In September 2025 a patient sent a digital inquiry to the GP Rachel James’s surgery in south London. The patient had presented at an emergency department the night before, had been discharged, and was asking for an urgent referral to a specialist. James was able to access the emergency department’s notes stating the diagnosis and advice for the patient to contact their GP for a routine referral if symptoms worsened.James messaged the department back, saying that she and the patient could talk about the issue at an appointment the patient had booked on the surgery’s system for the following month. Two days later, however, the patient submitted another inquiry through the Accurx digital communication tool, begging the GP for a referral because of abnormal results from their hospital blood test.The patient’s concern and persistence stemmed from them being able to see their blood results on MyChart, a patient facing digital...

The General Medical Council (GMC) is appealing to the High Court against a decision clearing a British-Palestinian plastic surgeon of support for terrorism and for the proscribed organisation Hamas.A medical practitioners tribunal last month found that allegations against Ghassan Abu-Sitta over a 2018 newspaper article and two reposts on Twitter (now X) were not proved.1 But the doctors’ regulator will argue at the High Court that the article and one retweet did support violence and/or terrorism and that the other retweet supported a proscribed organisation and terrorism.However, the GMC is not challenging the tribunal’s decision that the comments in the article were not proved to be objectively antisemitic.A GMC spokesperson said, “Exercising our right of appeal is something we do with great care and only after detailed consideration. Our focus is protecting the public, and we are satisfied given the nature of the allegations that it is right that we...

A study claiming that substituting nurses for doctors in a host of hospital settings is not only safe and effective but sometimes better for patients has critical flaws, experts have warned.Furore erupted last week when the results of a Cochrane evidence review1 were presented and then reported in the media. The review examined the effects of substituting nurses for doctors in a range of hospital settings.Researchers from Ireland, the UK, and Australia examined 82 randomised studies involving more than 28 000 patients across 20 countries. Their meta-analysis reported “little to no difference” between nurse led and doctor led care for critical outcomes, including mortality, quality of life, self-efficacy, and patient safety events.The studies included four types of interventions in different clinical settings where nurses of various seniority replaced doctors in specialties such as cardiology, diabetes, cancer, obstetrics/gynaecology, and rheumatology. The four interventions were:Inpatient services, where nurses looked after post?acute medical...

Artificial intelligence (AI) plays an increasing role in medical diagnosis, particularly in image recognition. In cancer pathways, AI tools are already established in mammography screening, where they can improve diagnostic performance and increase efficiency.12 But we need to consider what happens and who is responsible when AI gets it wrong.Cancer specialists have long used clinical decision aids in diagnosis and treatment. Initially based on published evidence or guidelines, decision support tools are now regulated as medical devices and products, such as the PREDICT3 breast cancer survival and treatment model, and have had to achieve both professional acceptance and regulatory compliance.Although there are no reported cases to date where an AI model has contributed to a delay in cancer diagnosis, it is inevitable that their use will come up in cases where a cancer is missed or a misdiagnosis leads to unnecessary investigations or treatment. In certain circumstances, claimants will still...

bmj;392/feb18_11/s326/FAF1faJulia Kochetova/MSFAs the war in Ukraine reaches its fourth anniversary, the charity Médecins Sans Frontières is marking the Russian invasion with a series of pictures taken by the award winning Ukrainian photographer Julia Kochetova.With more than four million people internally displaced, MSF teams consistently see that the last to leave their homes are often the most vulnerable: elderly people, young families, and people with illnesses. Kochetova has captured portraits of these people—such as Zinaida Babisheva and her dog Toshyk (pictured)—forced to survive in strange towns after being evacuated from their homes.

bmj;392/feb18_1/s295/FAF1faDaniel was born in Bristol to Sarah Stone and Colin Money, both teachers. He grew up in nearby Keynsham with his older brother, Joe, and younger sister, Freya. Daniel attended the Wellsway secondary school and, with an interest and aptitude for maths and science, he decided at an early age to become a doctor.As well as studying hard, Daniel was a talented sportsman. He excelled at hockey and tennis to county level and played badminton, football, and cricket, and swam for local Keynsham clubs.Daniel studied medicine at the University of Birmingham Medical School where he played a big role in medical society activities: playing with cricket and tennis clubs; becoming president of the hockey club; and directing and performing in the comedy revue. Covid stopped his planned elective in Vanuatu but he worked in hospital throughout the pandemic, supporting qualified staff, and graduated in 2021.Daniel completed his first foundation year...

Six doctors and nurses who cracked windows at JP Morgan’s European headquarters in London in protest against the bank’s funding of fossil fuels have been unanimously acquitted of criminal damage by a 12 strong jury.The jury members at Snaresbrook Crown Court in London delivered their not guilty verdicts after a retrial, following a 2024 trial at which a jury was unable to reach a verdict.1The four doctors and two nurses—who include the GPs Patrick Hart and David McKelvey, consultant obstetrician Alice Clack, and consultant psychiatrist Juliette Brown—are all members of Health for XR, a group of health workers supporting the environmentalist movement Extinction Rebellion.In July 2022, during a record heatwave, the group broke windows at the financial services firm JP Morgan, causing nearly £200 000 worth of damage. Two days later the UK recorded its hottest day ever at 40.3°C.Hart said in his closing speech to the jury at the...

US president Donald Trump says he has finalised rules to revoke the legal basis for emissions regulations related to climate change.Scientists and environmental lawyers have condemned the move, labelling it a rejection of scientific logic that will harm human health.US regulations on emissions that cause climate change hinge on a 2009 finding by the US Environmental Protection Agency (EPA) that greenhouse gases endanger human health and welfare. This “endangerment finding” means the EPA must regulate these gases under the rules of the 1970 Clean Air Act.But on 12 February the EPA announced1 that it had “finalised its rescission of the 2009 Greenhouse Gas Endangerment Finding.”The EPA statement reads, “Absent this finding, EPA lacks statutory authority under section 202(a) of the Clean Air Act to prescribe standards for greenhouse gas emissions.“Therefore, EPA also finalised the repeal of all subsequent greenhouse gas emission standards from its regulations for light, medium, and heavy...

The NHS has a longstanding ambition to bring down hospital clinic waiting times, and the cheapest way is by reducing referrals.1 Some referrals are simple, and the patient’s problem might be solved by a written exchange between GP and hospital specialist—usually through the advice and guidance (A&G) option on the e-referral system. The GP writes a brief outline of the case, including a succinct clinical question, and a specialist replies.At NHS England’s board meeting in early February, the national director for planned care spoke of A&G as a cornerstone of “outpatient transformation” and said that it would become mandatory in the top 10 specialties in each region.2 This has raised concerns: does this mean that it must be available in those specialties—or that it must be used before any referral?3 The latter implies that although GPs may wish to refer, the specialist will decide whether the patient is offered an...

AbstractObjectiveTo evaluate whether vitamin D supplementation improves live birth rates in women with polycystic ovary syndrome undergoing in vitro fertilisation.DesignMulticentre, double blind, placebo controlled, randomised clinical trial.Setting24 fertility centres in China.Participants876 participants with polycystic ovary syndrome undergoing in vitro fertilisation.InterventionsParticipants were randomised (1:1) to receive vitamin D 4000 IU/day or placebo before in vitro fertilisation for up to 90 days until the trigger day.Main outcomes measuresThe primary outcome was live birth after the first embryo transfer. Secondary outcomes included serum 25-hydroxyvitamin D (25-OHD) levels on trigger day, pregnancy outcomes, fertility outcomes, and adverse events including severe ovarian hyperstimulation syndrome.ResultsOf 876 participants randomised, 865 were included in the modified intention-to-treat analysis, with 435 in the vitamin D group and 430 in the placebo group. Baseline mean serum 25-OHD levels were 16.5±7.2 and 16.1±6.7 ng/mL in the vitamin D and placebo groups, respectively. On the day of triggering, the serum 25-OHD level was significantly higher in the vitamin D group than in the placebo group (32.3±11.2 v 18.2±7.6 ng/mL, adjusted mean difference 13.6, 95% confidence interval 10.9 to 16.3). 226 (52.0%) live births occurred in the vitamin D group and 216 (50.2%) in the placebo group (adjusted risk ratio 1.03, 95% confidence interval 0.91 to 1.18). Severe ovarian hyperstimulation syndrome occurred in three and six participants in the vitamin D and placebo groups, respectively (adjusted risk difference ?0.7%, 95% confidence interval ?2.0% to 0.6%).ConclusionsAlthough vitamin D supplementation (4000 IU/day) for up to 90 days increases serum 25-OHD levels, this does not translate to improved live birth rates after the first transfer for patients with polycystic ovary syndrome.Trial registrationClinicalTrials.gov NCT04082650

Abdosamad was born in Damavand, Iran. He qualified from Tehran University in 1957 and moved to the UK in 1959 to train in pathology and develop his interest in research. In 1965, after being awarded his doctorate, he became a lecturer at University College Hospital, London. This was an ideal post, allowing him to indulge in the parts of his work that he most enjoyed: pathology, research, and teaching. His research included work on the then recently observed retinal and pulmonary pathologies affecting pre-term neonates and related it to their management with high oxygen concentrations. He was also proud of his work on hepatic and pancreatic regulation of blood glucose levels.He divided his passions between pathology and politics and the 1960s and 70s saw the peak of his political activity. There were many groups opposed to the dictatorship of the Shah of Iran and my father, who was principled and...

bmj;392/feb17_6/s292/FAF1faRoger was raised in a small flat in Leytonstone, east London, and worked as a hospital porter before starting at Westminster Medical School. While at medical school he spent time working with the Flying Doctors’ Service in Lesotho and South Africa. His first role in the UK as a qualified doctor was as a house physician at Westminster in 1974 under Richard Bayliss, the queen’s physician. Subsequently, he worked for six months under Roy Calne, the organ transplant pioneer, at Addenbrooke’s Hospital in Cambridge.Roger was then recruited by the British Council to undertake a year’s posting to run the hospital on Gan Island in the Maldives, following the withdrawal of the Royal Air Force. This posting, and the high rates of asthma on the island, spurred his interest in respiratory medicine.Next came work in Bordeaux, Edinburgh, Newfoundland, Papua New Guinea, Sierra Leone, and the United Arab Emirates, followed by a...

On 17 November JAMA Internal Medicine published a study1 estimating that 383 clinical trials had been terminated after sweeping US government budget cuts2 led the National Institutes of Health to end their grant funding suddenly and unexpectedly.The study estimated that over 74 000 participants had been affected. One researcher, studying the effect of PrEP prevention drugs, told the Washington Post that he “firmly” believed that some of the participants enrolled in that trial would have been infected with HIV without the drugs from the study.Related articles on bmj.comHow China became the new world leader in clinical trials (BMJ 2026;392:s221 doi:10.1136/bmj.s221)India has overtaken the US on clinical trials but struggles with regulation (BMJ 2026;392:s219 doi:10.1136/bmj.s219)Clinical trials bring new treatments to market. They also determine which practitioners get to train with cutting edge technology, who has first access to new treatments, and where jobs and investment migrate. Data published in November 2025...

Men must avoid letting “stigma and embarrassment” put their health at risk, the UK drugs regulator has said in a warning about fake erectile dysfunction pills.The Medicines and Healthcare Products Regulatory Agency (MHRA) said that analysis has shown many seized pills contained no active ingredient, the wrong dose, or hidden drugs or toxic ingredients.UK officials have taken nearly 20 million illegally traded erectile dysfunction drugs off the market in the past five years, including a record 4.4 million in 2025 alone.Unlicensed erectile dysfunction drugs can be especially dangerous for people with heart disease or high blood pressure, or those taking other drugs, and can raise the risk of heart attack, stroke, and low blood pressure, the regulator said.Erectile dysfunction affects around half of men aged 40 to 70. The MHRA said research suggests that two in five men would avoid seeking medical advice and instead opt for unsafe online sellers.Andy...

Symbols used in medical recordsThe revelation that emojis are being increasingly used in medical records,1 at least in the USA, is unsurprising. It’s 21 years since I predicted that this would happen.2In a recent report from the University of Michigan Medical School, the 50 most commonly used emojis used in 4162 sets of electronic health records were identified from among 372 different emojis in all; about a quarter of them had been used repeatedly in the same sets of notes, giving a total of 7130 instances.3Each of the emojis was used anything from 18 to 1772 times (median 36, interquartile range 24-85). The most commonly used was the original “smiling face with smiling eyes.” Furthermore, a dozen of the top 50 were variations on that standard smiley face, 2284 instances in all. Here are their names, arranged in order of decreasing frequency of use:• smiling face with smiling eyes• slightly...

The Chinese government has marked biotechnology as a national strategic priority—part of a long term self-sufficiency drive that’s now bearing fruit and beginning to challenge US clout. Just as China’s electric vehicle sector garnered state support to leapfrog the global fossil fuel car industry, advanced biotechnologies are squarely on the agenda for state supported scaling-up, as shown in policy documents and statements by senior political and business figures.123World Health Organization (WHO) data published in November 20254 show that the US led the world in the number of clinical trials registered from January 1999 to June 2025, with a total of 197 090 (20% of the global total). But the WHO data also show that from January 2024 to June 2025 both China (24%) and India (23%) overtook the US in trials registered in that period.Related articles on bmj.comWhy clinical trials are leaving the US—and Asia and Australia are welcoming them...

An upcoming UK review1 into the possible “overdiagnosis” of mental health and neurodevelopmental conditions in children risks overshadowing another crisis: a generation being made ill by deprivation.As a paediatrician and inequality researcher in some of the UK’s most deprived areas, I see children whose health is deteriorating through poor living conditions and lack of support.2 I meet teenagers whose anxiety began when food ran out at home, children whose “behaviour problems” followed yet another move into temporary accommodation, and young people unable to sleep after years of community violence or racial bullying. Their distress is not mysterious; it maps directly onto their lives. Yet public discussion of the “youth mental health crisis” often treats these problems as if they arise de novo, detached from the material and political conditions of young people’s lives.3Children from more materially advantaged backgrounds are also experiencing rising distress linked to academic pressure, performance culture, social...

Data from the World Health Organization1 show that around 27 000 new clinical trials were registered in India from January 2024 to June 2025, up by 50% from 2023.2 This meant that it hosted 23% of all clinical trials worldwide in that period, ranking it second in the list of most popular trial destinations, behind China and ahead of the US.Recent initiatives include a partnership between India’s Central Drugs Standard Control Organisation (CDSCO) and the drug company Roche. This involves collaborations with 10 government hospitals across the country for phase 3 and 4 trials and the training of staff such as investigators, ethics committee members, and support staff. Elsewhere, the US biopharma company Bristol Myers Squibb has invested $100m (£73m; €85m) in early stage drug development since 2024.Related articles on bmj.comWhy clinical trials are leaving the US—and Asia and Australia are welcoming them (BMJ 2026;392:s220 doi:10.1136/bmj.s220)How China became the new...

As the UK Covid-19 Inquiry progresses, the actions of national government and its agencies have been scrutinised and widely criticised. But we are also learning more about how the pandemic was managed at a local level.Daszkiewicz concludes that the knowledge and expertise of local stakeholders often went ignored.1 But this didn’t stop local directors of public health and their partners making a major difference.Take contact tracing, for example. In many locations characterised by deprivation and ethnic diversity, the national “test and trace” system failed to reach enough infected people. Despite initially struggling to obtain the data needed from the national system, many directors of public health created their own local contact tracing services. In Sandwell, the service recruited staff fluent in the main languages spoken locally. It also eliminated any dependence on local people having regular internet access. This substantially increased engagement rates among those needing to isolate.2On vaccination, many...

GP records for over 3 million patients are to be shared with researchers as part of a drive to improve the diagnosis, treatment, and prevention of major diseases.Data will be shared with three large national research studies— Genomics England, Our Future Health, and UK Biobank—where participants in these trials have given consent.The move is a new legal direction from the health secretary Wes Streeting which hands NHS England responsibility for sharing coded GP data securely and directly with the three approved projects.Patients not participating in any of the three trials will not have their GP data shared.Until now, sharing patients’ GP data outside of the NHS has not been permitted, apart from during the covid pandemic when an exemption was made.The government said that giving researchers access to the data will help “map the nation’s health” and examine the underlying causes of and develop new treatments for diseases like cancer,...