A doctor who posted or reposted a series of racist, antisemitic, and sexist comments on social media over 20 months has been struck off the UK medical register.Asif Munaf failed to turn up to the Medical Practitioners Tribunal Service hearing, which decided his misconduct was so serious that he should be barred from practice.The tribunal found that on 36 occasions between October 2023 and July 2025 he posted or reposted material that was objectively antisemitic, racist, seriously offensive, or motivated by racial or religious hostility or prejudice.His comments included, “Jews have no limits to their depravity. Sick in the head,” and, ‘Jews are born with the inherent ability to deceive.”In another post he wrote, “You only have to go to North London to see the Jewish love for a bakery . . . Does the obsession with baking and ovens explain the uncontested and unproven claims of 6 million Jews...

Health and social care workers in Northern Ireland have been verbally or physically attacked more than 72 000 times during the past five years, new figures show. The vast majority of recorded attacks (60 000) were physical.The data emerged in response to a written question asked in Northern Ireland’s legislative assembly by Diane Dodds of the Democratic Unionist Party.1 She described the figures as “utterly appalling.”When averaged out, the numbers equate to 32 physical attacks on staff every day between 2020-21 and 2024-25.In 2023 Northern Ireland’s Department of Health revealed that 50 000 reported attacks on healthcare staff had occurred between 2018-19 to 2022-23.2 This suggests that, while there is some crossover in the time periods, the more recent five year period between 2020-21 and 2024-25 had a 40% higher number of attacks. However, the full picture remains unclear, as the data did not include records of attacks on GPs...

Many people argue that creating security by ensuring peace and preventing war is the most important duty of a state. Tedros Ghebreyesus, the director of the World Health Organization, is not alone in asserting that peace is a key determinant of health.1 Peace, security, and health are closely intertwined. Most states equate security with the need for armed forces and respond by training military personnel and growing their arsenal of weapons. Instead, burgeoning military spending is driving global conflict and instability. Investment must be redirected towards tackling the root causes of insecurity.A few countries, including the United Kingdom, have a substantial arms industry that flourishes on exporting weapons to numerous countries. The UK’s exports of arms were valued at £14.5bn in 2023.2 In 2023-24 the Ministry of Defence spent £25bn on military equipment compared with only £2.6bn spent on operations and peace keeping.3 The UK’s spending is trivial when compared...

The government has now made explicit its intention to prioritise UK graduates for NHS training posts.12 The bill, introduced by the health secretary, Wes Streeting, represents a decisive shift in workforce policy, responding to growing frustration over competition for posts, alongside ongoing industrial disputes.3 While its stated aim—aligning medical training with national workforce needs—is understandable, the practical consequences may prove more problematic than anticipated.There’s a strong argument that the system needed reform. The rapid expansion of UK medical school places without a commensurate increase in postgraduate training numbers has left many domestic graduates facing career bottlenecks.4 Prioritising UK trained doctors for publicly funded training is not inherently unreasonable. What’s harder to defend is the lack of advance planning and communication for the international medical graduates (IMGs) already in the system.From this year IMGs will be deprioritised for foundation training, effectively turning this stage into a choke point. For specialty training...

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: