bmj;393/apr02_10/s609/FAF1faJohn was born in Northern Rhodesia (now Zambia) where his parents were working with a Church of Scotland mission, his father as medical officer. After his mother contracted poliomyelitis, the family moved with their four children to a general practice south of Edinburgh. From George Watson’s College John proceeded to the University of St Andrews and, for his clinical years, to Dundee. St Andrews—the little grey town by the grey North Sea—was always a “region of his heart’s desire” and it was where he met and married Christine Davidson, a fellow medical student.After hospital posts, the Martins settled in Inverness, both in general practice. For many years John was a GP trainer and had a particular interest in the expectations of, and challenges faced, by sixth formers considering a life in medicine and by medical students planning their careers. Towards the end of his years in Inverness he took a...

A preschool child presented with a three day history of painless, non-pruritic pustules on her right palm (fig1). She was otherwise well, with no relevant medical history. The family reported keeping a pet rabbit at home.bmj;393/apr02_9/e086736/F1F1f1Fig 1Physical examination showed erythema, vesicles, and pustules localised to the ulnar aspect of the right palm. Bacterial culture of the pustule fluid showed negative results, whereas the results of the fungal culture were positive for Trichophyton mentagrophytes. Direct microscopic examination of skin scrapings showed abundant fungal hyphae. A fur sample taken from the rabbit was positive for the same fungal species when tested with a fungal culture.A diagnosis of inflammatory tinea manuum was made.T. mentagrophytes is a common causative pathogen in dermatophytosis, which affects about 25% of the global population, with markedly higher prevalence in tropical and subtropical regions.1Rodents and rabbits serve as primary reservoir hosts for zoophilic T. mentagrophytes. When humans are infected,...

The covid-19 pandemic exposed three longstanding problems with pulse oximetry. Firstly, pulse oximeters can produce inaccurate readings in some patients.12 Secondly, even small levels of inaccuracy can harm patients when clinicians follow guidelines in which critical clinical decisions are based on an absolute or narrow range of oxygen saturation values.3 Thirdly, many clinicians are unaware of the potential for pulse oximeters to produce inaccurate readings and the factors that can cause this (including patients with darker skin tones), as well as the importance of interpreting and evaluating oxygen saturation readings in their clinical context and with an understanding of the limitations and imperfections of pulse oximetry.1456Since the pandemic, the focus has been on improving the performance, testing, and regulation of pulse oximeters. But improvements in accuracy must be accompanied by improvements in training in pulse oximetry.Most clinicians have little, if any, training in pulse oximetry and no national guideline or...

The theme of World Health Day 2026, on 7 April, is “Together for health. Stand with science.”1 It marks the beginning of a year long campaign “celebrating the power of scientific collaboration to protect the health of people, animals, plants, and the planet.” This could not be more timely. In the immediate aftermath of the 2024 US presidential election, we warned that a second Trump administration would be a grave threat to evidence informed public health.2 But we, like many others, had no idea just how bad things would become.The damage to US science has been immense. The Trump administration has targeted the foundations of the science-policy interface, taking control of appointments, advisory processes, data access, and funding rules. The health consequences are already apparent, with the vaccine scepticism that has become an article of faith among the president’s acolytes contributing to outbreaks and some deaths from measles.3 Looking ahead,...

Few developments in psychopharmacology attract as much attention among clinicians, researchers, and the public alike, as psychedelics. The psychoactive compounds psilocybin and 3,4-methylenedioxymethamphetamine (MDMA), which produce profound alterations in consciousness and mental state, have reached phase 3 trials for treatment resistant depression and post-traumatic stress disorder (PTSD) respectively. These advances reflect a resurgence of interest after decades of regulatory prohibition,1 with few trials conducted before 2017, rising to over 134 registered for psilocybin alone by 2023.2 Today, what makes these drugs fascinating is their unconventional treatment model: rather than prolonged and sometimes lifelong daily dosing, psychedelics are hypothesised to produce acute and enduring change after only one to three doses.A recent review on psychedelic medicine in TheBMJ synthesises a complex body of data on the mechanisms, clinical findings, and translational challenges, and discusses key challenges including mechanistic uncertainty, functional unblinding, inconsistent adverse event monitoring, and scalability (doi:10.1136/bmj-2024-081723).3 Although findings from...

There are at least 996 shisha cafes in the UK, an increase of 33% in the past five years, and London has more shisha cafes than branches of McDonald’s.1 Yet the smoking of shisha tobacco (see box 1) continues to be overlooked as a public health matter, contributing to the widening of existing inequalities.Box 1What is shisha?Shisha, also known as hookah, narghile, and hubble bubble, is a waterpipe that is used to smoke a charcoal heated tobacco mix. Smoke passes through water before being inhaled through a hose-like pipe. The origin of shisha dates back centuries and it is especially common across the Middle East and South Asia.Shisha tobacco is generally flavoured and has become increasingly popular in the UK,2 especially among young people and those from Middle Eastern, North African, and South Asian backgrounds. It is primarily smoked socially and, though it can be smoked in homes, it is...

Just a few weeks apart, parliaments in Scotland and Jersey voted on assisted dying legislation with very different outcomes. The Assisted Dying for Terminally Ill Adults Bill was rejected in Scotland, while a draft law on assisted dying was approved in Jersey.12 The Terminally Ill Adults (End of Life) Bill for England and Wales is likely to fall in the House of Lords despite being approved by the House of Commons, and the prospect of it returning in the future is uncertain.34 It is important to consider the factors contributing to varying outcomes and reflect on what can be learnt from Jersey and Scotland.The legislative proposals in Scotland and Jersey have key differences.12 The Scottish bill bears greater similarity to the one going through the Westminster parliament. Two doctors must assess eligibility, approve the assisted dying decision, and then one doctor prescribes the medication that the patient self-administers. The Jersey...

A Colorado state ban on conversion therapy for minors likely violates constitutional protections of free speech, the US Supreme Court has ruled.The decision—widely criticised by LGBTQ+ advocacy groups—will send the case to the lower courts to determine whether therapists can resume offering gender conversion therapy to minors.This could have implications for similar laws in states across the US.The case was brought by Kaley Chiles, a counsellor from Colorado Springs, who argued that the state’s 2019 ban on licensed doctors or mental health professionals “converting” lesbian, gay, or transgender people unlawfully restricted her ability to provide talk therapy to clients who sought to change their sexual orientation or gender identity.The court voted 8-1 to side with Chiles, with liberal justices Elena Kagan and Sonia Sotomayor joining the conservative majority.Justice Neil Gorsuch said in his written decision, “While the First Amendment protects many and varied forms of expression, the spoken word is...

If you ask any doctor how their day is going, they’ll almost certainly reply “busy.” It’s an almost universal state of being in medicine, and we declare it like a kind of tic. But what if being perpetually busy isn’t just a symptom of being under pressure but one of its principal causes? Bob Klaber—a paediatrician at Imperial College Healthcare NHS Trust and its director of strategy, research, and innovation—argues that our collective busy-ness is a barrier to all the changes we say we want. When every minute is ridiculously full there’s no space for reflection, human connection, or the careful conversations from which better care emerges—and no time for teaching the next generation.Klaber invites us to adopt a different attitude to our work, one that de-emphasises frantic activity and multitasking and gives priority to being available for people and listening. As a clinician, he seems to practise what he...

Social media use makes it hard to separate a genuine rise from diagnostic inflation, but blaming it is an oversimplification—Annabeth P Groenman, Tessa Copp, Kirsten McCaffery, and Jesse JansenThe Lancet Psychiatry commission on youth mental health has called for action on a global “youth mental health crisis.”1 Rates of diagnosed mental health conditions have been rising in young people. For example, 11.4% of children in the US currently have a classification of attention deficit/hyperactivity disorder (ADHD). In specific groups this figure is even higher: around 22% of 17 year old boys in the US have received an ADHD classification at some point in their life.2This raises the question of whether young people’s mental health is actually worse than in the past, or whether we’re simply recognising and labelling what was always there.Many academics point to social media as a key driver for the rise in mental health conditions among young...

Yamey and Shaffer discuss how Trump and Robert F Kennedy Jr have promoted misinformation.1 Vaccine scepticism in the US is long standing, but recent revisions to the childhood immunisation schedule and other vaccine policy shifts risk intensifying public confusion and reinforcing discredited safety claims.2345Misinformation provided by the government heightens physicians’ responsibility to counter vaccine myths and misunderstandings. Fact based counselling remains vital. But innovative communication strategies are also needed to rebuild trust in routine childhood immunisations to prevent avoidable illness and restore population level immunity.Physicians can reclaim the narrative by pairing rigorous epidemiological data with human stories, translating statistics into tangible outcomes. A de-identified clinical vignette, for example, might describe a young adult with swollen lymph nodes, fatigue, and jaundice whose advanced cirrhosis from chronic hepatitis B necessitates a liver transplant. Timely vaccination could have prevented this condition.Physicians can use visual aids, displaying lifetime risks of vaccine preventable illnesses with...

A Kent hospital has admitted to being too slow to alert the UK Health Security Agency (UKHSA) to a suspected case of meningitis.There is a legal requirement for suspected cases of acute meningitis to be reported to the UKHSA immediately without waiting for laboratory confirmation of the disease.1 However, it has now emerged that this did not happen for the first known case of the Kent outbreak, which eventually included dozens of cases and the deaths of two young people.2The hospital’s delay in reporting meant that the UKHSA did not start investigating a potential outbreak as soon as it could have. It also led to delays in contacting and treating any close contacts of the patient.The Kent outbreak of meningitis B now seems to have passed its peak, with no new cases reported for the past five days. As of 24 March the confirmed number of cases of invasive meningococcal...

The scandal over student loan debt and interest has rightly dominated headlines in the past few weeks.12 The plan from chancellor Rachel Reeves to freeze loan repayment thresholds represents yet another burden placed on a financially beleaguered generation. For doctors, this new hit to our income feels like two steps back in the ongoing struggle for pay restoration. Something needs to change to relieve the financial strain on doctors.Last month I made the brave decision to check my student loan balance. I should have prepared myself more for the shock. Over my six year degree in medicine, I borrowed £44 000 but by my graduation I had accrued an additional £11 000 of interest before I had even started earning. My current balance sits at £63 500 and I’m only now close to paying off as much per month as I’m being charged in interest. I suspect most younger doctors...

The UK government must set out clear national standards to tackle “serious inadequacies” and staff shortages in children’s palliative care services, a group of MPs has urged.The House of Commons Health and Social Care Committee’s report on palliative care in England1 says that people enter a “postcode lottery” of care in their most vulnerable moments at the end of life. This variability is compounded by a workforce declining in numbers, the MPs warned.The report calls for a plan to increase the numbers of specialist doctors, nurses, and other healthcare professionals working across the palliative care sector. It emphasises that action is most urgently needed in children and young people’s palliative care, and it urges the government to include specific standards in its upcoming modern service framework later this year.The charity Together for Short Lives has estimated that 99 000 UK children were seriously ill in 2025.2 The committee’s report says...

Campaigners have criticised a midwifery journal for sending out an “inappropriate” prize survey targeting health professionals that was sponsored by a formula milk company.The survey of midwives and health visitors was shared by the British Journal of Midwifery in February. It is sponsored by SMA infant formula, owned by food and beverage giant Nestlé.Healthcare professionals who completed the survey and provided their personal details were entered into a prize draw for £100 of Amazon gift vouchers.Although the British Journal of Midwifery states at the beginning of the survey they “firmly believe that breastfeeding is always the best option for a baby,” all the questions relate to formula feeding and infant gut health.Victoria Thomas, a consultant paediatrician and co-chair of the Hospital Infant Feeding Network, said the survey reads as “a thinly veiled marketing exercise.”“I do not think it is appropriate for a scientific journal to send out a survey such...

After the creation of Bangladesh in 1971, the entire political, economic, and medical system was in disarray: the UK General Medical Council withdrew its recognition of medical graduates and the country faced a severe shortage of doctors. Ali Ashraf played a pivotal role in restoring standards of medical education, particularly in the surgical specialties. He was one of the prime movers in the establishment of the Bangladesh College of Physicians and Surgeons (BCPS) in 1972, a postgraduate medical institute modelled on the royal colleges in the UK. He held key positions in the BCPS and served as its vice president and president for 10 years.Ashraf and the founding president of Bangladesh, Sheikh Mujibur Rahman, had known each other as students in Calcutta and when Ashraf treated the president’s wife in the early days of the new country he seized the opportunity to highlight the severe shortage of trained doctors.In June...

AbstractObjectiveTo evaluate the efficacy of a clinical decision support system (CDSS) on stroke care quality and clinical outcomes among patients with acute ischaemic stroke.DesignMulticentre, cluster randomised clinical trial.Setting77 hospitals across China.Participants77 hospitals (38 randomised to intervention group, 39 to control group) enrolled 21?603 patients with acute ischaemic stroke admitted to hospital within seven days after symptom onset.InterventionsHospitals in the intervention group received stroke CDSS support including artificial intelligence assisted imaging analysis, classification of stroke causes, and evidence based treatment recommendations. Hospitals in the control group provided usual care.Main outcomes measuresThe primary outcome was a new vascular event (composite of ischaemic stroke, haemorrhagic stroke, myocardial infarction, and vascular death) within three months after initial symptom onset. Secondary outcomes included the composite measure and all-or-none measure of evidence based performance measures for acute ischaemic stroke care quality, a new vascular event at six and 12 months, and disability (modified Rankin Scale score 3-6) and all cause mortality at three, six, and 12 months. Safety outcomes were moderate or severe bleeding events and all bleeding events at three, six, and 12 months.Results11?054 patients in the intervention group and 10?549 patients in the control group were enrolled from January 2021 to June 2023. New vascular events at three months occurred in 2.9% (320/11?054) in the intervention group compared with 3.9% (416/10?549) in the control group (adjusted hazard ratio 0.74, 95% confidence interval (CI) 0.58 to 0.93, P=0.01). The CDSS intervention effect remained significant in the cluster level analysis (?0.01, ?0.02 to ?0.004, P=0.003). Patients in the intervention group were more likely to have a higher composite measure (91.4% (77?049/84?276) v 89.8% (70?794/78?834), adjusted odds ratio 1.21, 95% CI 1.17 to 1.26, P<0.001). New vascular events were significantly lower in the intervention group at 12 months (4.0% (440/11?054) v 5.5% (576/10?549), adjusted hazard ratio 0.73, 95% CI 0.56 to 0.95, P=0.02). No significant differences were found in disability and all cause mortality. Moderate or severe bleeding, and all bleeding did not differ significantly between the two groups.ConclusionsUse of the stroke CDSS in patients with acute ischaemic stroke in China led to a significant decrease in new vascular events at three months. The stroke CDSS intervention was also effective in improving stroke care quality and decreasing long term vascular events.Trial registrationClinicalTrials.gov NCT04524624

William Blake, George Russell, and Aldous HuxleyAldous Huxley (1894?1963) is best known as a novelist, particularly for his futuristic science fiction novel Brave New World (1932), although most of his other well known novels were social satires.However, Huxley was also a poet and essayist, his best known essays being two that are often published together: The Doors of Perception (1954) and Heaven and Hell (1956). In the former, Huxley described his disappointing experience with mescaline:“I swallowed four-tenths of a gram of mescalin dissolved in half a glass of water and sat down to wait for the results. … From what I had read of the mescalin experience I was convinced in advance that the drug would admit me, at least for a few hours, into the kind of inner world described by Blake and AE. But what I had expected did not happen. I had expected to lie with my...

NHS watchdogs will re-evaluate their decision not to fund two new Alzheimer’s treatments on the health service after appeals from the drugs’ manufacturers.The National Institute for Health and Care Excellence (NICE) has also confirmed that the reassessment will take place under new, and controversial, cost effectiveness thresholds that were agreed as part of a trade deal with the US.1NICE previously concluded in June234 that lecanemab and donanemab should not be provided on the NHS for treating mild cognitive impairment or mild dementia caused by Alzheimer’s disease.Despite substantial interest in the drugs from patient representative groups NICE determined that neither was a cost effective use of NHS resources.The treatments were estimated to cost five to six times more than the threshold NICE can normally recommend, with high rollout costs including both regular infusions and monitoring of side effects such as swelling and brain bleeds.But NICE has now said it will review...

What has led to such a large spike in cases when compared with previous outbreaks?“This is the most fascinating question that has arisen from this outbreak,” says Emma Wall, clinical professor of infectious diseases at Queen Mary University of London. She tells The BMJ, “Meningitis A outbreaks in the Sahel [semi-arid region extending from Senegal in West Africa to Sudan and Eritrea in East Africa] can comprise thousands of cases, but MenB has never caused an outbreak of this size before.”While the UK has previously seen meningitis outbreaks caused by the bacterial strain B of meningitis (MenB), case numbers have been small—as with the two cases seen in nursery in 20231—or have occurred over many years, as happened in Gloucestershire in the 1980s.2“It’s speculation, but whether this strain has acquired the ability to spread more rapidly is something under investigation,” Wall explains. “Otherwise, I suspect this is due more to...