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...

Davies provides a salutary reminder of the harm that can be caused by the diagnoses we make.1 Most melanoma in situ is biologically indolent and will never progress, and the dramatic rise in incidence is largely a marker of diagnostic scrutiny. The absence of a corresponding fall in invasive melanomas is the hallmark of overdiagnosis.2 I hope she will take consolation from the fact that a diagnosis of melanoma in situ is associated with an overall reduced risk of death from any cause over the 15 years after diagnosis, which greatly exceeds any (exceedingly small) risk of death from melanoma.3Overdiagnosis of melanoma is being recognised as a major problem in dermatology.45 Several factors have contributed, including social media messaging; government cancer targets with increased melanoma awareness; and for-profit “mole screening” shops on high streets, open to anyone despite the absence of any evidence that undirected mole screening reduces melanoma mortality....

A new outbreak of Ebola virus disease in central Africa, caused by the rare Bundibugyo version of the virus, has caused more than 300 suspected cases and killed 100 people, health officials have said.The World Health Organization (WHO) has declared the situation a public health emergency of international concern.1The Africa Centres for Disease Control and Prevention (Africa CDC) has so far identified 336 suspected and 10 confirmed cases in the Democratic Republic of the Congo (DRC).2 There have been 87 deaths in the DRC to date. Uganda has had two confirmed cases and one additional death.3In response WHO has sent five tonnes of medical supplies to the DRC, and $500 000 (£374 000; €430 000) has been released from the agency's contingency fund for emergencies.This Ebola outbreak is causing particular concern because it has been caused by the Bundibugyo strain, which has been detected in only two previous outbreaks, in...

Screening with a PSA (prostate specific antigen) blood test reduces prostate cancer deaths by two for every 1000 men screened, though the risk of overdiagnosis remains high, an updated Cochrane review says.1The evidence of a “modest” benefit is a shift from a 2013 Cochrane review that concluded there was not enough evidence that screening reduced prostate cancer deaths.In the UK, more than 64 000 men are given a prostate cancer diagnosis every year, and one in eight will receive a diagnosis in their lifetime.The merits of routine screening for prostate cancer have long been debated. In recent years there has been high profile campaigning for PSA testing to be rolled out more widely, including by former prime ministers Rishi Sunak and David Cameron and the Olympic cyclist Chris Hoy.However, last year the UK National Screening Committee advised against routine screening for prostate cancer, saying the harms outweighed the benefits.2 Instead...

I want to take a career break—what do I need to know?Considering why you want to take a break and what you want to achieve can be a great place to start.Lucy Henshall—founder of Welcome Back to Work (https://www.welcomebacktowork.co.uk/), which provides support for GPs returning to work after a break—says: “You need to decide what is important to you.“People take career breaks for many different reasons, and there is no right or wrong path. It is a very personal decision that needs careful thought to minimise the hurdles and mitigate the risks when you do return to medicine.”Henshall, a retired GP, says that taking breaks was not the norm when she qualified back in 1987 but that “times have changed.”“Life is much more complicated for young medics now—and student debts are higher than ever,” she says. “The heady combination of excessive workloads, financial pressures, social isolation due to frequent geographic...

One French woman and one US national who disembarked from the cruise ship MV Hondius have now tested positive for hantavirus.Another US national was also reported as showing symptoms of possible infection. The fresh wave of cases came as passengers disembarking the ship were repatriated after the MV Hondius docked in the Canary Islands on the morning of 10 May.The World Health Organization (WHO) has confirmed that the hantavirus outbreak on the ship1 was caused by the Andes strain of the virus, which has been known to spread between people. As of 8 May eight cases were confirmed or suspected on board, of which three had proved fatal. By 10 May this had risen to 10 cases, said US and Spanish officials.Giulia Gallo, postdoctoral scientist in the viral glycoproteins group at the UK’s Pirbright Institute, said that the potentially new cases derived from the same cluster of exposed people on...

A risky gamble?It’s certainly a controversial one. But the practice of staking money on the likelihood of disease outbreaks or future pandemics is a growing trend, with gamblers flocking to online prediction market platforms like Polymarket to lay down their money.1High stakes?You bet. In the wake of the hantavirus outbreak on a cruise ship, traders are placing wagers on whether it will escalate into a pandemic1 (as defined by the World Health Organization) before the end of 2026. As of 11 May, a whopping $6m has been staked.What are prediction markets?Essentially, they allow people to bet on the outcomes of future events. Online platforms like Polymarket and Kalshi allow users to stake money on all manner of events such as elections, sports results, and major global events.Dead pool?The hantavirus market is the latest controversial market to emerge. Recently, gamblers started placing bets on how many people would be infected with...

In this paper by Sandbank and colleagues (BMJ 2023;383: e076733, doi:10.1136/bmj-2023-076733, published 14 November 2023), supplementary tables S3 and S4 included limited reference information. These tables have been corrected to include full reference information.

Doctors who have been struck off in one European Union country are continuing to practise in another, an investigation has found.News outlets De Tijd, Le Monde, and France Télévision found that four French doctors barred from practising in France had subsequently obtained licences in Belgium.1One doctor was a 65 year old French cardiologist convicted in April 2024 of sexually assaulting his patients in France. The Brussels based Iris Hospitals South that hired him said it was not aware he had a criminal record until it was contacted by journalists.The hospital group said it had followed procedures by checking the practitioner’s licence with Belgium’s Federal Public Service for Health and the Order of Physicians.“The hospital had no legal basis, or any indication whatsoever, that would allow it to identify or suspect such a situation,” hospital spokesperson Céline Barcham said. After being alerted to the cardiologist’s past, the hospital fired him in...

Thirty US psychiatrists and other doctors specialising in mental health have signed a statement declaring President Donald Trump mentally unfit to serve, warning that his ability to launch nuclear weapons is a “danger” to the world.The signatories say that Trump’s behaviour over the past year has shown “objectively observable signs of serious medical concern.”They cited examples of his “marked deterioration in cognitive functioning,” “episodes of apparent somnolence during critical public proceedings,” “severely impaired judgment and impulse control,” and “significant loss of self-control,” as well as “grandiose and delusional beliefs, including assertions of infallibility, imagery of himself as Pope suggestive of a divine mission.”The doctors called for Trump’s immediate removal from office, arguing that he presents a “clear and present danger” to the whole world.“It is our expert opinion that Donald J Trump is mentally unfit to be the president of the United States and that steps to remove him from...

Lawyers for the US state of Pennsylvania have filed a lawsuit against a company it alleges is allowing a chatbot to impersonate a doctor.1Pennsylvania filed the action against the tech company Character.AI after a state investigator posing as a patient was told by an AI chatbot that it was licensed to practise medicine in Pennsylvania and the UK and provided a fake Pennsylvania medical licence number.“We will not allow companies to deploy AI tools that mislead people into believing they are receiving advice from a licensed medical professional,” said Josh Shapiro, governor of Pennsylvania, in a statement announcing the lawsuit.2Character.AI allows users to interact with themed AI personas that can pose as particular people, members of certain professions, or fictional characters. Responding to the lawsuit, a Character.AI spokesperson said, “We have taken robust steps to make that clear, including prominent disclaimers in every chat to remind users that a Character...

Doctors who prescribe psychiatric medications should regularly review whether the drugs are effective and, if not, consider deprescribing and using non-medication approaches, the Trump administration announced in an “action plan” to tackle overprescribing.“Today, we take clear and decisive action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications—especially among children,” said the health and human services secretary, Robert F Kennedy Jr.1“We will support patient autonomy, require informed consent and shared decision making, and shift the standard of care toward prevention, transparency, and a more holistic approach to mental health,” he added.The idea that overprescribing of psychiatric drugs is harming young people has been a popular topic for Kennedy for many years. “We are not just overmedicating our children, we are overmedicating our entire population,” he said at his 2025 confirmation hearing.2 He told that hearing that 15% of US children were taking drugs for attention...

Artificial intelligence (AI) is becoming part of everyday clinical life. From drafting clinic letters to suggesting differential diagnoses, it is changing how we learn and practise medicine. For doctors in training, its use can often feel like progress, saving time, reducing uncertainty, and making us more efficient. But we should pause before celebrating too quickly. If we rely on AI too early in our clinical training, before core clinical reasoning skills are fully developed, we risk losing the one skill that defines our profession: the ability to think.Recent evidence suggests that this risk is not theoretical. In a multicentre, observational study, endoscopists who routinely used AI to detect polyps saw their accuracy drop when they performed colonoscopies without AI assistance.1The adenoma detection rate fell from 28% to 22% after just a few months of exposure.1 The researchers concluded that continuous exposure to AI might dull independent ability, subtly changing how...