Thousands of men in England with prostate cancer are to be offered high powered “precision” radiotherapy that will cut their number of treatment sessions from 20 to five.The pioneering multibeam radiotherapy, known as stereotactic ablative radiotherapy (SABR), will treat the condition far more quickly and with fewer side effects, said NHS England (NHSE).Standard external beam radiotherapy delivers several beams of radiation to the treatment area and is typically given as a number of daily doses over a period of weeks. But SABR uses many smaller, focused beams of radiation directed from different angles that meet at the tumour, thus giving it a high dose of radiation while the surrounding healthy tissues get a much lower dose, lowering the risk of damage to normal cells.SABR is already offered to some patients with lung, liver, pancreatic, or brain cancer. The announcement on 10 June means that it will now also be available...

Ongoing resident doctors' strikes indicate overt workforce tensions in the UK.1 By contrast, Japan faces a less visible but equally concerning “silent strike.” Despite universal health coverage, increasing numbers of young doctors are opting out of core specialties such as internal medicine, general surgery, and paediatrics.2Government data show that, between 2006 and 2024, the number of trainees under 30 declined by 48% in internal medicine, 36% in general surgery, and 17% in paediatrics.3 Meanwhile, entry into cosmetic medicine has risen 16-fold. This shift reflects structural disincentives. Cosmetic practice, outside the national insurance system, allows flexible pricing, whereas insured care is tightly regulated. Financial pressures have intensified, the proportion of clinics making a loss increasing from 24.6% in 2023 to 39.2% in 2024.4Career structures further limit choices. The specialist training system introduced in 2018 restricts mobility by tying early career doctors to financially vulnerable institutions. In addition, the 2024 work-style reform,...

AbstractAutism is a neurodevelopmental condition with varied trajectories through the lifespan, leading to individualized patterns of strengths and challenges. Longitudinal autism cohort studies show the importance of developmental and adaptive skills starting in the early years, followed by emerging co-occurring conditions, and opportunities for autonomy and community participation when approaching adulthood. Studies of interventions to support developmental outcomes in autistic children have shown benefits; however, adverse events from therapies and outcomes prioritized by autistic people must be incorporated. Programs for autistic children and youth are making some progress by including members of diverse communities, developing and adapting interventions to meet their needs. Most importantly, autistic people have highlighted the many contributors to a ‘good life’, prominent among which are acceptance and meaningful inclusion. This review summarizes the latest evidence about developmental trajectories and outcomes among autistic children and youth, and how this translates into clinical practice and policy.

Retatrutide, a triple action treatment for type 2 diabetes, could significantly reduce blood glucose concentrations and body weight in patients with the condition, a phase 3 trial has reported.The results, published in the Lancet,1 show that patients who received injections of retatrutide for 40 weeks lost more than four times as much weight as those in the placebo group. After 40 weeks the average reduction in HbA1c with the new treatment was more than twice that in the placebo group, showed the trial, which was funded by the drug's manufacturer, Eli Lilly.Retatrutide is a triple hormone receptor agonist that targets receptors for glucagon-like peptide-1 (GLP-1) to suppress appetite, glucose dependent insulinotropic polypeptide (GIP) to control blood glucose concentrations, and glucagon to increase energy expenditure. This is in contrast to semaglutide (Ozempic), which targets just GLP-1 receptors, or tirzepatide (Mounjaro), which works on both GLP-1 and GIP, so is termed a...

Resident doctors and consultants in Northern Ireland have voted to go ahead with two 24 hour strikes later this month in a dispute over pay.A pay uplift of 3.5% for 2026-27 was recommended by the Doctors' and Dentists' Pay Review Body earlier this year.But the offer was rejected by the BMA in Northern Ireland, which then balloted its members on strike action.1 The organisation claims that Northern Irish doctors' real terms pay is significantly lower than 18 years ago.With the strikes now imminent, the BMA said that it was up to the minister of health in Northern Ireland to come forward with a “credible” pay offer.David Farren, chair of the BMA's Northern Ireland Consultants Committee, said, “This result sends a very clear message that concerns about pay erosion, workload, and the future of the profession are widely shared across the workforce, across all grades of hospital doctor.”Of the doctors who...

The retired GP and climate activist Sarah Benn has had her suspension from the medical register extended again after a tribunal.Benn was initially suspended for five months in April 2024 for breaching court orders and for contempt of court while taking part in climate change protests at an oil terminal in 2022.1In 2023 she pleaded guilty to criminal damage after chalk spraying the gates and a wall at a company involved in animal testing. She was referred for a second hearing at the Medical Practitioners Tribunal Service (MPTS), which then suspended her for 12 months in June of last year.2 Last week (5 June) she was suspended for a further 12 months after a fresh MPTS hearing.Benn qualified in 1990 and spent 32 years in clinical practice, working as a GP for most of her career before retiring in 2022. In 2022 she attended climate protests on three occasions at...

Doctors could be told to stop wearing political badges at work and not to attend political protests in work uniforms, after a national review.Strengthened official guidance on uniform and workwear for NHS staff is expected after a government commissioned review on tackling antisemitism and other forms of racism across the NHS.1However, doctors' leaders labelled some of the proposals as “deeply concerning.”They said having a “blanket ban” on all symbols being worn as a step too far and there are questions over who decides what is “political.”The review, carried out by the Labour peer and UK government adviser on antisemitism John Mann, was commissioned after an attack at Heaton Park Synagogue in Manchester in October 2025 and reports of doctors being struck off the medical register because of antisemitic comments.2Mann heard from Jewish people who said they experienced “routine ostracism” in the NHS.Jewish staff were also the only religious group in...

McNally correctly identifies that many of the challenges affecting parents who are doctors are compounded for trainees with frequent rotations and often long commutes.1 Being a dual doctor couple, which has become increasingly common, further compounds the problem. The degree of influence that trainees have over their rotations varies considerably across grade, region, and training programme. We started a family during higher specialty training, but there are many parents in foundation or early specialty training who are even more vulnerable to these problems, with shorter rotations and even less agency. Most trusts lack an on-site nursery, which is of limited use when both parents are working in different places. Our friends and colleagues who rely on family might seem to have a better deal, but these arrangements often strain personal relationships and can be vulnerable to changes of health or circumstance.2Less than full time (LTFT) working has allowed my wife...

bmj;393/jun05_11/e491185/VS1F1vs1Eric was born in Liverpool in 1925, was educated at Liverpool College, and went on to Liverpool University to study medicine.He qualified as a urologist and started his career at Sefton General, where he met his wife, Rosemary, who was working there as a physiotherapist. Most of his career was spent at the Manchester Royal Infirmary, where he became head of urology surgery.Eric was very involved in kidney research, and he spent his early career in the US at the Mayo Clinic, studying the artificial kidney. On his return to the UK, he developed and performed the first cadaver transplant. He was a leading force in Kidney Research Northwest and much involved in raising funds through the rugby sevens team. This was recognised by the Queen, and he attended one of her garden parties in the late 1970s.Eric became chair of the British Association of Urological Surgeons and was also...

A new drug to treat resistant ovarian cancer, and the first to be approved in over two decades, has been approved for patients in the NHS in England.What is the new drug?Mirvetuximab soravtansine (marketed as Elahere), developed by AbbVie, is an advanced, targeted treatment that combines a “homing” antibody with a cancer destroying drug.Often described by scientists as a “biological missile” or “trojan horse” therapy, the drug is already available in the US and Europe.It costs £4950 per 100 mg vial at list prices, excluding VAT.1 However, for the health service it is being made available subject to a confidential commercial arrangement between AbbVie and NHS England.How does it work?In contrast to chemotherapy, it uses a targeted therapy that seeks out a specific protein found on the surface of cancer cells called folate receptor alpha (FR?) and delivers a molecule that destroys the cancer cell from within.The drug is given...

While the growth rate of the world's population has declined to 0.86% per year, the rate of mortality has also slowed down. Part of the decline in mortality can be attributed to considerable efforts on young infant and child survival, which have been successful. But the message from a linked series of papers on neonatal, child, and adolescent mortality published in The BMJ (doi:10.1136/bmj-2025-088684; doi:10.1136/bmj-2025-088685; doi:10.1136/bmj-2025-088686; doi:10.1136/bmj-2025-088687) is clear: since 2015, the rate of decline in mortality rates in newborn babies, children under 5 years old, older children, and adolescents has slowed substantially.1234 Although the number of deaths among children under 5 has decreased over the past two decades, 4.9 million children in this age group died in 2024, with almost half of the deaths occurring in newborn babies. While the mortality rate among children under 5 declined by 3.9% in 2000-15, the rate of decline was only 1.5% in...

AbstractObjectiveTo estimate cause specific mortality among neonates and children under 5 for 195 countries from 2000 to 2024.DesignSecondary data analysis using a Bayesian multinomial logistic regression model to estimate cause specific mortality fractions.Data sourcesPubMed, Embase, Web of Science, SCOPUS, Cochrane, Global Health Index Medicus, PAHO, Global Health OVID, Africa-Wide Information, IndMed, WHO Mortality Database, Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), and Health and Demographic and Surveillance Systems (HDSS).Inclusion criteriaStudies in the general population reporting empirical cause specific mortality for at least two causes in the age groups of interest, with a specified method for cause ascertainment. For studies identifying causes of mortality with verbal autopsy, ?25 deaths reported with ?25% of these deaths with unknown cause. For vital registration, ?80% population completeness and ?10% deaths assigned to ill defined causes determined by the international classification of diseases, 10th revision.ResultsCause specific mortality for countries with adequate quality vital registration was estimated with their own data with minor adjustments. For countries with low mortality without adequate quality vital registration, cause specific mortality was modeled by age group and based on vital registration. For high mortality areas, cause specific mortality was modeled primarily on the basis of verbal autopsy data identified in a systematic review. Estimated cause distributions were applied to all cause mortality rates and death counts estimated by the United Nations Inter-agency Group for Child Mortality Estimation. Among 4.9 million estimated global deaths in under 5s in 2024, the most important cause of death was preterm birth complications, with 0.82 (90% uncertainty interval 0.76 to 0.88) million deaths and 6.17 (5.93 to 6.42) deaths for every 1000 live births. This was followed closely by lower respiratory infections at 0.66 (0.60 to 0.71) million deaths, intrapartum related events (0.48 (0.43 to 0.52) million), and malaria (0.45 (0.39 to 0.51) million). Analysis for trends over time showed that the decline in most causes has slowed since 2016.ConclusionWith the recent slowed pace of decline in under 5 mortality for most primary causes of death, many high mortality countries are at risk of missing the sustainable development goal targets of ?12 neonatal deaths and ?25 under 5 deaths per 1000 live births without acceleration. Estimates presented here can help countries to determine the most appropriate course of action to reduce under 5 mortality and achieve these targets.

bmj;393/may28_11/s953/FAF1faThe zenith of Joseph Ana’s passion to improve healthcare in Africa, particularly in his native Nigeria, came in 2004, when he was appointed health commissioner of Cross River State in the south east of the country. Donald Duke, the state governor, was impressed when Ana, a GP in the UK at the time, made clear that “medicine was not about buildings and equipment but love and care.” Duke had “gone through two health commissioners already without the satisfaction of making progress.”When Ana took up his post, the state had to serve more than three million people with only 72 doctors, no psychiatrist, radiologist, or pathologist, and just over 1000 nurses and midwives, with most practitioners concentrated in the cities. Maternal mortality was over 1% and child mortality over 20%. Only a fifth of the population were immunised, and—although hardly acknowledged because of the stigma—12% of the population were HIV positive.Ana...

Resident doctors in England will return to the picket lines next month in their 16th walkout over pay and conditions, the doctors' union has announced.The strike will run from 7 am on Monday 15 June to 6 59 am on Friday 19 June, and the BMA has threatened “more strike dates in July” if no further progress is made.The announcement comes after talks broke down between the new health and social care secretary, James Murray, and the BMA's Resident Doctors Committee (RDC). BMA officials said Murray had made it clear that he would not put any more money on the table beyond what his predecessor, Wes Streeting, had previously offered. Murray expressed disappointment that the BMA had “rushed once again to unnecessary and unreasonable strike action.”On 27 May the RDC chair, Jack Fletcher, said he had hoped that a change in health secretary “would lead to a change in approach.”“Sadly,...

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/).

UK government plans to increase the price the NHS pays for drugs will face a legal challenge from a patient campaign group.The changes, announced in December 2025, formed a key part of a trade deal aimed at avoiding tariffs being imposed by the US president, Donald Trump.1These new regulations would allow ministers to increase the cost threshold that the National Institute for Health and Care Excellence (NICE) uses to determine which drugs are made routinely available in the health service from a range of £20 000-£30 000 per quality adjusted life year to £25 000-£35 000. The change is expected to cost the NHS billions, which critics say could be better spent improving services.But these plans are now being challenged by Just Treatment, a patient led campaign group working alongside Global Justice Now, a social justice organisation. The two groups have written to the secretary of state for health and...

Regulations for handling “vexatious” patients must be toughened to protect GPs and their staff against the growing threat of harassment and abuse, general practice leaders say.The UK conference of local medical committees (LMCs) in Belfast heard distressing accounts from GPs about doctors, staff, and their families being harassed, stalked, and targeted by patients.Delegates said that current rules on handling patients who engage in repeated harassment, stalking, or abuse did not adequately protect doctors and staff against what was a growing problem.Claire Barnsley, of Wakefield LMC, who proposed the motion, said, “Harassment and stalking are patterned based forms of abuse, not single instance. They escalate over time, and in modern general practice they are increasingly enabled by our own systems.“Police thresholds are high and inconsistently applied. NHS systems compel repeated engagement with patients demonstrating vexatious behaviours, even after abusive or threatening behaviours.”GPs have consistently highlighted the need to deal with abuse...