transient ischaemic attacks (TIAs) was being challenged. Ross Russell’s research focused on the mechanism of hypertension and its role in cerebrovascular disease, research he...

bmj;392/mar20_1/s505/FAF1faLeo was born in Leipzig, Germany, in 1930 into a poor Orthodox Jewish family who had fled the pogroms in Poland after the first world war. His father became a communist and was in and out of prison from 1932. Leo escaped Nazi Germany and arrived in the UK in September 1939 as part of Kindertransport, aged 8. Leo and his four sisters and brother were the only members of their family to survive the Holocaust. Leo was educated at Battersea Grammar School and won a scholarship to study medicine at Guy’s Hospital.After house jobs he did national service, eventually reaching the rank of captain. On returning to London he became a paediatric resident at New Cross and St Olave’s hospitals before becoming a junior registrar at Great Ormond Street. In 1961 he obtained a research fellowship at Denver University Medical School. He returned to the UK in 1964 to...

A plastic surgeon who is serving a life sentence for attempting to murder a colleague and burn down his home has been struck off the UK medical register.Jonathan Peter Brooks was convicted of attempted murder and arson with intent to endanger life last April.Leicester Crown Court, sitting at Loughborough, heard that Brooks hated Graeme Perks, who had recently retired as head of plastic surgery at Nottingham University Hospitals NHS Trust and was a witness against Brooks in disciplinary proceedings.Brooks went to Perks’ house in the early hours of the morning of 14 January 2021, a few days into the disciplinary hearing.Brooks, dressed in camouflage and equipped with petrol cans, a knife, and a crowbar, broke in through the conservatory and doused the foot of the staircase in petrol.Perks was woken by the sound of smashing glass and came downstairs and interrupted Brooks before he could start the fire, but was...