More than a quarter of medical trainees in some specialties reported feeling apprehensive or hesitant about escalating a patient to the supervising clinician, a “deeply troubling” finding that the General Medical Council says could put patient safety at risk.This year’s GMC national training survey1 was completed by around 50 637 doctors in training and 21 289 trainers. For the first time the survey asked about escalation of care.Among doctors in training, 21% reported feeling uncomfortable raising concerns with their senior colleagues. The figure was even higher among trainees in certain specialties—with 26% of trainees in emergency medicine, 27% in obstetrics and gynaecology, and 29% in surgery reporting they had felt this way.Pushpinder Mangat, medical director and director of education and standards at the GMC, said, “These findings are concerning because doctors need to work in environments where they feel comfortable escalating. When they don’t, there are potentially serious risks to...

Twenty years of working in medicine is just long enough to realise how much things change and how little the core truths ever will. In 2004, in my first year as a doctor, we lived in a world defined by flip phones, Blockbuster video rentals, and towers of dusty CDs in plastic covers. Medicine involved paper notes, bleeps clipped to belts, and the art of deciphering doctors’ handwriting. Some things haven’t changed. Even this year’s Glastonbury headliners were the same artists I saw in my first year—although the past 20 years are now etched clearly into their faces, bodies, and voices. And mine.Fast forward two decades, and we live in an era of smartphones. Blockbuster has morphed into limitless film and TV streaming, and CDs have been replaced by music streaming platforms. In medicine, electronic health records and telemedicine have replaced messy handwriting, even if endless ward rounds remain. Yet,...

In July 2024, the UK government abandoned long awaited reforms to address England’s two tier care system, in which people with care needs either self-fund or receive state support if their assets fall below £23 250. For care homes—residential facilities licensed to deliver personal care and support, which may include nursing care—this two tier system has created wide care inequalities, with state funded residents experiencing worse quality care, while many others have unmet needs or rely heavily on unpaid family carers. These inequalities are not just costly for local authorities, which fund social care, but also create substantial downstream costs for the NHS.1Although most countries have elements of two tier funding in their care systems, England’s sharp wealth threshold has created a system in which care home providers focus on richer areas with a higher concentration of self-funders, with low incentive for homes to open and operate in poorer, high...

Alder Hey Children’s Hospital has said that it is treating an increasing number of children for measles, amid reports that a child died after contracting the infection.1The Times reported that a child died in the Liverpool hospital’s intensive care unit while severely ill with measles as well as other serious health problems.2Alder Hey said that while it could not comment on individual cases, it was “concerned about the increasing number of children and young people who are contracting measles.” It said that since June it has treated 17 children for the effects and complications of measles.An open letter from Alder Hey, the UK Health Security Agency (UKHSA), and the directors of public health for Liverpool, Sefton, and Knowsley urged parents to vaccinate their children against the infection.3“Several children are seriously unwell and receiving treatment at Alder Hey Children’s Hospital,” the letter said. “Children in hospital who are very poorly for...

Over 12 000 Gazans desperately need to be evacuated for medical care, Médecins Sans Frontières (MSF) said in a plea to countries around the world to “open their doors” to evacuees.“As the genocide in Gaza continues, more than 56 000 people have been killed and around 125 000 wounded since 7 October 2023,” the aid organisation said, adding that the thousands of people requiring specialised medical care are unable to access services because Gaza’s healthcare system has been “decimated by Israeli forces.”“To make matters worse, Israel has reduced medical evacuations to a minimum,” it continued.MSF said that medical evacuations must be authorised by the Coordinator of Government Activities in the Territories, the body managing Israeli governmental activities in the occupied Palestinian territory, but that decisions are “often arbitrary and opaque” with critical cases “either delayed or denied, regardless of medical urgency.” There are also a limited number of countries willing...

In The Time Machine by HG Wells, a Victorian scientist travels into the future to witness a society with deep inequalities between two devolved species. This dystopian future is built on a long forgotten history of technical advance, division, and exploitation. It is a cautionary tale: without tackling structural inequality, no level of technological progress can prevent social decline. Scientific innovation without justice, and greater knowledge without action, risk reinforcing stasis over structural reform.Precision public health is a specialty with radical potential that applies emerging technologies to public health policy and implementation. It has the potential to reallocate resources through predictive equity models1 to improve structural determinants of health, democratising governance by embedding community data sovereignty, and disrupting commercial drivers of ill health using algorithms to hold industry accountable.In the context of widespread embrace of artificial intelligence (AI) in health systems globally, precision medicine strives to deliver the right interventions...

Parliament’s spending watchdog has warned that badly managed private finance contracts could result in poor quality assets, including hospitals, being handed back to the public sector.1The Public Accounts Committee’s report into the use of private finance initiatives (PFI) for infrastructure came as the government has identified infrastructure investment, delivered in partnership with the private sector, as critical to its central mission of growing the economy.The MPs’ report criticised the lack of a credible pipeline for future projects and a lack of data on the past performance of projects, which it said puts the government’s ambitions at risk.Of the 665 ongoing PFI contracts, half—covering hospitals, schools, and transport—are set to expire in the next decade. Public bodies are to pay £136bn in charges up until 2052-53, and the MPs warned that there must be careful management to ensure that private sector firms comply with their contractual obligations and that “only quality...

The UK’s drug regulator has become the first in the world to approve elinzanetant to treat moderate to severe vasomotor symptoms (“hot flushes”) associated with the menopause.The once daily non-hormonal drug works by “calming” brain signals that interrupt the body’s ability to control temperature, said the Medicines and Healthcare Products Regulatory Agency (MHRA).1The regulator granted elinzanetant, manufactured by Bayer and marketed as Lynkuet, approval after results from the Oasis clinical trials, which involved more than 1400 women aged 40 to 65 in several countries. The studies showed that taking a daily 120 mg tablet of elinzanetant significantly reduced the number and intensity of hot flushes and night sweats over 26 to 52 weeks, which compared with a placebo.The drug is administered in capsule form to be taken orally.“It may also help improve sleep problems that often come with menopause,” the MHRA added.Patients can now access the drug through private prescriptions,...

At the June 2025 Royal College of Obstetrics and Gynaecology (RCOG) World Congress, Secretary of State for Health and Social Care Wes Streeting, called out, with the frankness that has been his characteristic since taking up his post last year, the unacceptable state of current NHS maternity care. He also outlined key elements of a plan to improve.Although mentioned again in the 10 year plan for health, the detail, for now, is limited. But two key elements are prominent. First, a rapid investigation into ten maternity units across England will take a system wide look at maternity and neonatal care, reporting by the end of 2025. As well as delivering “truth and accountability” for families affected by poor care, the investigation seeks to bring together lessons from past inquiries and create a single set of actions for national maternity improvement.1 Second, a National Maternity and Neonatal Taskforce, comprising experts, families,...

The US has recorded its highest number of confirmed measles cases since the year 2000, adding to fears that falling rates of vaccination are allowing infectious diseases to propagate.The country has recorded 1288 cases so far in 2025, the Centers for Disease Control and Prevention (CDC) reported on 9 July. That figure eclipses the previous high of 1274 cases reported in 2019, despite only six months having passed so far this year—and is the highest number since the US declared the disease officially eliminated in the year 2000.Public health experts said the grim milestone indicated that the eradication of infectious diseases was now being taken for granted and that persistent circulation could be the new normal.“Unless we do something to really increase vaccination rates across the country, this is going to be kind of a new normal, of seeing these outbreaks in different parts of the US,” Katherine Wells, director...

Thousands of victims of the UK’s infected blood scandal have been “harmed further” by the operation of the compensation scheme set up by the government, the senior judge who chaired the public inquiry has concluded.1Former High Court judge Brian Langstaff, who delivered his main report in May 2024, has taken the unusual step of holding a further hearing and issuing an additional report after being inundated with complaints about delays and difficulties in accessing payments from the Infected Blood Compensation Authority (IBCA).In the 1970s and 1980s around 30 000 people were infected with HIV and hepatitis B or C after receiving contaminated blood and blood products on the NHS, in the biggest treatment disaster in NHS history.2 The UK had failed to become self-sufficient and had imported commercial products with plasma pooled from the blood of paid donors, including prisoners and drug addicts.Langstaff’s May 2024 inquiry report concluded that the...

A survey by the Unite union1 has found that almost a fifth of female healthcare workers have experienced work related sexual assault.Unite counts 65 000 women in the healthcare sector among its membership, including GPs, hospital doctors, paramedics, and nurses. As part of a wider survey polling members in all 19 occupational sectors, it found that 18% of female healthcare workers had been sexually assaulted at work.In addition, 46% had experienced unwanted flirting, gesturing, or sexual remarks, 47% had been the recipient of sexually offensive jokes, 34% had been inappropriately touched, and almost one in five had been shown pornographic images or had them shared by a manager, colleague, or third party.It further found that 60 women among 1000 healthcare workers who responded to the survey had been a victim of sexual coercion at work.Unite’s national officer for health, Richard Munn, said, “No woman in the health sector should go...

Medical associations in the Indian state of Maharashtra have raised concerns over a state government order allowing homeopaths to practise allopathic medicine, including prescribing, after completing a certificate course in modern pharmacology.On 30 June the Maharashtra Medical Council (MMC) published a notification1 permitting homeopathic practitioners to begin registering with the council starting 15 July.The Indian Medical Association (IMA) Maharashtra has threatened a 24 hour withdrawal of services on 11 July and a mass protest march of hundreds of thousands of doctors in the state on 19 July if the order is not revoked.“The order sets a dangerous precedent,” Santosh Kadam, president of IMA Maharashtra, told The BMJ. “After completing a one year course, held two days a week, these practitioners would be treated the same as graduates with medical degrees. This is unacceptable. They do not undergo the rigorous education and clinical training that medical students do. Allowing them to...

Cancer screeningAlmost everyone believes that cancer screening is a good thing because it leads to early detection of malignancy and better outcomes for people who screen positive. An essay in the New Yorker explains why almost everyone is wrong (https://www.newyorker.com/magazine/2025/06/23/the-catch-in-catching-cancer-early). It’s worth reading even by doctors who think they understand lead time bias, predictive values and Bayesian probability. Muir Gray and colleagues (BMJ 2008 doi:10.1136/bmj.39470.643218.94) were right nearly 20 years ago when they wrote: All screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost.Novelty in scienceScientific papers often boast about the novelty of their findings. But novelty doesn’t necessarily imply usefulness or importance. By contrast, investigations that replicate previous work can be valuable without being novel. In an attempt to measure novelty and find out whether it matters, an open competition to devise and validate indicators of scientific...

Twenty years ago, one of the London bomb attacks of 7/7 was on a bus passing the headquarters of the BMA (doi:10.1136/bmj.r1416).1 Staff from the BMA and The BMJ helped with the emergency response. It was a time of fear of further attacks, but we took for granted the capacity of the emergency services and the health system to respond.It was also a time of optimism in the future of the NHS. That optimism has evaporated. The question now is how to save the NHS in a digitally advanced world. The constant expansion of digital technology, particularly artificial intelligence, won’t necessarily save healthcare. Yet this is the big bet in England’s new 10 year health plan (doi:10.1136/bmj.r1394 doi:10.1136/bmj.r1405).23The inevitable rise of algorithms means, the plan’s authors imagine, that we’ll achieve the productivity benefit of more healthcare delivered by fewer health professionals. This sounds good in theory, but with a technologically...

Since its inception in 2003, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has stood as a cornerstone of the global fight against HIV, channeling $110 billion into prevention, detection, and care programmes worldwide.1 PEPFAR is credited with saving more than 25 million lives, preventing 5.5 million babies from being born with HIV, and providing critical support for 7 million orphans, vulnerable children, and their care givers.2PEPFAR received bipartisan support across four presidential administrations.3 But, with the recent expiration of re-authorisation and the announced freezes in US international aid, PEPFAR’s future is uncertain.4 The termination of US government support necessitates immediate, coordinated action from the international community to ensure that we remain on track to achieve the sustainable development goal of ending the HIV epidemic by 2030.5We were part of a recent report forecasting the negative health impact of suspending PEPFAR funding in South Africa. Our findings are chilling:...

This man in his early 70s with type 2 diabetes mellitus presented with a one year history of intermittent dysphagia and regurgitation of both liquids and solids, retrosternal pain, and 4 kg weight loss (fig 1).bmj;390/jul10_7/e081229/F1F1f1Fig 1Barium swallow showed irregular oesophageal dilation. Oesophago-gastro-duodenoscopy showed a spiralling appearance,1 with spastic contractions of the lower oesophagus, and the gastro-oesophageal junction continuously closed during gas insufflation. The diagnosis of type III (spastic) achalasia was confirmed by high resolution oesophageal manometry, which demonstrated the lack of coordinated peristalsis and impaired relaxation of the lower oesophageal sphincter (LES).Type III achalasia is a rare form of achalasia characterised by premature oesophageal contractions, affecting the mid and distal oesophagus and leading to symptoms such as dysphagia, chest pain, and weight loss. The diagnosis is confirmed through high resolution oesophageal manometry, showing premature contractions and LES dysfunction.2This patient declined surgical myotomy and was treated with oral calcium channel...

Democrat mayors sue over Trump era cuts to Obamacare enrolmentDemocrat mayors from Baltimore, Chicago, and Columbus, Ohio, have filed a lawsuit1 against the Trump administration’s rollback of access under the Affordable Care Act, alleging that the changes will increase the number of uninsured Americans. The new rules shorten enrolment periods, impose stricter income verification, and add fees for autorenewals. Around two million people may lose their cover. Two advocacy groups also joined the suit, citing harm to public health and a lack of proper public input.RFK Jr approves prior CDC vaccine panel’s recommendationsThe health secretary, Robert F Kennedy Jr, approved two long pending vaccine recommendations from the Centers for Disease Control and Prevention (CDC)2: GSK’s MenABCWY meningococcal vaccine for at-risk people aged 10 and over and healthy people aged 16-23; and expanded vaccination against respiratory syncytial virus in high risk adults aged 50-59 who are using GSK, Pfizer, or Moderna...

US federal and state authorities have charged 324 people with healthcare fraud offences, seized $245m (£180m; €208m) in cash and assets, and broken up criminal networks that collectively billed Medicare and private insurers for $14.6bn, the Department of Justice has announced. Of these claims, just $2.9bn was paid out.“This record healthcare fraud takedown delivers justice to criminal actors who prey on our most vulnerable citizens and steal from hardworking American taxpayers,” said attorney general Pam Bondi. The previous record for a coordinated healthcare fraud operation involved $6bn in claims, she noted.Such coordinated efforts typically involve multiple fraud rings. It has become standard practice for the justice department to lay charges in several cases at once, in order to generate news coverage.1 While the current announcement involves the largest amount in false claims, it is not the biggest in terms of arrests and charges.2It does, however, include the largest single healthcare...

The government has unveiled its 10 year plan to transform the NHS in England, underpinned by housing more services under one roof in community settings to relieve pressure on hospitals, boosting use of technology, and sharpening the focus on preventing ill health.1Central to the plan are new “neighbourhood health centres” offering GP appointments, diagnostic and blood tests, scans, postoperative care, mental health support and rehabilitation, dentistry, debt advice, employment support, and smoking cessation and weight management advice in a single location.Many of these services are already offered in urgent treatment centres or minor injuries units, but the government wants to expand their scope to move more care out of hospitals into community settings.The new centres will “eventually” open 12 hours a day, six days a week, with each covering around 250 000 people. The government said it would start by establishing them in places with the lowest healthy life expectancy...