The story so farIn my search for the earliest instances of the word “sleuth” and its derivatives in relation to observers of academic misconduct, I have found that there is a wide range of different types of sleuths, together calling out for a taxonomy.The origin of the word has so far been traced back only to a Norwegian word, sl?ð, meaning a track or a trail. However, that word must itself have had an antecedent form with a corresponding theoretical IndoEuropean forerunner. IndoEuropean roots starting with consonants such as K, L, M, P, T, or W sometimes have an S prefixed to them. For example, the root LEU, meaning to loosen or unbind, gives us words such as loose and lost, words ending in –less, implying absence, and lysis and its derivatives; and LEU has a counterpart, SLEU, to relax, giving us words such as sloth, slouch, and slow, sludge,...

NHS patients in England are struggling to access cutting edge cancer treatments because of bureaucracy and inadequate funding, senior doctors have warned.The Royal College of Radiologists (RCR) gave the warning as new analysis by Cancer Research UK (CRUK) showed that only half of people in England diagnosed with cancer after an urgent referral are being diagnosed on time.The RCR, which also represents oncologists, urged the government to overhaul the uneven commissioning and funding structures for cancer treatments that create “a postcode lottery” for access.Nicky Thorp, the RCR’s vice president for clinical oncology, said, “The government’s upcoming cancer plan presents a fantastic opportunity to reconsider how treatments are commissioned and funded.”In a briefing paper1 published on 11 September, the RCR said that “a cumbersome application process” that NHS trusts must undergo can delay the adoption of innovative treatments. It added that the funding received by trusts for delivering some treatments can...

Two part magnetic resonance imaging (MRI) is just as effective at diagnosing prostate cancer as the UK standard three part scan and is almost half the price, a study shows.1The researchers said their results could pave the way for a new standard of care in the UK, at a time when prostate cancer diagnosis tools are being assessed as part of a multimillion pound research programme back by the government.2However, independent experts warn that the alternative scanning method could do more harm than good. They argue that it fails to tackle concerns over prostate cancer overdiagnosis—and in a worst case scenario could actually cause an increased cost and burden to health systems.What did the study find?Funded by the John Black Charitable Foundation and Prostate Cancer UK and conducted by researchers from University College London (UCL), UCL Hospitals NHS Foundation Trust, and the University of Birmingham, the trial was conducted across...

US health secretary Robert F Kennedy Jr has officially unveiled the much anticipated second report of the Make America Healthy Again (MAHA) Commission.1He labelled it a “sweeping plan with more than 120 initiatives to reverse the failed policies that fuelled America’s childhood chronic disease epidemic.”2As with the first MAHA report, published in May,3 the primary focus is on tackling childhood obesity through improved nutrition and promoting physical activity, increasing the oversight of food additives and chemicals, and tackling environmental exposures.However, critics said the report was more of a manifesto than a detailed strategy, pointing to a lack of specific detail and concrete regulatory action.Elizabeth Kucinich, an organic food campaigner, said the pesticide section of the report directs the Environmental Protection Agency to partner with industry on public relations campaigns to convince Americans that the system is “robust.” The section “reads like it was written by Bayer and Monsanto,” she added.4In...

Over half of women giving birth in England, Scotland, and Wales did so by induction or caesarean section, a large scale audit has found.The latest National Maternity and Perinatal Audit (NMPA) of 592 594 births in 2023 shows that 50.6% involved a caesarean section or the use of instruments, compared with 40% in the previous report in 2018-19. In 2023, 49.4% of births were vaginal compared with 60% in 2018-19.The trend was driven by a rise in unplanned caesarean sections, which made up nearly a quarter (23.1%) of births in England, Scotland, and Wales in 2023 compared with 15% in 2018-19.Planned caesarean sections have also increased since the previous report, from 12.1% to 16.4%, the report by the royal colleges of midwives, obstetricians and gynaecologists (RCOG), and paediatrics and child health found.The latest audit, which will be followed by a more detailed report later this year, also found that around...

AbstractObjectiveTo evaluate the clinical effectiveness of the YCMAP intervention (Youth Culturally Adapted Manual Assisted Problem Solving) for adolescents after self-harm in Pakistan.DesignMulticentre, randomised controlled trial that compared YCMAP with enhanced treatment as usual.SettingsGeneral practices, emergency departments, medical wards of participating hospitals, and community centres across Karachi, Hyderabad, Lahore, Multan, and Rawalpindi.ParticipantsAdolescents with a recent history of self-harm identified at participating health centres by treating physicians between 5 November 2019 and 31 August 2021.InterventionThe YCMAP group received up to 10 treatment sessions over three months; the intervention was based on the principles of cognitive behaviour therapy.Main outcome measureThe primary outcome was the repetition of self-harm at 12 months after randomisation. Secondary outcomes were distress, hopelessness, suicidal ideation, and health related quality of life at three, six, nine, and 12 months after randomisation. Participants’ satisfaction with the services was assessed at three and 12 months after randomisation.ResultsThis trial was conducted between November 2019 and February 2023 and included 684 adolescents randomised to YCMAP (n=342) or enhanced treatment as usual (n=342). The YCMAP group had a significantly lower risk of self-harm repetition than the enhanced treatment as usual group at 12 months after randomisation (odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006). YCMAP participants showed a statistically significant reduction in distress, hopelessness, and suicidal ideation at three months, but these differences were not statistically significant at 12 months. YCMAP participants also reported significantly better quality of life and satisfaction with services at three months, with these effects sustained at all follow-up points.ConclusionThe YCMAP intervention was shown to be beneficial in self-harm prevention among adolescents. Further research and replication of findings in diverse settings are recommended to strengthen the evidence base for this public health intervention.Trial registrationClinicalTrials.gov NCT04131179 and ISRCTN registry ISRCTN57325925.

bmj;390/sep10_1/r1891/FAF1faIn the late 1960s and early 1970s a series of scandals shed much needed light on the plight of people with learning disabilities. Many were living in large institutions, removed from society, and were often treated appallingly by the people meant to care for them.In 1972 Oliver Russell, a child psychiatrist, was asked to provide two sessions a week at Farleigh Hospital in Bristol. The psychiatric hospital had been brought back under the health authority’s control in 1968 after three nurses were jailed for abusing patients. Hospital managers were resistant to the new regime, however, and it took Russell two years to persuade them to allow him to take charge of a single ward. When he eventually took over he found that 10 out of the 22 male patients were detained under the Mental Health Act 1959. Russell and a colleague interviewed the men and reviewed their notes.“By the end...

An industrial action ballot of first year doctors has been launched by the BMA, just days after the union said the majority of its senior doctor members are willing to strike over pay.Faced with the barrage of disputes, Health Secretary Wes Streeting has urged doctors not to let the union “derail” their careers.The ballot, open to BMA members who are foundation year 1 (FY1) doctors in England from 8 September until 6 October, demands the government “act to fix the unemployment crisis affecting resident doctors.”1In July a BMA survey of 4401 resident doctors with a response rate of around 5.7% found that a third of respondents had no planned substantive employment or regular locum work from August.2BMA Resident Doctors Committee co-chairs Ross Nieuwoudt and Melissa Ryan have called the unemployment figures a scandal, saying, “Thousands of doctors have been left in career limbo while patients desperately need them. We are...

People seeking assisted dying should undergo an assessment with a palliative care specialist, experts have argued ahead of the official Lords debate on the Terminally Ill Adults (End of Life) Bill on Friday 12 September.At a roundtable event organised by The BMJ and hosted on 9 September by the Conservative politician and former health minister James Bethell and the Labour MP Simon Opher of the All Party Parliamentary Health Group, experts from across the NHS and social care, as well as peers, discussed the challenges posed by the current bill and amendments that could improve its implementation.While some raised concerns over adding unnecessary layers of bureaucracy to the system, others argued the need for a specialist palliative care assessment as part of the process to ensure that patients can make an informed decision. Experts also discussed whether assisted dying should be considered a treatment or a service, reaching a consensus...

The Conservative Party leader’s career could have taken a very different turn had she snapped up a place nearly 30 years ago to study medicine at the elite Stanford University in the United States. But what sounds like a potential Sliding Doors moment may not be as straightforward as it seems.Media reports have raised doubts over Kemi Badenoch’s claims that she was offered a place and a partial scholarship to study in California at 16 years of age but couldn’t take up the “pre-med” owing to family circumstances.Politicians in the UK have urged Badenoch to clarify the record and provide documentary proof after former Stanford admission staff told the Guardian that they couldn’t recall such an offer having been made and described such a scenario as impossible.1Medicine at Stanford—where competition for places is intense—is for graduates only, and the university’s website suggests that there was no pre-med degree at the...

AbstractObjectiveTo determine the effect of a prepregnancy lifestyle intervention on glucose tolerance in people at higher risk of gestational diabetes mellitus.DesignSingle centre randomised controlled trial (BEFORE THE BEGINNING).SettingUniversity hospital in Trondheim, Norway.Participants167 participants with at least one risk factor for gestational diabetes mellitus who contemplated pregnancy.InterventionThe participants were randomly allocated (1:1) to a lifestyle intervention or a standard care control group. The intervention consisted of exercise training and time restricted eating, started before pregnancy and continued throughout pregnancy. Exercise volume was set using a physical activity metric that translates heart rate into a score (personal activity intelligence, PAI), with the goal of ?100 weekly PAI points. Time restricted eating involved consuming all energy within ?10 hours/day for at least five days a week.Main outcome measuresTwo hour plasma glucose level in an oral glucose tolerance test at gestational week 28. The primary analysis used an intention-to-treat principle.Results167 participants were enrolled from 2 October 2020 to 12 May 2023: 84 in the intervention group and 83 in the control group, out of whom 111 became pregnant (56 in intervention group and 55 in control group). One participant in the intervention group was excluded from the analysis because of prepregnancy diabetes. Pregnancy data from one participant in the control group were excluded from the analysis because of twin pregnancy. The intervention had no significant effect on two hour plasma glucose level in an oral glucose tolerance test at gestational week 28 (mean difference 0.48 mmol/L, 95% confidence interval ?0.05 to 1.01, P=0.08). In the prepregnancy period, 31/83 participants (37%) in the intervention group adhered to prespecified criteria, whereas 24/55 participants (44%) in the intervention group who became pregnant fulfilled these criteria. During the prepregnancy period, the average eating window was 9.9 hours/day (standard deviation 1.2) and the average number of weekly PAI points was 111 (standard deviation 54), but the adherence to both intervention components decreased during pregnancy.ConclusionsA combination of time restricted eating and exercise training started before and continued throughout pregnancy had no significant effect on glycaemic control in late pregnancy.Trial registrationClinicalTrials.gov NCT04585581.

Each year brings variations to the GP contract, and one hotly debated tweak this year was the stipulation that patients should be able to contact their practice online throughout core hours (8 am to 6 30 pm). On the face of it this doesn’t sound very onerous, but if a patient sends an online query at 6 29 pm, someone has to be there to read it and decide whether it needs an urgent response.This is because, mixed in with requests for a repeat “fit note” and advice on which vitamin supplement the GP would recommend to a patient with acne, there will be a query about whether a parent should be worried about their child who has a rash and a fever. No matter how clearly you signpost that this communication channel isn’t for urgent medical questions, patients will still use it for these. So, most practices currently turn...

I fully support the government investing in new IT and artificial intelligence (AI) for the NHS,1 but I think that it needs to fix the current IT problems in the NHS first.My hospital is one of a handful in the country that still does not have a proper electronic patient record (EPR) system. Unfortunately, this has been delayed as the trust cannot afford to pay for even the cheapest EPR system. Before investing in the NHS app and other new IT based solutions, I think the government needs to put forward the cash to get my hospital, and the others, an updated EPR system. It is hard to deliver the efficient care the government requires with our current systems.

In the US, few healthcare experiences are as universally resented (and feared) as an unexpected medical bill. Such “surprise” medical bills arise when patients receive care from clinicians who they did not authorize to care for them and do not participate in their insurance plan. These situations occur because most adults in the US have private health insurance, typically obtained through their employer. For each private insurance plan, the insurer negotiates a specific fee schedule with healthcare providers included in its insurance network. If insurers and healthcare providers cannot agree on reimbursement rates—or a contract is never pursued—the clinician or hospital will be excluded from the insurance plan’s network (out of network).Before the No Surprises Act legislation, evaluated in the linked study by Liu and colleagues (doi:10.1136/bmj-2025-084803),1 out-of-network providers could charge patients whatever they chose. Insurers were under no obligation to pay the full charges, and if they paid less,...

A recent review into the role of physician assistants has had a catastrophic effect on their mental health, with some even considering suicide, a survey indicates.It follows the landmark review of PAs by Gillian Leng, which recommended sweeping changes to the role. These included a name change from physician associates and that PAs must no longer see undifferentiated patients, except within clearly defined protocols.Concerns over possible job losses,1 uncertainty over the future of the role, and reported hostility towards them among some doctors have prompted concerns about PAs’ mental health.2In the new survey the PAs’ trade union, United Medical Associate Professionals (UMAPs), asked members about their mental health, using questions from the patient health questionnaire 9 (PHQ-9). This self-administered questionnaire is used in NHS talking therapies to screen and measure the severity of depression but does not provide a definitive diagnosis.3The survey was conducted over 24 hours, 8-9 August 2025....

Researchers have urged the World Health Organization not to scrap a landmark report on the commercial determinants of health amid concern that it is at risk from the financial crisis engulfing the agency.WHO’s first ever global report on the commercial determinants of health,1 analysing the effect of corporate industries on peoples’ health and recommending policy, was due to be published this year. But after rumours that the report could be scrapped in the wake of US aid cuts, 12 academics, experts, and former employees of WHO wrote its director general, Tedros Adhanom Ghebreyesus, last month to express “extreme concern” that work in this area “may be entirely lost.”Financial crisisIn their letter to Tedros, seen by The BMJ, the experts claimed that the report has been threatened by the “financial crisis that WHO is facing following the withdrawal of the USA and its funding from the organisation.”In March the Trump administration...

Countries should move towards banning all forms of surrogacy, a new UN report has said.1The UN’s special rapporteur on violence against women and girls, Reem al Salem, called for a ban on the grounds of the “exploitation and violence against women and girls” that characterises surrogacy arrangements, as well as health risks to the mother and baby.Al Salem will present the report to the UN General Assembly in October 2025. It will call for the 193 UN member states to “take steps towards eradicating surrogacy in all its forms.” Pending its abolition, states should adopt a legal and policy framework for surrogacy that is modelled on the Nordic model for prostitution and includes penalties for commissioning parents and surrogacy agencies alongside decriminalisation and exit support strategies for surrogate mothers.The report cites higher rates of caesarean section, gestational diabetes, hypertension, preeclampsia, and placenta previa in surrogate births, and lower birth weights...

NHS England has issued a 10 point plan to improve the working lives of the 75 000 resident doctors it says form the “backbone” of the health service.The plan, sent to NHS trusts on 29 August, emphasised the importance of fixing “unacceptable working practices” that younger doctors too often face during their employment.1These include tackling “basic issues” such as payroll errors, poor rota management, lack of access to rest facilities and hot food, and unnecessarily repeating training, it said (box 1).Box 1NHS England’s 10 point plan to improve resident doctors’ working livesTrusts should take action to improve the working environment and wellbeing of resident doctorsResident doctors must receive work schedules and rota information in line with NHS England’s resident doctors rota code of practice4Resident doctors should be able to take annual leave in a fair and equitable way and which enables wellbeingAll NHS trust boards should appoint two named leads:...

The “publish or perish” doctrineBeing interested in why people write, and having surveyed the musings of several well known writers, including Alphonse Daudet, Joan Didion, E M Forster, Neil M Gunn, Rayner Heppenstall, Stephen King, George Orwell, and Alfred Perlès, I have come to the conclusion, following the trail of the cacoethes scribendi, first laid by the Roman poet Juvenal, that the main reason for the itch to write is the need for self-comprehension. Or, as Stephen King put it, “I write to find out what I think.”1Among others who have tackled the question of why they write, the Canadian writer Mordecai Richler repeated Orwell’s quartet of reasons (egoism, aesthetic enthusiasm, historical impulse, and political purpose) and recognised being “driven by some demon whom one can neither resist nor understand.” However, he might have seemed to have failed to realise the source of this as a need to know what...

More than half a million people in Gaza are now “trapped in famine,” as food and clean water continue to be used as weapons of war as part of Israel’s “genocidal campaign,” aid agencies have said.The latest report from the Integrated Food Security Phase Classification (IPC) system has confirmed that famine is now widespread in Gaza. This is the first time a famine has been officially declared in the Middle East region.1 It means that three critical thresholds have been met: extreme food deprivation, acute malnutrition, and deaths related to starvation.Save the Children’s international chief executive officer, Inger Ashing, said, “All of Gaza is being systematically starved by design, and children are paying the highest price. The world has failed to act as their tiny, emaciated bodies have been overcome by hunger and disease and shut down.“This engineered famine is the ultimate and inevitable result of the government of Israel’s...