Doctors who prescribe psychiatric medications should regularly review whether the drugs are effective and, if not, consider deprescribing and using non-medication approaches, the Trump administration announced in an “action plan” to tackle overprescribing.“Today, we take clear and decisive action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications—especially among children,” said the health and human services secretary, Robert F Kennedy Jr.1“We will support patient autonomy, require informed consent and shared decision making, and shift the standard of care toward prevention, transparency, and a more holistic approach to mental health,” he added.The idea that overprescribing of psychiatric drugs is harming young people has been a popular topic for Kennedy for many years. “We are not just overmedicating our children, we are overmedicating our entire population,” he said at his 2025 confirmation hearing.2 He told that hearing that 15% of US children were taking drugs for attention...

Artificial intelligence (AI) is becoming part of everyday clinical life. From drafting clinic letters to suggesting differential diagnoses, it is changing how we learn and practise medicine. For doctors in training, its use can often feel like progress, saving time, reducing uncertainty, and making us more efficient. But we should pause before celebrating too quickly. If we rely on AI too early in our clinical training, before core clinical reasoning skills are fully developed, we risk losing the one skill that defines our profession: the ability to think.Recent evidence suggests that this risk is not theoretical. In a multicentre, observational study, endoscopists who routinely used AI to detect polyps saw their accuracy drop when they performed colonoscopies without AI assistance.1The adenoma detection rate fell from 28% to 22% after just a few months of exposure.1 The researchers concluded that continuous exposure to AI might dull independent ability, subtly changing how...

“So, I’m a rheumatologist—obviously we specialise in gossip,” Matthew Hutchinson says, pausing before clarifying the pun: “rumour.”Humour might be the entry point to Are You Really the Doctor? but Hutchinson’s book touches on difficult topics—from examining what it means to practise medicine to navigating race, identity, and institutional power in the NHS.Medicine can be a challenging profession, and Hutchinson turned to comedy initially as a pressure valve—a way to manage the stress of frontline medical work. “Having something outside of medicine helps to keep perspective, stay sane, and keep going,” he says.Hutchinson, also a PhD candidate as well as a stand-up comic and soon-to-be consultant, writes not simply about being a black doctor, but about how identity shapes clinical encounters, professional expectations, and public trust. Comedy, he says, is not a detour from medicine but a lens through which to examine it.Belonging and perceptions of credibility and competenceIn Hutchinson’s book,...

What is hantavirus?Hantavirus is not one virus but a group of negative stranded RNA viruses in the family Hantaviridae, within the order Bunyavirales. They contain three segments of single stranded, negative ribonucleic acid (RNA) molecules.2 The viruses are primarily carried by rodents such as mice, rats, and voles. People usually contract disease from them through exposure to rodent urine, faeces, and saliva.34Although relatively uncommon worldwide, with around 10 000 to 100 000 infections reported each year, the virus causes two diseases.5 The first, haemorrhagic fever with renal syndrome (HFRS)—formerly known as Korean haemorrhagic fever—was first detected in US soldiers fighting in Korea in the 1950s. The second, hantavirus pulmonary syndrome, or hantavirus cardiopulmonary syndrome (HPS/HCPS), was first recognised in a 1993 outbreak of severe respiratory disease in the Four Corners region of the southwestern United States.6The highest incidence of HFRS is in East Asia, particularly China, followed by Russia and...

Complications of diabetes pose a noticeable burden for individuals and society.12 In a recent review in The BMJ (doi:10.1136/BMJ-2024-081217), Fridman and colleagues describe advances in the pathophysiology and treatment of diabetic peripheral neuropathy (DPN).3 The review of DPN covers epidemiology and risk factors, pathophysiology, diagnosis, treatment, as well as global considerations.3 The authors acknowledge that translation of emerging evidence into clinical practice remains challenging. However, since microvascular complications of diabetes are often systemic,45 clinical assessments should account for the patient’s total complication burden.In the review, the authors suggest that the presence of atypical neurological features should lead to more extensive investigations, such as electrodiagnostic testing to explore alternative causes of peripheral neuropathy.6 However, this should also be the case if there is peripheral neuropathy without accompanying retinopathy. Clinical assessment should also involve consideration of autonomic neuropathic features. For example QTc prolongation in those presenting with type 2 diabetes and foot...

Last year, Abbasi and colleagues highlighted the lack of progress towards nuclear disarmament.1 Recent US-Iran nuclear diplomacy probably followed a familiar script.2 Diplomats discussed enrichment levels, deterrence, regional security, and escalation risks, with input from intelligence, military, and foreign policy experts. But one voice was noticeably absent: doctors.Nuclear weapons are often treated as political tools, but their use would cause mass death, illness, and system collapse. Yet nuclear diplomacy proceeds as if medical expertise is optional, excluding doctors.In humanitarian settings, doctors are trained to anticipate unlikely scenarios with severe outcomes, from emerging infectious diseases to mass casualty events. By contrast, nuclear policy regards catastrophe as theoretical until it occurs, excluding professionals equipped to evaluate its medical consequences.Negotiators often rely on invisible medical optimism. They assume that healthcare systems would function, with hospitals operating, supply chains intact, doctors available, and long term care assured. These assumptions are infrequently stated, stress tested...

Health Secretary Wes Streeting needs to stop trying to “politic” his way out of the dispute with resident doctors and focus on negotiating, the doctor tasked with leading talks with the government says.BMA Resident Doctors Committee (RDC) chair Jack Fletcher made the comments to The BMJ as resident doctors in England wrapped up their 15th strike since 2023.1Fletcher said that before the walkout negotiations with the Department of Health and Social Care (DHSC) had been going well.“We were moving in the right direction,” he said.The government’s latest offer included pay structure reform, reimbursement of royal college exam fees, contract reform for locally employed doctors, and up to 4500 more specialty training places over the next three years (including 1000 this April).Looking back on those conversations, Fletcher said that discussions about jobs and training numbers and trying to tackle the “gig economy”—which many doctors outside of training find themselves working in—were...

MPs have urged the UK government to scrap a “dreadful” and “shameful” £330m NHS contract with the controversial US tech giant Palantir during a Westminster debate.1Palantir, which also provides services to US immigration enforcement and the Israeli military, is contracted to create a federated data platform (FDP) for NHS England to help streamline health service data.But the deal has proved controversial, with concerns raised by the BMA2 and others over risks to patient trust, data security, and Palantir’s background with military and surveillance contracts.Earlier this week—amid reports that ministers were mulling scrapping the contract3—The BMJ revealed how data from pilots of the FDP, run at Chelsea and Westminster Foundation Trust and promoted as a Palantir success story, were flawed.4Against this backdrop MPs debated the FDP on 16 April, with several Labour and Liberal Democrat MPs urging the government to remove Palantir as the contract supplier. The debate was led by...

In recent weeks, the UK has seen masked students queueing for emergency meningitis jabs and the publication of the module 3 of the UK covid-19 inquiry,1 which criticised the government’s reliance on flawed advice that the virus did not spread through the air.2One aspect of our lack of readiness for the next pandemic is the current policy on protecting healthcare workers from airborne respiratory pathogens. Specifically, whether respirators should be used instead of ordinary medical masks. Current policy in the UK and many other countries,3456 based on non-inferiority randomised controlled trials,78 is that respirators are needed only for aerosol-generating medical procedures such as intubation. But such trials are inherently predisposed to produce null results and mislead policymakers and potentially cause harm.Randomisation reduces some forms of bias, but it does not abolish bias altogether. Post-randomisation biases can arise once a trial is underway, for example in how interventions are delivered, how...

On the eve of the Easter bank holiday weekend, the UK government finally published the full text of its deal with the US government on the prices the NHS will pay for new branded drugs.1The central plank of the deal is to waive tariffs on UK pharmaceutical exports to the US in return for the NHS paying 25% more for new branded drugs. The initial mechanism for the latter is an equivalent increase in the National Institute for Health and Care Excellence’s (NICE) standard cost threshold from 1 April 2026, although further price increases may well be needed to meet the scale of extra drug spending the government has signed up to.2 This revised threshold means that a drug will be considered sufficiently cost effective if for every £35 000 extra it costs above the current standard NHS treatment for the condition, it improves health by at least one quality...

The Pakistan Medical Association (PMA) has raised alarm over 329 children who have tested positive for HIV in the southeastern province of Sindh in the first quarter of 2026, calling it a sign of major failures in infection control and regulation.A separate BBC investigation reported 331 HIV positive children in Punjab province in 2024 and 2025 in an outbreak linked to unsafe injection practices.Sindh health department data, reported by local media, showed 329 children among 894 HIV cases recorded from January to March 2026.1 The PMA blames the rise on contamination resulting from lax health practices such as reuse of needles in unauthorised clinics, and it warned in a 14 April statement that the reported figure was “merely the tip of the iceberg.”It estimated that the actual number of infected children could be fourfold higher than currently documented, because of the critical unavailability of mass screening facilities across the province.The...

Opioid use disorder during pregnancy poses substantial risks of harm to maternal and fetal health, including overdose, preterm birth, neonatal complications, and maternal and fetal death.12 Methadone and buprenorphine are the recommended medications for opioid use disorder (MOUD).123 Methadone has been the standard treatment in pregnancy for more than three decades, but buprenorphine is increasingly used in many settings.3 This shift reflects buprenorphine’s pharmacological advantage as a partial opioid agonist2 with a lower risk of sedation and respiratory depression, together with early evidence suggesting favourable neonatal outcomes.12 Yet, uncertainty has persisted about the comparative effects of opioid use on the neurodevelopment of children.The linked study by Friedrich and colleagues (doi:10.1136/bmj-2025-087321) addresses this evidence gap.4 Using nationwide Medicaid data from the US, the authors compared the risk of neurodevelopmental disorders during the first eight years of life among children prenatally exposed to buprenorphine versus methadone. Their findings are reassuring: exposure to...

AbstractObjectiveTo compare the incidence of neurodevelopmental disorders among children with prenatal exposure to buprenorphine versus methadone.DesignPopulation based cohort study.SettingUS nationwide Medicaid data on >2.5 million live births from 2000 to 2018.Participants18?612 pregnancies exposed to buprenorphine or methadone, of which 587 were excluded from the analysis owing to exposure to the comparator drug.Main outcome measuresThe primary outcome was a composite of neurodevelopmental disorders (autism spectrum disorder, attention deficit/hyperactivity disorder, developmental speech or language disorder, developmental coordination disorder, behavioural disorder, learning difficulty, or intellectual disability). Individual neurodevelopmental disorders were considered secondary outcomes. Cumulative incidences were obtained using Kaplan-Meier analyses, and hazard ratios using Cox proportional hazards regression. Propensity score overlap weighting was applied to adjust for confounding, including personal characteristics, maternal medical and mental health comorbidities, exposure to medications and other substances, proxies for severity of opioid use disorder, healthcare utilisation, and adequacy of prenatal care utilisation.Results12?635 children were exposed to buprenorphine and 5390 to methadone prenatally. The crude cumulative incidence of any neurodevelopmental disorder at age 8 years among those exposed to buprenorphine was 34% (95% confidence interval (CI) 30% to 38%) and among those exposed to methadone was 33% (29% to 37%). Adjusted analyses suggested slightly lower hazards of any neurodevelopmental disorder associated with exposure to buprenorphine versus methadone (adjusted hazard ratio 0.81, 95% CI 0.70 to 0.94). Similar results were obtained for the individual neurodevelopmental disorders such as attention deficit/hyperactivity disorder (0.89, 0.65 to 1.21) and autism spectrum disorder (0.74, 0.46 to 1.21). With prevalent use, prenatal exposure to buprenorphine was associated with lower hazards of any neurodevelopmental disorder compared with prenatal exposure to methadone (adjusted hazard ratio 0.62, 0.51 to 0.76). This association was not observed with treatment initiation during pregnancy (adjusted hazard ratio 1.13, 0.90 to 1.42). Further sensitivity analyses indicated results consistent with no increased risk of neurodevelopmental disorders among pregnancies exposed to buprenorphine versus methadone.ConclusionsThe findings of this study suggest no increased risk of long term adverse neurodevelopmental outcomes among children with prenatal exposure to buprenorphine versus methadone, further supporting buprenorphine as a safe treatment option for opioid use disorder during pregnancy.

AbstractObjectivesTo identify the effective components of interventions to increase vaccine uptake and to explore variations in effectiveness by population group and in relation to the covid-19 pandemic.DesignComponent network meta-analysis.SettingSystematic review of randomised controlled trials in high and upper middle income countries.Participants237 studies with 570 intervention arms and 4?361?717 participants.InterventionsAny intervention targeting vaccine recipients or their caregivers aiming to increase demand for, or access to, vaccinations on the UK immunisation schedule. Key content and delivery features of interventions were identified using a bespoke coding framework co-developed with stakeholders.Main outcome measuresThe outcome of interest was vaccine uptake. Bayesian component level meta-regression estimated relative effects of intervention components as ratios of odds ratios with 95% credible intervals (CrIs).ResultsOf the included studies, 110 were at low risk of bias, 96 had some concerns, and 31 were at high risk. 40% (n=1?744?686) of the participants were male. For children, there was evidence of beneficial effects for payments to cover costs (ratio of odds ratios 3.01, 95% CrI 1.49 to 6.06) and decision aids (2.73, 1.14 to 7.06), and some evidence for extended opportunities (1.37, 0.98 to 1.95) and social factors (1.27, 0.99 to 1.65). For adolescents and young adults, there were beneficial effects for personal delivery formats (2.13, 1.09 to 4.40), delivery by community members alongside healthcare professionals (6.42, 1.94 to 25.62), and social factors (2.62, 1.45 to 5.04), and negative effects for decision aids (0.43, 0.18 to 0.98) and human versus non-human interaction (0.47, 0.21 to 1.02). For adults, beneficial effects were shown for human interaction (1.86, 1.42 to 2.45), extended opportunities (1.63, 1.35 to 2.00), help with appointment scheduling (1.38, 1.06 to 1.78), payments to cover costs (1.47, 1.03 to 2.16), and motivational interviewing (1.79, 1.21 to 2.64), and there was some evidence for financial incentives (1.15, 0.99 to 1.35) and information on vaccine safety and/or efficacy (1.15, 0.99 to 1.32). For adults, evidence also showed a negative effect of non-human interaction versus no interaction (0.72, 0.57 to 0.92). Subgroup analyses showed variation for underserved populations and in relation to the covid-19 pandemic (before 2020 and 2020 onwards).ConclusionOverall, extended opportunities, appointment scheduling help, financial incentives, payments to cover costs, and motivational interviewing were effective content components of interventions to increase vaccine uptake. Effective delivery components overall were human interaction and delivery by community members alongside healthcare professionals. However, effective components varied by age group, for underserved populations, and in analyses investigating the impact of the covid-19 pandemic. These findings have important implications for designing, optimising, and implementing targeted interventions, highlighting which components are effective across different populations and contexts. Consideration of the economic data on interventions should further support resource informed decision making.

Kickbusch’s call to reframe artificial intelligence (AI) governance through a planetary health lens is timely and compelling.1 As AI systems—particularly large language model (LLM) applications—move rapidly into use, we must ask how governance can be operationalised in healthcare practice.One of the most practical and underused levers for responsible AI is robust evaluation. In healthcare, evaluation standards have long aligned innovation with patient safety, quality, and equity. Encouragingly, this is a growing area of AI research, with emerging frameworks for assessing clinical performance,23 extensions to trial reporting such as CONSORT-AI,4 and examples of structured safety testing in real world tools.5A critical gap remains, however. Current evaluation frameworks rarely consider the computational and environmental costs of LLM powered systems, with environmental impact absent from criteria even in otherwise comprehensive approaches.6 Although recent frameworks such as FUTURE-AI7 have broadened evaluation, environmental and computational impact remain largely neglected. Each LLM query carries an energy...

Six months after the Gaza ceasefire was announced Palestinians are still experiencing “extreme deprivation, hunger, injury, and death” as Israeli attacks and aid restrictions continue, charities have warned.1Five major humanitarian organisations—the Danish Refugee Council, the Norwegian Refugee Council, Oxfam, Refugees International, and Save the Children—have assessed the progress made against the ceasefire plan and produced a scorecard. They conclude that the ceasefire announced in October 2025, with the promise of an end to attacks and an increase in aid, is failing.At least 738 Palestinians have been killed since the ceasefire came into effect, said the UN.2 At least 70 000 Gazans have been killed in Israeli attacks since 7 October 2023, although experts say that the true number is probably much higher.3The UN’s human rights chief, Volker Türk, said that Palestinians were still unsafe amid routine Israeli attacks. “The unrelenting pattern of killings reflects continuing disregard for Palestinian lives, enabled...