The debate over rising numbers of people claiming disability benefits in the United Kingdom, particularly relating to mental health, has become increasingly highly charged over recent months, especially in the context of an underperforming UK economy.1 The UK is an outlier among the G7 countries in terms of economic inactivity.2 These countries also saw a post-pandemic rise in disability benefit claims, but, unlike the UK, they are now seeing a return to normal. Why is the UK different?Could it be a problem of overdiagnosis, as the health secretary, Wes Streeting, controversially stated recently?3 Or is it related to the medicalisation of everyday worries, as previous prime minister Rishi Sunak speculated?4 Or is it a sickness problem that can only be resolved once NHS waiting lists reduce and people have improved access to support?5Opinions remain divided. It’s not straightforward, however, to get through a benefits assessment and be awarded payments on...

On 27 March the US health secretary Robert F Kennedy Jr, abruptly announced the termination of 10 000 jobs at the Department of Health and Human Services (HHS), with 10 000 more cut through early retirement and buyouts.1 The repercussions became clearer this week as employees received their notice on 1 April—or turned up to work to find their security passes had been deactivated.Kennedy said that HHS was being “recalibrated to emphasize prevention, not just sick care.” On X he wrote, “The reality is clear: what we’ve been doing isn’t working.2Two senators, Bill Cassidy and Bernie Sanders, invited Kennedy to a 10 April hearing to explain the restructuring. A HHS spokesperson told Politico that Kennedy had yet to accept the invitation.Senior figures reassigned and relocatedAs employees were served notice by email early on 1 April, many staff in high ranking posts found themselves reassigned and facing relocation or put on...

Since the passage of the US Administrative Procedures Act of 1946, public commentary has remained a cornerstone of US policy making, establishing transparent procedures with which federal agencies must comply.1 Public comment is not a bureaucratic formality: it’s part of a deliberate process designed to ensure accountability in policy making. These mechanisms are foundational to a democratic government reliant on public trust derived from careful and transparent decision making.That’s why a proposal by the new US health secretary, Robert F Kennedy Jr, to eliminate public comment requirements for key decisions in the US Department of Health and Human Services (HHS) is so alarming.2 If implemented, this change would strip away a critical mechanism that invites patients, care partners, healthcare professionals, and advocacy organisations to weigh in on policies that directly affect them. Removing the formal mechanism for public comment would set a dangerous precedent by permitting policies to be formulated...

The US Supreme Court unanimously upheld the decision by the Food and Drug Administration (FDA) to reject an application for approval of flavoured liquids used in vapes, also called e-cigarettes, on 2 April.12However, the Supreme Court’s decision was not a clear win for the FDA.Yolanda Richardson, president of the Campaign for Tobacco-Free Kids, said in a statement, “While the FDA has authorized the sale of 34 e-cigarette products, manufacturers continue to flood the market with thousands of illegal, unauthorized products. To end this crisis, the FDA must deny marketing applications for flavoured e-cigarettes and step up enforcement efforts to clear the market of illegal products. Today’s ruling should spur the FDA to act quickly to do so.”3The Supreme Court overturned a ruling by a lower court, the conservative US Court of Appeals for the Fifth Circuit. That court had decided that the FDA had changed the rules for companies applying...

Experts have called for a new alcohol strategy for England as deaths from alcohol reached a record high in 2023, with the average heavy drinker now older.An analysis by the Nuffield Trust and the Health Foundation showed 8273 deaths from alcohol in England in 2023, up from 5050 in 2006—a 60% increase.1 These were deaths from conditions caused entirely by alcohol consumption, including alcoholic liver disease and accidental poisoning. A further 14 370 deaths in 2023 were from conditions caused partially by alcohol.The current upward trend in deaths began in 2020 at the start of the covid pandemic, when 6984 deaths were recorded in the year.The UK’s last national alcohol strategy was published in 2012 and focused much of its attention on binge drinking and reducing harm among young people.2 But the Nuffield Trust said that this no longer reflected the reality of problem drinking in England. The analysis highlights...

In this paper by Lunny and colleagues (BMJ 2025;388:e079839, doi:10.1136/bmj-2024-079839, published 18 March 2025), there was a presentation error in figure 1, which has since been corrected in the article and PDF.

The chancellor of the exchequer, Rachel Reeves, will set out the UK government’s spending plans in her spring statement on 26 March.1 The consultative green paper, Pathways to Work,2 has already outlined plans to cut several billion from the welfare budget, with the aim of saving £5bn by 2029-30.3 The plans include stricter criteria for personal independence payments (PIP) for people with disabilities; halving incapacity benefit payments under Universal Credit for new claimants; and restriction of incapacity benefit top-ups to those aged 23 years and older.Ministers have argued there is a “moral case” for these cuts, and that “people that can work [should be] able to work.”3 However, the chancellor’s approach is unlikely to achieve this goal for two key reasons. First, high rates of economic inactivity in the UK reflect its almost unique failure among industrialised countries to recover population health after the pandemic,456 which came on top of...

In the UK more than 3 in every 1000 people are taking glucagon-like peptide-1 (GLP-1) agonist drugs, says Kevin McCarroll, consultant physician and geriatrician at St James Hospital, Dublin.1 Depending on the region, 77-179 in 100 000 people are using the leading GLP-1 drug semaglutide (Ozempic for type 2 diabetes, Wegovy for obesity), he says.1 And these are just the official prescribing figures—anecdotal evidence suggests many are purchasing the drugs from unofficial sources.Growing evidence of the drugs’ efficacy for weight loss2 is fuelling demand worldwide. The number of patients in the US approved for GLP-1 agonist treatment for obesity rose from 190 000 a month in 2021 to 1.8 million in 2024.3 Analysis of the US market shows that 5.2% of women and 4.2% of men with obesity are being prescribed the drugs, although access varies.“The global supply shortage seen in 2024 was at least partly because of a surge...

The UK has confirmed a case of H5N1 influenza of avian origin in a sheep in Yorkshire, in a world first.The infection in the animal was identified through routine and repeated milk testing, which was enforced after avian influenza was confirmed in captive birds on the same premises. The sheep has now been “humanely culled” and no other cases of avian influenza have been detected in the remaining sheep, the Department for Environment, Food, and Rural Affairs and the Animal and Plant Health Agency have said.“While this is the first time this virus has been reported in a sheep, it is not the first time influenza of avian origin has been detected in livestock in other countries,” the announcement said. “There is no evidence to suggest an increased risk to the nation’s livestock.”In January the UK confirmed a human case of influenza A (H5N1) in a person in the West...

A growing tendency in official data to ask a person for their gender identity rather than their sex is having serious consequences in some areas of healthcare such as missed cancer screenings and mistakes in blood testing.An independent, government commissioned report1 into the collection of accurate data and statistics on biological sex concluded that public bodies should collect distinct data on both sex and gender identity to ensure that nationally held data are accurate and clear.The report, published by the Department for Science, Innovation, and Technology, sets out a timeline of how survey data have been collected since the 1960s. It shows how the word “gender” started to replace “sex” in some data collection in the 1990s, and in some survey data, gender was defined as “sex” while in others gender was defined as “identity.”The review authors found that from around 2015 the word “gender” started to be understood in...

bmj;388/mar24_9/r574/FAF1faIn 1983 surgeons across East Africa began to compare notes about a new disease, known colloquially as “slim,” which was prevalent across the region. At the time, Anne Bayley was running a clinic at the University Teaching Hospital in Lusaka, Zambia, for patients with endemic Kaposi’s sarcoma, a relatively indolent skin tumour, found mainly in older men.In 1983, however, the number of new cases of Kaposi’s sarcoma doubled to 23—and 13 of these patients (including three women) presented with unusual, more aggressive disease. Eight patients died in less than a year.1 There was also a rise in reports of Kaposi’s sarcoma in the literature, reflecting the emergence of HIV/AIDS among mainly gay men in the West. Bayley realised that HIV was the underlying problem in her patients with aggressive Kaposi’s sarcoma, which she thought implied heterosexual transmission. Not everyone agreed, convinced that it was spread by sex between men.Keeping an...

Researchers have criticised the UK drug industry trade association’s decision to restore Novo Nordisk’s membership despite the company being subject to ongoing regulatory breaches during its two year suspension period.In March 2023 the Danish pharmaceutical company, which manufactures the high profile weight loss drugs Ozempic, Saxenda, and Wegovy, was suspended as a member of the Association of the British Pharmaceutical Industry (ABPI) for two years because of “serious breaches” of the organisation’s code of practice.1 The company failed to disclose clearly its sponsorship of a weight management training course for healthcare professionals which included positive information on its obesity drug liraglutide (Saxenda).The ABPI, announcing its decision to reinstate Novo Nordisk’s membership on 17 March, said it was satisfied that the company had made “clear, significant, and sustained improvements” to ensure it properly adheres to strict industry standards.2But academics from the University of Bath told The BMJ that the available evidence—including...