In this article (BMJ 2026;393:e629407; doi:10.1136/bmj-2026-629407) the first initial of D Gareth Evans was omitted. The online version has been corrected.

Various media outlets have described the current Ebola outbreak affecting eastern Democratic Republic of the Congo (DRC) and Uganda as “a perfect storm.”1 A convergence of critical factors has made the outbreak difficult to control: a rare virus for which there are no licensed vaccines or therapeutics, combined with transmission occurring in conflict affected areas characterised by high population mobility, weak health infrastructure, and longstanding challenges around community trust and engagement.The outbreak is caused by Bundibugyo, a rare Ebola-causing virus identified in two previous outbreaks, Uganda in 2007 and DRC in 2012. Unlike Ebola virus (formerly Zaire ebolavirus), which caused the devastating West African epidemic of 2014-16, there are currently no approved vaccines or therapeutics for Bundibugyo virus disease. This raises a difficult question: if Ebola has been recognised for decades, why do we still not have vaccines for all Ebola viruses?The answer reflects an uncomfortable reality about how the...

Wes Streeting's time as health and social care secretary has been a missed opportunity. Instead of using Labour's overwhelming majority to fix the fundamental problems of the NHS he embarked on the unnecessary abolition of NHS England while failing to put in place a credible plan for reform.Labour's 2024 general election manifesto promised not just to improve NHS performance but ensure its long term success through three shifts: hospital to community, treatment and prevention, and analogue to digital.1 This was supposed to be part of a pan-government “health mission” to help people to live longer healthier lives, which was quietly ditched.It took 12 months to publish the 10 Year Health Plan for England.2 It was well received, but Streeting failed to set out how it would be delivered. By the time he resigned almost a year later he had still not published either the delivery plan or the workforce plan,...

AbstractObjectivesTo study the prevalence and characteristics of outcome switching, the completeness of outcome prespecification, and factors associated with outcome switching in observational cohort studies of interventions.DesignLongitudinal meta-epidemiological study.SettingRegistry records and journal publications.ParticipantsControlled cohort studies investigating the effects of interventions. Eligible studies were registered on ClinicalTrials.gov within one month of their start date (2014-16) and had published results in peer reviewed journals by 2024.Main outcomes measuresFirstly, proportion of studies with outcome switching identified by comparing the prespecified outcomes in the registry and those reported in the journal publication of results. Discrepancies were categorised as omission (prespecified primary outcomes not reported), downgrading (prespecified primary outcomes reported as non-primary), upgrading (prespecified non-primary outcomes reported as primary), and introduction of new primary outcomes (not registered as an outcome). Secondly, proportion of studies with completely prespecified primary outcomes, defined as registry entries that include the measurement variable, analysis metric, method of aggregation (the statistic summarising the outcome within each study group), and time point.ResultsOf 9965 registration records screened, 124 eligible studies with results published between 2015 and 2024 were included. Only 30 studies (24%) completely prespecified their primary outcomes. Outcome switching occurred in 60 (48%) studies, but only two provided an explanation. The most common types of switching were omission (n=32, 26%) and downgrading (n=32, 26%), followed by the introduction of new primary outcomes (n=25, 20%), and upgrading (n=2, 2%). Among 57 studies with outcome switching other than omission (ie, outcome results were reported), statistically significant results were favoured in 77% (44/57) by introducing or upgrading a new significant primary outcome or downgrading a non-significant one. No study characteristics were significantly associated with outcome switching in multivariable logistic regression.ConclusionsOutcome switching and inadequate outcome prespecification were common in cohort studies of interventions. Most changes were unexplained and favoured statistically significant results, raising concerns about potential selective reporting and highlighting the need for improved transparency in outcome reporting.Study registrationOpen Science Framework (https://osf.io/xn5zt/).

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.

This study investigates emergency department visits for violence-related injuries occurring at home and outside the home in Cardiff, Wales, before and after COVID-19 lockdown measures were instituted in March 2020.

As long ago as in the issue of this Journal for Oct. 13,1894, the promising merits of Ian Maclaren, the now popular story-teller, were recognized. We there spoke of Maclaren’s “A General Practitioner,” as “a classic of its kind,” although it was far from being in classic dress at that time; it was then to be found only in a penny paper of London, called the British Weekly. Since that time, the features of the Highland country doctor, Dr. Weelum MacLure, have been made known all the world round in the “Bonnie Brier Bush” stories. And his physiognomy is everywhere recognized as that of one of the sturdiest and noblest medical characters that have ever appeared in fiction. If there is anywhere in fiction a more worthy, admirable and attractive personage than Dr. MacLure of Drumtochty, we will be thankful to have him pointed out to us. As his portrait has not, so far as we know, been seen in any medical gallery, we will here give space to a sketch taken from the earliest publication by Maclaren: