US federal and state authorities have charged 324 people with healthcare fraud offences, seized $245m (£180m; €208m) in cash and assets, and broken up criminal networks that collectively billed Medicare and private insurers for $14.6bn, the Department of Justice has announced. Of these claims, just $2.9bn was paid out.“This record healthcare fraud takedown delivers justice to criminal actors who prey on our most vulnerable citizens and steal from hardworking American taxpayers,” said attorney general Pam Bondi. The previous record for a coordinated healthcare fraud operation involved $6bn in claims, she noted.Such coordinated efforts typically involve multiple fraud rings. It has become standard practice for the justice department to lay charges in several cases at once, in order to generate news coverage.1 While the current announcement involves the largest amount in false claims, it is not the biggest in terms of arrests and charges.2It does, however, include the largest single healthcare...

The government has unveiled its 10 year plan to transform the NHS in England, underpinned by housing more services under one roof in community settings to relieve pressure on hospitals, boosting use of technology, and sharpening the focus on preventing ill health.1Central to the plan are new “neighbourhood health centres” offering GP appointments, diagnostic and blood tests, scans, postoperative care, mental health support and rehabilitation, dentistry, debt advice, employment support, and smoking cessation and weight management advice in a single location.Many of these services are already offered in urgent treatment centres or minor injuries units, but the government wants to expand their scope to move more care out of hospitals into community settings.The new centres will “eventually” open 12 hours a day, six days a week, with each covering around 250 000 people. The government said it would start by establishing them in places with the lowest healthy life expectancy...

In an inauspicious beginning to one of the biggest weeks in the NHS’s history, England’s Department of Health and Social Care press released its NHS 10 year plan without providing an embargoed copy of the plan for scrutiny. This behaviour became standard practice under the previous UK government. Whether intentional or not, the result is a free pass for political spin. However, the truth will out. The last notable example was the government’s long awaited workforce plan, which ended up being heavily criticised (doi:10.1136/bmj-2024-079474).1 When the new NHS plan finally arrived it was missing detail on how the ambitions, many of them noble, would be delivered.Speaking at a conference earlier this year (doi:10.1136/bmj.r990), Michael Marmot advised, “There’s enough in the world to make one despair. But, to quote Raymond Williams: ‘To be truly radical is to make hope possible, rather than despair convincing.’ We know what needs to be done....

Sleeping in?Safety concerns have been raised about doses of the sleep-wake hormone melatonin in over-the-counter supplements that are often marketed to parents as gummies that they can give to their children.1Nightmare tablets?A large US study has found that doses in over-the-counter products can differ significantly from those stated on the label.2 Researchers at the US Food and Drug Administration analysed 110 melatonin products marketed at children and found that doses varied from 0% to 667% of the amount stated. The dose was deemed accurate in only half of the products (76-126% of the stated dose).Is this only an American dream?Not exclusively. While use of the drug is more common in the US with one in five US children under 14 reported to be taking it,3 a recent investigation by the Guardian newspaper reported evidence of a UK black market for melatonin.4Are we talking backstreet deals?Not exactly, but in the UK...

AbstractObjectiveTo quantify and identify the main causes of increased disease burden due to coronavirus disease 2019 (covid-19) pandemic.DesignTime-series modelling study.Data sourceGlobal Burden of Disease Study 2021.Main outcome measuresAbsolute and relative rate differences were calculated, along with their 95% confidence intervals (95% CIs), between the observed and expected rates for 174 causes of increases in incidence, prevalence, disability adjusted life years (DALYs) and deaths in 2020-2021. A statistically significant increase was indicated if the 95% CIs of the rate differences were above 0.ResultsGlobally, the rate of age standardised DALYs increased in absolute difference per 100?000 and relative rate difference by 97.9 (95% CI 46.9 to 148.9) and 12.2% (95% CI 5.8% to 18.5%) for malaria, 83.0 (79.2 to 86.8) and 12.2% (11.7% to 12.8%) for depressive disorders, and 73.8 (72.2 to 75.4) and 14.3% (14.0% to 14.7%) for anxiety disorders, which were prominent and statistically significant, followed by stroke, tuberculosis, and ischaemic heart disease. Additionally, the age standardised incidence and prevalence per 100?000 significantly increased for depressive disorders (618.0 (95% CI 589.3 to 646.8) and 414.2 (394.6 to 433.9)) and anxiety disorders (102.4 (101.3 to 103.6) and 628.1 (614.5 to 641.7)), as well as notable rises in age standardised prevalence for ischaemic heart disease (11.3 (5.8 to 16.7)) and stroke (3.0 (1.1 to 4.8)). Furthermore, age standardised mortality due to malaria significantly increased (1.3 (0.5 to 2.1) per 100?000). Depressive and anxiety disorders were the most predominant causes of increased DALY burden globally, especially among females; while malaria had the most severe increased DALY burden in the African region, typically affecting children younger than five years; and stroke and ischaemic heart disease in the European region and in individuals aged 70 and older.ConclusionThe covid-19 pandemic significantly increased the burden of several non-covid conditions, particularly mental health disorders, malaria in young children in the African region, and stroke and ischaemic heart disease in older adults, with notable disparities across age and sex. These findings underscore the urgent need to strengthen health system resilience, enhance integrated surveillance, and adopt syndemic-informed strategies to support equitable preparedness for future public health emergencies.

A group of medical researchers has urged the UK government to act decisively to end the “horror” that continues to unfold in Gaza, including ensuring aid can safely be delivered to the territory.In an open letter published in The BMJ, researchers from the London School of Hygiene and Tropical Medicine noted that Israel’s military bombardment of Gaza had resulted in the deaths of more than 56 000 people, a third of them children aged under 18.1 More than 1200 families have been killed, and 470 000 people are now at risk of famine, the letter said.On 18 June the United Nations reported that more than 400 Gazans had been killed by Israeli forces while trying to obtain food and other humanitarian aid since the US and Israel backed Gaza Humanitarian Foundation started distributing food.2In their letter the academics wrote, “What is unfolding in Gaza bears historical and global significance beyond...

This Viewpoint discusses policies the Biden administration can enact to reduce costs, including benchmarking Medicare Part B drug payments to the lowest price paid in similar countries, preventing Part D plans from negotiating confidential rebates with manufacturers, and patent reform to promote generic drug use.

This Viewpoint reviews evidence that higher hospital prices reflect greater market power more than higher-quality services and proposes that backstop price caps can mitigate harms from the most excessive prices without constraining or distorting competitive health care markets.

This narrative review summarizes the epidemiology, pathophysiology, diagnosis, management, and prognosis of irritable bowel syndrome.

In this narrative medicine essay an infectious diseases physician shares the sense of forgiveness she brings to anyone possibly involved in COVID-19 transmission, having learned as a child the healing power of family absolution after she witnessed the death of a cousin.

I will work. I will work without a mask. I will mask the work of courage. I will say there is a reason, bury my aunt, and say it again. I will walk on any street without a graveyard without a mask. I will let our children play there. I will see them share the sand. I will let them touch each other. I will see them slip in soil. I will remember I played dead. I will forget two hundred thousand bodies. I will sift anything but ash.

This randomized trial compares the effects of blinatumomab, an antibody construct that links CD3+ T cells to CD19+ leukemia cells, vs consolidation chemotherapy as a third consolidation block before allogeneic hematopoietic stem cell transplant (HST) on event-free survival in children with high-risk first-relapse B-cell acute lymphoblastic leukemia (B-ALL).

This randomized trial compares the effects of postreinduction therapy consolidation using blinatumomab, an antibody construct that links CD3+ T cells to CD19+ leukemia cells, vs chemotherapy on disease-free survival among children, adolescents, and young adults with first relapse of B-cell acute lymphoblastic leukemia (ALL).

In Reply Dr Kim and colleagues state that the results of our study are not comparable with those of PLATO and suggest that our findings may differ because patients enrolled in PLATO had a higher proportion of prior myocardial infarction. First, as we mention in our article, PLATO failed to show benefit in North America and included few Asian patients. It did show that ticagrelor reduced ischemic events and increased the rate of nonprocedural bleeding. However, several studies have demonstrated that high-risk patients with ACS do not have a net benefit with ticagrelor. For example, the SWEDEHEART registry showed that ticagrelor was associated with higher rates of bleeding and increased mortality in patents with ACS who were aged 80 years or older. A reduction in ischemic outcomes from ticagrelor was also not observed in this study. The open-label randomized clinical trial POPular AGE demonstrated that clopidogrel is favored for older patients with non–ST-elevation ACS, a high-risk subgroup. The TICA-KOREA trial showed that ticagrelor use was not associated with fewer ischemic events but was associated with increased risk of bleeding in Korean patients with ACS treated with PCI.

In Reply Our recommendations for initial antiretroviral therapy are based on evidence from randomized clinical trials demonstrating superiority of InSTI-based therapy vs comparators that included boosted protease inhibitors or efavirenz. Additional benefits of dolutegravir-based and bictegravir-based therapies include a low risk of treatment-emergent resistance, lack of need for pretreatment genotype results, few significant drug interactions, and a highly favorable tolerability profile, along with a very low rate of discontinuation due to adverse effects.

In Reply We agree with Dr Donzelli that reforming health care payment is an essential step in reducing the delivery of low-value services. This is core to our argument around the economic forces that guide the de-adoption of low-value care. Within this realm of economic levers, Donzelli makes an important distinction between pay-for-performance and pay-for-health models, noting some inconsistent results from the former. Although there is evidence that targeted payment policies can reduce the provision of low-value care, we agree that more holistic value-based payment models are needed. Our understanding of how to best pay for health continues to evolve and requires precise measurement of and alignment around the definition of health. One approach raised by Donzelli is to move toward risk-adjusted capitated payments, an approach already used at scale within the Medicare Advantage program. There is also some evidence to suggest that other global payment structures influence the provision of low-value services. As the adoption of value-based payment continues to grow, it will be important to rigorously evaluate the impact on low-value care.

To the Editor A recent retrospective cohort analysis by Dr You and colleagues demonstrated that compared with clopidogrel, ticagrelor was not associated with better outcomes in patients from the US and South Korea with acute coronary syndrome (ACS) undergoing percutaneous intervention (PCI). However, there are several important discrepancies between this cohort analysis and the randomized Platelet Inhibition and Patient Outcomes (PLATO) trial.

To the Editor As HIV clinicians, we read with interest the new antiretroviral treatment guidelines published on behalf of the International Antiviral Society–USA. Nevertheless, we believe these guidelines failed to integrate emerging evidence and may have reflected implicit commercial bias.

To the Editor In their Viewpoint, Dr Powers and colleagues analyzed 3 forces governing de-adoption of low-value care: evidence, eminence, and economics. A common denominator underlies them: the interest and convenience of the health care producers, providers, and purchasers. Fee-for-service creates strong incentives to continue delivering low-value but profitable care and technological abuse. More generally, it incentivizes provision of services with a profitable differential between the production costs and the fee applied by purchasers. The production cost is physician- or hospital team–specific, based also on specific skills and preferences, whereas the applied fees are not hospital- or physician-specific, further limiting targeted tariff policies. Aligned with pressure from patients and induced by technology producers and professional societies, fee-for-service multiplies outputs, which translates into financial and career benefits for hospitals, physicians, and producers. Therefore, low-value care for patients and society can be of high value for the producers, hospitals, and physicians selling it. A distorted rewarding model for health players puts the health systems in structural conflict of interest with health.