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,...

NHS patients are receiving remote care from GPs based overseas under a pilot scheme that claims to reduce clinical admin for UK practices.Doctors based in countries including Australia, India, and Malaysia are providing virtual appointments to UK patients as part of the trial.The scheme, run by private company Asterix Health, recruits overseas doctors and matches them for remote work with UK surgeries (see box).The GPs—who are registered with the General Medical Council—carry out tasks such as reviewing test results and conducting phone consultations with patients based in the UK.Asterix Health is working with seven UK surgeries which it said “are struggling to cope with the increasing demands of clinical administrative tasks.” It is currently employing eight doctors to provide care to patients at these surgeries.The scheme follows a pledge in the government’s 10 year plan to “explore opportunities to deploy UK registered professionals working in other countries to provide remote...

The competing interest statement of this editorial by Robert Howard (BMJ 2024;386:q2044, doi:10.1136/bmj.q2044) has been amended to note that he was an unpaid member of the scientific board of Synaptogenix.

The competing interest statement of this editorial by Robert Howard and Helen Kales (BMJ 2023;382:p1852; doi:10.1136/bmj.p1852) has been amended to note that Robert Howard was an unpaid member of the scientific board of Synaptogenix.

NHS cost cutting measures are undermining national efforts to reduce waiting times for cancer care and elective treatment, health leaders have said.It comes amid reports of a surge in recruitment bans in cancer units and operations being cancelled until the new financial year to allow NHS organisations to reduce their deficits.New figures released by the Royal College of Radiologists show that the number of NHS radiology departments and cancer centres imposing recruitment freezes on consultants doubled in the past year.In 2025, half (31 of 60) of specialist cancer treatment centres in the UK were unable to hire clinical oncologists because of recruitment freezes imposed by trusts to save money. This compared with 13 centres (23%) in 2024.The recruitment bans come despite widespread delays in cancer diagnoses and treatment, exacerbated by shortages of these doctors.The preliminary data from the college’s annual workforce census, to be published in the summer, also show...

The fate of a controversial US funded trial of a neonatal hepatitis B vaccine remains unclear, with different authorities claiming it is cancelled, suspended, or going ahead.The study aimed to look for any negative effects of the vaccine and would have been led by two Danish researchers, Peter Aaby and Christine Stabell Benn, whose work has been cited by the US health secretary and vaccine sceptic Robert F Kennedy Jr.However, the Africa Centres for Disease Control (Africa CDC) says it has now been cancelled. The organisation said this was because it exploited shortages of vaccine in Guinea-Bissau, the west African country where the trial was to be conducted, to find a study population in whom the shot, normally given at birth, was delayed to six weeks.Despite Africa CDC’s statement the US health department, the principal funder of the trial, told The BMJ it was proceeding.However, Guinea-Bissau’s health minister has now...

It started with delays. Patients queued for hours outside pharmacies from dawn and routine surgeries were regularly postponed. Then came shortages. Shelves of basic drugs emptied, insulin and cancer drugs ran out, and critically ill patients were turned away from hospitals.Now, there are closures. Maternity wards and neonatal units are shutting their doors. Emergency departments are overwhelmed and training programmes for specialist doctors are being cancelled.1The tragedy is that all this was “completely avoidable,” says Andrés Vecino, who studies the economics of Latin American healthcare systems at Johns Hopkins Bloomberg School of Public Health in the US.“Millions of lives have been put at risk and people are dying,” he says. “There are so many lessons to be learnt.”A broken modelFor the past two decades Colombia’s healthcare system had been hailed as an example for the rest of Latin America to follow. The World Health Organization and the World Bank both...

Like the NHS itself, postgraduate medical education in England seems to be in a perpetual state of crisis. John Tooke, in his 2008 forensic review of the Modernising Medical Careers debacle, laid considerable blame for the system’s difficulties on the dichotomy between “training/education” and “service/work.”1 Tooke warned that, unless the resulting confusions and tensions were resolved, the same problems would continue to recur in the NHS.One might have hoped that NHS England’s Medical Training Review: Phase 1 Diagnostic Report, led by Chris Whitty and Steve Powis and published in October 2025, would finally provide a resolution.2 However, it seems likely that it will only perpetuate the problem.The training/service dichotomyThe distinctions between “training,” “education,” and “service” were introduced into postgraduate medical training by Kenneth Calman’s review in 1993.3 Calman recognised that the traditional model of apprenticeship training in medicine was predicated on the supervision of work by an expert (the consultant),...

I’m early in my career. How can I get involved?“Start by exploring what’s available, such as foundation posts with research time, taster programmes, or departmental audit projects,” says Rosalind Smyth, vice president (clinical) at the Academy of Medical Sciences.She highlights structured schemes like the National Institute for Health and Care Research (NIHR) integrated academic training programme,1 which allocates academic clinical fellowships and clinical lectureships to doctors and dentists looking to pursue clinical academic careers in England.Smyth says, however, that there isn’t one single path doctors have to follow. “What matters isn’t following a prescribed path but finding opportunities that align with your interests and developing them systematically.”Funders such as NIHR,2 Wellcome,3 and the Medical Research Council (MRC) “offer clinical fellowships at all different stages of the research pathway,” she says.One way to get started is by speaking to “clinical academics in your specialty and consider joining events like the Academy...

General practice consultations are getting more complicated.1 In the 40 plus years since I qualified, medicine has changed considerably. Many patients who previously would have died, now survive—those with, for example, some cancers or ischaemic heart disease. In many cases, they live productive lives for another 15 years or more before ultimately dying with dementia. Undoubtedly this has increased the complexity of cases I see, in addition to the fact that the “simple” attendances for patients requesting the contraceptive pill or those with an upper respiratory tract infection are now seen by clinical colleagues.Doctors are, therefore, at high risk of “complexity fatigue,” especially given the high expectations of patients, politicians, and the professions including regulators. I know that I need to see fewer patients for longer to deal with their often multiple problems, but yet again we are being asked to prioritise access, when the evidence is clear that continuity...

F. Gordo Vidal
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