The BMJ’s analysis of Mounjaro’s cost to the NHS is fascinating.1 Kudos to the drug industry for finding a true and perhaps never ending El Dorado. There is no shortage of obese people with medical problems or those with body image issues in need of a quick fix.But the NHS expenditure, representing government expenditure or our tax money, is sadly also a quick fix—£574m a year could fund six Olympic velodromes in six cities in the UK (based on figures from 2011).2 It could also fund approximately 5740 high quality tennis courts in state schools across England.3 Investing in health, in sport, and in young people is more likely to produce sustained impact in the effort to tackle the obesity epidemic.The complex interplay between eligibility, affordability, and effectiveness is likely to be exploited by the drug industry. But as a nation, our preference should be for a healthy, active lifestyle...

Climate change is increasing the frequency, intensity, and duration of hazardous heat, particularly in tropical and subtropical regions, and strong El Niño conditions may push temperatures even higher.12 An estimated 2.41 billion workers are exposed to excessive heat each year, contributing to 22.85 million injuries and 18 970 deaths.3 A meta-analysis of 111 studies from 30 countries and more than 40 occupations found that 35% of workers exposed to heat experienced heat strain and 30% reported productivity losses.4 In 2024, heat caused an estimated 639 billion lost working hours and $1.09tn in lost income.1Temperature is not the only determinant of heat risk. Humidity, radiant heat, air movement, workload, clothing, exposure duration, and acclimatisation interact with access to water, sanitation, shade, and recovery time.The burden is unequal; those with the least bargaining power and weakest protection face the greatest risks. Around two billion people work informally worldwide, often beyond the reach...

International efforts to develop pandemic vaccines within the goal of 100 days must be accompanied by stronger basic infection control, the World Health Summit heard this week.Jean-Jacques Muyembe Tamfum, the leading Congolese scientist who co-discovered Ebola virus disease 50 years ago, was referring to the current outbreak of Bundibugyo Ebola virus in the Democratic Republic of the Congo (DRC).He told the meeting in Berlin that, despite advances in vaccine science, weaknesses in outbreak preparedness continue to persist.Muyembe Tamfum said these weaknesses in providing basic tools are resulting in the infection and death of health workers in the DRC outbreak, in outcomes similar to those of the first Ebola outbreak he witnessed back in the 1970s.“The infection prevention control is not working. We cannot strengthen the health system without improving infection control. There’s no protective equipment in most of our hospitals, or disinfectant, or sometimes running water. Or safe and dignified...

Danish researchers behind a controversial study of hepatitis B vaccination in Guinea-Bissau have defended their plan to explore any potential negative consequences of the jab.Controversy regarding the proposed research project, which was supported by US funding, erupted earlier this year as Guinea-Bissau’s government, the Africa Centers for Disease Control, and the World Health Organization (WHO) all voiced their objections or concerns.1The trial would have given half of the 14 000 children a hepatitis B vaccine at birth, alongside the BCG and oral polio vaccine, and the others would instead get the hepatitis B vaccine jab at age 6 weeks—as is currently standard in Guinea-Bissau—observing health differences between the two cohorts.This brought an international cry of ethical concern, however, with half the cohort at significantly greater risk of hepatitis B infection than the other and some critics labelling the trial “neocolonialist.” Adding to the controversy was the study being championed by...

Safety warnings about antidepressants are to be strengthened to emphasise to doctors and patients the risks of suicidal thoughts and behaviours and sexual dysfunction.The regulator the Medicines and Healthcare Products Regulatory Agency (MHRA) is introducing the measures after a major review. This was initiated after patients and families raised concerns about the way the two key risks were currently communicated in patient information leaflets.However, some experts said the addition of the warnings didn’t “go far enough.”More than nine million people in England are estimated to take antidepressants.1 The drugs are commonly prescribed to treat the symptoms of depression along and also other conditions such as migraine, neuropathic pain, and anxiety.Following the review, patient information leaflets for antidepressants will be updated to include a new boxed warning signposting patients to information on suicidal thoughts and behaviours.The MHRA said the expectation is that a new patient card will be included in or...

Chinese health authorities have moved to strengthen disease surveillance at a major crossing with Russia after the unexplained death of a laboratory worker at an antiplague research institute in Siberia.1The Centre for Disease Control and Prevention (CDC) in Manzhouli, China’s largest land port, held a risk assessment meeting to examine the possibility of imported infections and called for stronger monitoring and coordination with customs and border authorities.The measures follow the death on 2 October of a 28 year old worker at the Irkutsk Antiplague Research Institute of Siberia and the Far East.Russian authorities have reported no evidence of plague or other high threat pathogens, but the cause of the worker’s fatal pneumonia remains undetermined, despite an exhaustive contact tracing and testing effort, according to Russian health authorities and Telegram posts by local officials—at least one of which initially identified plague as the cause.The World Health Organization also said on 10...

The threat of bioterrorism is real and proven. Past incidents are well documented. The willingness of certain countries to engage in biological warfare, in contravention of international treaties, is well established. But it seems that we can’t agree on whether artificial intelligence adds to that risk. How worried should we be?The views of experts broadly divide into three categories (doi:10.1136/bmj-2026-101086).1 One group believes that the risks are existential. Others say that the risks are exaggerated by the industry. They believe that when Anthropic warns that people are already experimenting by using AI to create bioweapons, this is a thinly disguised ruse by a technology company to boast about AI’s capabilities and boost its commercial value. It’s “highly, highly unlikely,” they believe, that AI will cause human mass extinction in the near future. The third group argues that the capabilities of AI aren’t what the technology companies would have us believe:...

bmj;395/oct16_1/e100833/F1F1f1As a young researcher in infant nutrition, Alan Lucas was influenced by two of his colleagues at the MRC Dunn Nutrition Unit in Cambridge, Robert McCance and Elsie Widdowson. These giants in the field had done experimental research on the consequences of early life nutrition in rats and other animals in the 1960s,1 spurring Lucas to do similar work in humans.He set up a multicentre trial in 1982 to look at the differences in growth, development, and health outcomes in preterm infants who received different types of feeding. Mothers were asked about their feeding intentions, and the babies whose mothers didn’t provide breast milk were randomly allocated to receive standard formula, unfortified donor breast milk, or a specially designed, nutrient rich preterm formula. A supplementary trial included babies whose mothers provided breast milk.23This was the first time anyone had conducted an experiment to show that how preterm babies were fed...

On 2 October, a 28 year old employee of Russia’s Irkutsk Anti-Plague Research Institute died after developing severe pneumonia.1 The first reports raised the possibility of pneumonic plague and an incident at a laboratory that works with dangerous pathogens.12 Russian officials denied an incident had taken place and said tests found no high threat pathogen.1On 10 October, the World Health Organization published a notice summarising what Russian authorities had reported.1 WHO first learnt of the death from media reports. After it requested verification, Russia confirmed the death and said that contacts remained well, that no additional linked cases had been found, and that investigations had identified no laboratory incident.1 We still don’t know what killed the otherwise healthy young woman who worked in a laboratory handling dangerous pathogens. We only have the word of the Russian authorities who say that there is no reason for concern.This is hardly reassuring. Without...

bmj;395/oct15_9/e101074/F1F1f1Chris was a proud Glaswegian. The third of three brothers, he attended grammar school in Glasgow before studying medicine at the University of Glasgow. After house appointments in the city he worked as an anatomy demonstrator in Dundee, where he obtained his fellowship, before joining the orthopaedic rotation at Oswestry.Initially attracted to hand surgery, he completed a hand fellowship in Derby. Recognising the growing importance of joint replacement surgery, he then undertook a fellowship at the London Hospital with Mike Freeman. On returning to Oswestry, he was appointed consultant orthopaedic surgeon to the Royal Shrewsbury Hospital and the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust.A passionate advocate for his patients, Chris combined technical excellence with sound judgment, calm authority, and a generous approach to teaching younger colleagues. He played a leading part in reorganising trauma care in Shrewsbury into a consultant delivered seven day service, with dedicated...

bmj;395/oct15_8/e101076/F1F1f1John attended medical school in London, trained in England, and then went to New York in 1973, where he was offered an assistant professorship at Mount Sinai Medical School. He also worked at its affiliate, the Bronx VA Medical Centre, where, as assistant chief of surgery, he developed a revolutionary liver surgery technique that cut blood loss by two thirds and was adopted worldwide. In 1981 he was recruited to New York Medical College as associate professor of surgery and chief of gastrointestinal surgery, which included the liver surgery centre for the Hudson Valley region. Teaching courses on this technique involved him in monthly overnight flights to St Louis. In 1987 he was promoted to professor of surgery.In 1997 he developed prostate cancer, and the surgery left him with a paralysed right leg, which took eight months to recover from. But he was recruited by the Montefiore Medical Centre/Albert Einstein...

bmj;395/oct15_7/e101077/F1F1f1Raju was born on 28 November 1957 in Kisumu, Kenya, one of 12 children. His father died before he was born, and he and his siblings were raised by their mother. When Raju was 10 the family moved to the UK in search of a better life, settling first in Edmonton, London, where he attended Aylward School.Inspired by one of his teachers, Raju became determined from a young age to pursue a career in medicine. He went on to become the only member of his immediate family to attend university. With the family facing significant financial hardship, he supported himself through his studies by taking on numerous jobs alongside his academic work.Raju attended medical school at St Bartholomew’s Medical College, starting in 1977 and qualifying in 1983, and he also completed an intercalated BSc in immunology in 1980 at Chelsea College. He developed a close group of friends at Bart’s,...

AbstractObjectivesTo evaluate the accuracy and completeness of adverse event summary reports for medical devices and compliance of the reports with the Food and Drug Administration (FDA) requirements.DesignCross sectional study.SettingThe FDA manufacturer and user facility device experience (MAUDE) database.ParticipantsAll adverse event summary reports filed in MAUDE from July 2019 to June 2025.Main outcome measuresIdentification of device problem codes, appropriate identification as summary reports in the submission form, concordance between the number of events data field and the report narrative, and compliance with FDA reporting deadlines.Results6308 summary reports were submitted to MAUDE containing 159?503 adverse events. Use of summary reports increased from 808 to 1757 between 2020 and 2024, a factor of 1.21 per year (P<0.001). Most (91%) adverse events in summary reports were for class 3 high risk devices. Summary reports lacked descriptions of potential device related problems: 57% of reports denoted an “adverse event without identified device or use problem” and 38% of reports selected “insufficient information” in the device problem code data field. Manufacturers incorrectly checked “N” (no) in the summary report (Y/N, reporting yes/no) field for 694 summary reports (11%) and erroneously listed “n=1” under the number of events field for 423 summary reports (7%), causing an undercount of 11?902 adverse events. The majority (55%) of summary reports failed to comply with the FDA reporting deadline of 30 days after the manufacturer became aware of the adverse event.ConclusionsAdverse event summary reports in MAUDE are frequently incomplete, inaccurate, and delayed. Improvements are needed to ensure timely identification of device safety signals and uphold FDA transparency standards.

Medical devices often enter clinical practice on the basis of premarket studies that are smaller and shorter than those required for medicines, while device performance may depend on operator experience and real world use. Postmarketing surveillance is used to identify emerging hazards and determine whether they represent genuine increases in risk.Individual medical device reports are important in identifying hazards, providing public visibility and alerting regulators, clinicians, and researchers to previously unrecognised problems. Direct reports to the US Food and Drug Administration’s (FDA’s) Medical Device Reporting programme have provided the initial signal for many FDA medical device safety communications.1 However, spontaneous reporting systems are limited by underreporting, incomplete information, uncertain causality, and a lack of reliable information on how many patients received each device.23 These systems can generate hypotheses but cannot reliably estimate incidence or compare device performance.In the linked study (doi: 10.1136/bmj-2026-100812),4 Zhou and colleagues identify important shortcomings in adverse...

The rapid expansion of testosterone prescribing risks broadening treatment from men with well characterised hypogonadism to people with non-specific symptoms and borderline biochemical findings, for whom the balance of benefit and long term risk are less certain.The testosterone replacement market in the UK was valued at around $205m in 2024 and is projected to grow substantially, reaching $365m by 2032.1 Testosterone prescribing in the NHS is rising rapidly: data from the NHS Business Services Authority show community dispensing rose by 52% between 2020-21 and 2024-25.2 In England, 429 women aged 50 or older received NHS prescriptions for testosterone gel in November 2015, compared with 4675 in November 2022.3 These figures count recipients, not prescriptions, and cannot establish whether treatment was appropriate.Private prescriptions are not recorded nationally, so the scale of private testosterone provision is unknown. However, several indicators suggest rapid growth: a proliferation of private and online clinics,2 subscription pricing...

Hospitals and ambulance services have been warned that blood ketone testing—vital for patients at risk of diabetic ketoacidosis (DKA)—may be disrupted amid recalls of testing strips.The NHS supplier Nova Biomedical has withdrawn and recalled specified lots of its StatStrip ketone test strips because of quality control failures and is continuing to test its stock. New shipments are not expected to reach the UK until the end of the month.In response, a national patient safety alert has been issued by the Medicines and Healthcare Products Regulatory Agency.1 It warned that “loss of testing capacity may result in delayed recognition or assessment of DKA, delayed escalation or hospital transfer, delayed treatment decisions, or impaired monitoring of response to treatment.”“DKA is a potentially life threatening condition, and such delays may contribute to severe clinical deterioration, critical illness, permanent harm or death,” it added.The testing strips are used across primary, community, and secondary care,...

Ministers have been warned by their own independent adviser of potential problems surrounding federated data platform (FDP) and its supplier, Palantir, as the government considers its future.1The national data guardian (NDG) for health and social care, Nicola Byrne, issued the warning in a letter to minister for health innovation James Frith.Byrne listed three major concerns: a lack of public and professional trust; the absence of clear, objective evidence of the platform’s benefits and limitations; and problems with interoperability, vendor lock-in, and data sovereignty.She added that the recent increase in the national data opt-out rates “is a significant concern,” noting that the rise coincided with growing public concern and media coverage of the FDP and Palantir.“Even modest bursts of increases in opt-out rates accumulate over time, potentially introducing bias and reducing the value of data for research, service improvement, and life sciences innovation,” she wrote.As of 22 September, around 3.6 million...

The International Criminal Court (ICC) has been urged to investigate whether Israeli doctors, as well as the Israeli Medical Association and officials from the Israeli ministries of health and defence, have been involved in the “death, torture, and ill treatment of Palestinian detainees.”1The Hind Rajab Foundation (HRF) has filed a communication under article 15 of the Rome Statute—a mechanism that allows anyone to submit information relating to alleged crimes for assessment by the Office of the Prosecutor—with the ICC, regarding events at the Sde Teiman detention facility.Natacha Bracq, the HRF’s head of litigation, said, “The evidence shows that medical participation in torture and abuse at Sde Teiman was structural. The medical system kept detainees alive to endure further torture and interrogation while ensuring their injuries could not be traced through clinical records.“HRF’s article 15 submission calls on the ICC prosecutor to investigate this system for what it is: a chain...

Health professionals must be protected from attacks in times of conflict, the World Medical Association (WMA) has reaffirmed in a declaration1 adopted at its general assembly on 10 October.Known as the Declaration of Rotterdam, the statement calls on states and armed groups to protect medical workers, patients, and healthcare infrastructure during war. It also reiterates that doctors and other healthcare professionals have a duty to provide impartial care to all patients, regardless of their roles in a conflict, and must not participate in military operations.The WMA president, Jung Yul Park, said, “The principles of medical ethics do not change in times of war. Physicians must be free to treat patients regardless of their role in the conflict, without fear of sanctions, intimidation, or interference.”Healthcare facilities are protected under international humanitarian law,2 but attacks on medical staff and infrastructure have risen markedly in the past six years.3 Reporting by The BMJ...

Doctors must be more transparent with patients and families about the role of antimicrobial resistance (AMR) in deaths, especially among cancer patients, the UK’s special envoy on AMR says.Speaking at the World Health Summit in Berlin, Sally Davies—England’s previous chief medical officer—said it was common for families to understand a death as being caused by cancer without being told that an untreatable infection had contributed.Instead, greater openness and patient advocacy were needed to urge political action on AMR, she argued.“When patients die … the relatives think of cancer and they had an infection. No one says actually it was untreatable; it was AMR,” she said.“AMR is much more common in cancer patients, and one in four have serious infections. We’ve got to be much more open. We’ve got to communicate; we’ve got to get the patients talking about it.”Davies was speaking at the launch of the Lancet commission on 21st...