Sports utility vehicles (SUVs) are passenger cars that have a chassis with extra ground clearance and are generally taller, wider, and heavier than other models. Once a niche vehicle for offroad driving, SUVs now make up half of new car sales globally, up from 15% in 2010.1 In the UK, SUVs accounted for 63% of new sales in 2024, compared with 12% in 2010. The proliferation of SUVs is one aspect of the wider trend of “carspreading,” whereby cars are becoming steadily larger over time,23 and with this comes potential harms to health.In a collision, pedestrians and cyclists are at greater risk if hit by an SUV than by a regular car.45 A recent systematic review found a 44% relative increase in the likelihood of death for an adult pedestrian or cyclist hit by a SUV or similarly large car compared with a standard car.4 For children there was an...

Rachel Carson’s seminal 1962 book Silent Spring highlighted research on the health consequences of exposure to the agricultural pesticide dichlorodiphenyltrichloroethane (DDT). The outpouring of public concern that followed led to government restrictions on its use and, ultimately, a global ban in the Stockholm Convention on Persistent Organic Pollutants. However, such definitive legislative action in the light of scientific understanding of health risks is regrettably rare.Toxicologists and epidemiologists have shown how exposure to air and water pollution—and to toxic substances such as pesticides—can cause cancer, respiratory, neurological, and cardiovascular diseases, among others. Epidemiological evidence has shown the scale of the mortality and morbidity burdens of many sources of environmental pollution. Yet pollution is pervasive and relatively unhindered. Some of its health risks have been known since Victorian times, but air pollution remains one of the main environmental health risks in Europe,1 causing around 300 000 premature deaths annually in the EU.2...

Climate and conflict seriously threaten human health.123 From 1995 to 2015, more than 10 million child deaths were attributed to conflict, while women of reproductive age in high intensity conflict zones experienced mortality rates three times higher than those in peaceful areas.4 Additionally, over 60 000 heat related deaths occurred in 32 European countries during both the exceptionally hot summers of 2022 and 2024, with women substantially more affected than men.5 Beyond direct loss of life, climate and conflict hazards threaten health indirectly, such as by damaging health infrastructure, disrupting supply chains, threatening the safety of health workers, as well as by reducing access to food and essential services, including water and sanitation—escalating the risk of undernutrition and spread of infectious diseases.167Although climate hazards and conflicts each pose serious health risks on their own, their intersection can produce synergistic effects, leading to more severe and complex outcomes. Climate hazards can...

AbstractObjectivesTo examine the association between exposure to greenness and hospital admissions for mental disorders, and to estimate greenness related hospital admissions under various greenness intervention scenarios.DesignMulticountry time series study.Setting6842 locations in seven countries (Australia, Brazil, Canada, Chile, New Zealand, South Korea, and Thailand).Participants11.4 million hospital admissions for mental disorders, 2000-19.Main outcome measuresHospital admissions for all cause mental disorders and for six categories in relation to greenness (measured by the normalised difference vegetation index (NDVI)): psychotic disorders, substance use disorders, mood disorders, behavioural disorders, dementia, and anxiety. Associations were estimated using quasi-Poisson regression models, controlled for weather conditions, air pollutants, socioeconomic indicators, seasonality, and long term trends. Models were stratified by sex, age, urbanisation, and season. Hospital admissions were estimated under different greenness intervention scenarios.ResultsDuring 2000-19, of hospital admissions related to mental health disorders, 30.8% (3?522?749 patients) were for psychotic disorders, 24.7% (2?821?860) for substance use disorders, 11.6% (1?325?305) for mood disorders, 7.4% (845?561) for behavioural disorders, 3.0% (348?149) for dementia, and 2.5% (283?914) for anxiety. A 0.1 increase in NDVI was associated with a 7% reduction in the risk of hospital admissions for all cause mental disorders (relative risk 0.93, 95% confidence interval (CI) 0.89 to 0.98) in pooled analyses. However, associations varied across countries and disorder types. Brazil, Chile, and Thailand showed consistent protective associations across most disorder categories, while modest adverse (ie, harmful) associations were observed in Australia and Canada for hospital admissions for all cause mental disorders and for several specific disorder categories. Exposure-response analyses showed a generally monotonic and approximately linear relation without clear thresholds. When limited to urban settings where associations were generally more consistent, an estimated 7712 (95% CI 6701 to 8726) hospital admissions for mental health disorders annually in urban areas were statistically attributable to observed greenness levels. Analysis by greenness intervention scenarios in urban areas suggested that a 10% increase in greenness was associated with reductions in hospital admissions for mental disorders ranging from ~1 per 100?000 in South Korea to ~1000 per 100?000 in New Zealand.ConclusionsGreenness was statistically associated with lower risks of hospital admissions for mental disorders in several countries, particularly in urban settings. Some adverse associations were, however, observed, and findings were heterogeneous across contexts.

In October the Lancet Countdown on Health and Climate Change reported that between 2012 and 2021 an average of 546 000 people died worldwide each year from heat, up 63% in 1990 to 1999.1Extreme heat is just one impact of climate change. Lives and livelihoods are also lost to droughts, floods, rising sea levels, storms, and wildfires. Climate change threatens our economy, society, and civilisations. Over the coming years the predictability of our food supply will no longer be reliable2 and we face the loss of 50% of global domestic product,3 and even of the entire economy, without immediate action.4Ultimately, the survival of all species is threatened. Experts argue that we are “on the brink of an irreversible climate disaster” and that “much of the very fabric of life on Earth is imperilled.”5Attribution science already allows us to demonstrate the damage done by high emission countries or companies, the so...

The US health secretary, Robert F Kennedy Jr, has called on the world’s health bodies to “follow America’s lead” and remove mercury from all vaccines.In July the US moved to ban the mercury based preservative thiomersal (known in the US as thimerosal) from all influenza vaccines.1 Kennedy said that the move was to “put safety first.”Before the ban thiomersal was used only in multidose vials of the flu vaccine in the US and accounted for only about 5% of adult flu vaccine doses used in the last flu season.“There is no excuse for inaction or holding stubbornly to the status quo,” Kennedy said in a video message to the Minamata Convention in Geneva, Switzerland, on 3 November.The Minamata Convention—a global treaty to protect human health and the environment from the adverse effects of mercury—has been signed by more than 100 countries, including the UK. “Now that America has removed mercury...

Doctors’ leaders have reacted strongly to the government’s proposed 2.5% pay rise for clinicians next year, suggesting it’s “neglect dressed up as restraint.”The Department of Health and Social Care (DHSC) submitted its annual evidence1 to the pay review body, the Doctors’ and Dentists’ Remuneration Body (DDRB), calling for a 2.5% uplift in 2026-27. It warned that anything higher would hamper the NHS’s ability to deliver services and could mean cuts to staffing levels.The BMA has condemned the proposal, however, calling it “indefensible” and one which is likely to worsen already strained relations between the union and government.The union is already in dispute with the government over the online GP consultation rules introduced from 1 October, and its resident doctor members are set to hold a five day strike from 14 November.23In its 103 page submission to the DDRB, the DHSC said it has only planned for a 2.5% pay uplift...

Mention China to a medical journal editor, and their mind will leap to studies on irrelevant research questions drawn from the UK Biobank. It might also jump to numerous analyses of Global Burden of Disease study data. It will inevitably dwell on risks of research misconduct and ethical breaches. The overriding sentiment, however, might be: how do we get through an avalanche of substandard submissions seeking an international journal with an impact factor?On a recent trip to China I championed the advice of Doug Altman, The BMJ’s former chief statistician who not only led the field of medical statistics but helped establish it. In a landmark editorial in The BMJ in 1994 describing the “scandal of poor medical research,” Altman wrote, “We need less research, better research, and research done for the right reasons” (doi:10.1136/bmj.308.6924.283).1 Good advice travels slowly, in time and place. Urging China’s researchers to abide by Altman’s...

Doctors have urged Florida policymakers to reject plans to end childhood vaccine mandates, with others claiming they are being silenced on the matter by their institutions.On 3 September, Florida Surgeon General Joseph Ladapo announced that “the Florida health department is going to be working to end all vaccine mandates in Florida law.” He said, “Who am I, as a government or anyone else, to tell you what you should put in your body?”The announcement builds on the decision by Florida Governor Ron DeSantis during the covid-19 pandemic to reject vaccine and mask mandates for schools and workplaces.Florida is scheduled to end mandates for the hepatitis B, chickenpox, haemophilus influenza type b, and pneumococcal conjugate vaccines in December. The state’s health department said this will go into effect 90 days after the 3 September announcement.But before mandates can be removed for other vaccines, including those for measles, the change must be...

A long criticised study on antidepressant use in adolescents has been flagged with an “expression of concern” by a leading academic journal after the launch of legal action.12George Murgatroyd III, a lawyer, is suing the publishing giant Elsevier, as well as the American Academy of Child and Adolescent Psychiatry, demanding the retraction of the 24 year old randomised trial.3Concerns about the widely cited article—including numerous demands for retraction456—have been circulating for almost as long as the paper itself, and the trial, known as Study 329, is regularly referred to as one of the best examples of spin, misreporting, and ghostwriting in industry funded medical research.In 2012 paroxetine’s manufacturer, GlaxoSmithKline (GSK), was fined a record $3bn (£2.27bn; €2.58bn), in part for illegally promoting paroxetine using the journal article.7 Published by the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) in 2001, the article declared paroxetine “generally well tolerated...

Older people are systematically excluded from research, particularly clinical trials, despite having the highest health and care needs.1 The joint statement from research funders calls for a renewed commitment to ensuring better inclusion of older adults, particularly those with multiple long term health conditions.2But the statement doesn’t mention the growing number of older people with cognitive impairment who are often excluded altogether.3 This is primarily owing to the ethical, legal, and methodological complexities around involving participants who lack capacity to consent. A researcher we interviewed described this as “an insurmountable black box of horrendousness that I dare not go into” fearing that, if they get it wrong, they will be “illegal . . . and the ethics police will come for you.”4 This urgently needs to be tackled if we are to ensure better inclusion.Hope comes in the form of trials methodology research, which provides evidence based strategies to improve...

McNally raises the very important point of reversing silent osteoporosis.1 As a gynaecologist with a special interest in menopause care, I want to highlight the importance of hormone replacement therapy (HRT) for the prevention of osteoporosis in women.As McNally quotes, the prevalence of osteoporosis in women increases significantly from 2% at age 50 to 50% at 80. The average age of menopause in the UK is 51.2 Oestrogen has a profound effect on bone, and replacement of oestrogen in women has been seen to improve bone health in numerous studies—so much so that the British Menopause Society states that it should be considered a first line therapeutic intervention for the prevention of osteoporosis.34 This is especially true for women with premature ovarian insufficiency (whether iatrogenic or non-iatrogenic).5 Alongside discussions about balanced diet, vitamin D and calcium supplementation, reducing smoking, and improving exercise, HRT should be part of the consultation for...

Analogies and analoguesThe words “analogy” and “analogue” come from the Greek word ????????, which had several different meanings, including mathematical proportion, proportion in general, correspondence, and resemblance. The meanings that dominate English today are reasoning on the basis of parallel cases (analogy) and forms of technology other than digital (analogue).Although “analogy” entered English in the 15th century, via the Latin analogia and the French analogie, with the now obsolete meaning of proportion or mathematical agreement of ratios, most of its other meanings did not emerge until the 16th century or slightly later, including “a thing which (or occasionally person who) corresponds to or resembles another; a parallel, an equivalent ….”1Here, for example, is the Elizabethan physician Philip Barrough in The Methode of Physicke in 1583: “Therefore by the example and analogie of one difference of tumours, which are caused thorough defluxion (for here we mind to intreate only of them)...

Bodies of Palestinians returned by Israel as part of a ceasefire deal show signs of torture, execution, and being run over by tanks, hospital workers have said.Sources at Nasser Hospital in Khan Younis, which received the remains, told Middle East Eye (MEE) that several bodies bore strangulation marks, broken bones, and mutilation, while others were missing limbs.1The news comes as UN leaders called for a “massive surge” in aid as doctors in Gaza report that “nothing has changed on the ground” and there is still a huge shortage of aid and medical supplies.Speaking to MEE, the source said that some 45 bodies returned on 14 October were recently killed, while others arrived in a decomposed state or as partial remains.The ceasefire agreement between Israel and Hamas, brokered by the US, included an exchange deal that has seen Hamas release all 20 living hostages taken during the 7 October 2023 attack...

How far will you go to promote your medical invention? This is a question for clinical innovators. How far will you go to market the invention? This is a question for corporations whose primary purpose is to keep pleasing their shareholders. The limits of promotion, of course, should be reached when the balance of benefits and harms is no longer favourable. That balance is a judgment, made by people capable of deciphering the evidence and seeking to protect the public—drug and device regulators, for example.What happens when an intervention seems innocuous, the data are equivocal, and the benefits are more theoretical than demonstrable? Again, it depends. There is no free good; every intervention is a vector of harm—trivial, minor, major, or yet to be determined. It is in these grey areas, where judgment is required, that the peddlers of a new product show their true colours and the vigilance of...

American pharmaceutical giant Eli Lilly has said it will crack down on suppliers who are selling fake versions of its unapproved weight loss drug retatrutide.Social media companies TikTok and Meta have also intervened against black market sellers operating on their platforms.The decision comes after a Channel 4 investigation found that patients have been able to buy fake versions of retatrutide on social media.1 The triple glucagon hormone receptor agonist drug is currently in phase 3 clinical trials, set to conclude in May 2026.2As a glucagon-like peptide-1 receptor agonist, it is similar to other weight loss drugs such as tirzepatide (Mounjaro) and semaglutide (Ozempic, Wegovy). It is also an agonist for glucagon receptors and gastric inhibitory polypeptide.Undercover journalists from Channel 4 were able to buy a fake version of the unapproved weight loss injection online, and find members of the public who had bought the drug from TikTok.A spokesperson for Eli...

The prime minister, Keir Starmer, has ordered a rapid review of how healthcare regulators such as the General Medical Council deal with allegations of racist or antisemitic behaviour in the NHS. The government will also roll out mandatory antisemitism and antiracism training for all 1.5 million NHS staff and has promised a “zero tolerance” approach to discrimination in healthcare.The move follows a case in which a British-Palestinian trainee doctor, Rahmeh Aladwan, was allowed to continue practising pending a full Medical Practitioners Tribunal Service hearing into allegations that she made antisemitic remarks.1Aladwan, who has continued to comment on social media, has been referred for a new interim orders tribunal hearing, set for 23 October.In another recent case, a former consultant surgeon, Manoj Sen, was struck off the UK medical register for antisemitic comments in social media, including calling a Jewish man “vermin” and “rodent.”2The rapid review will be led by John...

A long acting injection given every two months to reduce the risk of contracting HIV is to be made available in England for people who are unable to have a daily prophylaxis tablet.The National Institute for Health and Care Excellence (NICE) said its approval1 of the “groundbreaking” preventative therapy would support the government’s target of eliminating HIV transmissions by 2030.Latest data from the UK Health and Security Agency show that new HIV diagnoses fell by 2% in England from 2838 in 2023 to 2773 in 2024.2“This breakthrough preventative therapy is another powerful tool in our arsenal to reach that crucial goal,” said health secretary Wes Streeting.NICE’s final draft guidance recommends cabotegravir (Apretude, made by ViiV Healthcare) as an option for pre-exposure prophylaxis (PrEP) alongside safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults and young people who weigh at least 35 kg.It is only recommended...

bmj;391/oct16_10/r2181/FAF1faUntil her untimely death aged 44, Scottish born Vicky Johnson, associate professor of neurosurgery at Perelman School of Medicine, University of Pennsylvania, led landmark international research exploring the biology and pathology of traumatic brain injury (TBI), with projects spanning complex pre-clinical models to human pathology studies. She established herself as one of the leaders in TBI research, directing multiple programmes and mentoring many students and postdoctoral researchers.“Traumatic brain injury is a common and often devastating health problem,” she said on the Johnson Laboratory website, highlighting how it affected 2.5 million people a year in the US.1 Johnson’s research focused largely on links between TBI and neurodegenerative diseases such as Alzheimer’s and chronic traumatic encephalopathy, including the short and long term outcomes of sports concussions. Her work advanced understanding of the mechanisms by which acute brain trauma leads to long term neurological decline. She contributed to more than 120 published research...

Healthcare in low and middle income countries in Africa and elsewhere is being “hijacked” by commercial surrogacy companies, experts have warned.At a session at the European women’s rights conference FiLia in Brighton on 12 October, former surrogates and women’s rights campaigners from France, the US, and Germany argued that pregnancy complications such as sepsis, postpartum haemorrhage, and pre-eclampsia are higher in surrogate pregnancies and that the industry is distorting healthcare provision in commercial surrogacy destinations.Marie Josephe Devilliers, president of the feminist organisation International Coalition Against Surrogate Motherhood, presented evidence of such practice in Uganda, where a medical sector has been developed for in vitro fertilisatoin (IVF) and reproductive surrogacy but where local women cannot access obstetric care. The situation is similar in South Africa, where “ordinary citizens have little access to medical care for their own pregnancies, but the most sophisticated clinics are available for surrogate pregnancies,” Devilliers said.Lexi Ellingsworth,...