Medical Journal News

In this paper by Gao C and colleagues (BMJ 2025;399:e082945, doi:10.1136/bmj-2024-082945, published), in the pdf, figure 2 had missing data for number censored at days 365, the HTML live figure was unaffected. Additionally, in figure 3, the number in the hierarchical component for death in the Ties box, should have been 929 398.

Last month NHS England issued a press release announcing a “nationwide rollout” of an “artificial intelligence tool that predicts falls and viruses.”1 It said that the tool, developed by the care provider Cera, was being “rolled out across the NHS” and “can predict a patient’s risk of falling with 97% accuracy, preventing as many as 2000 falls and hospital admissions each day.”The press release quoted senior government officials backing the tool as a “perfect example of how the NHS can use the latest tech to keep more patients safe at home and out of hospital.” The announcement was covered across several media outlets, including ITV News, the Independent, and the London Standard.23 The NHS Confederation issued a response, welcoming the rollout of the technology, but warning of the need for robust evaluation of AI in the health service.4How will the NHS roll out the AI?The BMJ approached Cera and NHS...

by Marie Payen de la Garanderie, Anaïs Hasenbohler, Nicolas Dechamp, Guillaume Javaux, Fabien Szabo de Edelenyi, Cédric Agaësse, Alexandre De Sa, Laurent Bourhis, Raphaël Porcher, Fabrice Pierre, Xavier Coumoul, Emmanuelle Kesse-Guyot, Benjamin Allès, Léopold K. Fezeu, Emmanuel Cosson, Sopio Tatulashvili, Inge Huybrechts, Serge Hercberg, Mélanie Deschasaux-Tanguy, Benoit Chassaing, Héloïse Rytter, Bernard Srour, Mathilde Touvier

Background

Mixtures of food additives are daily consumed worldwide by billions of people. So far, safety assessments have been performed substance by substance due to lack of data on the effect of multiexposure to combinations of additives. Our objective was to identify most common food additive mixtures, and investigate their associations with type 2 diabetes incidence in a large prospective cohort.

Methods and Findings

Participants (n = 108,643, mean follow-up =  7.7 years (standard deviation (SD) =  4.6), age =  42.5 years (SD =  14.6), 79.2% women) were adults from the French NutriNet-Santé cohort (2009–2023). Dietary intakes were assessed using repeated 24h-dietary records, including industrial food brands. Exposure to food additives was evaluated through multiple food composition databases and laboratory assays. Mixtures were identified through nonnegative matrix factorization (NMF), and associations with type 2 diabetes incidence were assessed using Cox models adjusted for potential socio-demographic, anthropometric, lifestyle and dietary confounders. A total of 1,131 participants were diagnosed with type 2 diabetes. Two out of the five identified food additive mixtures were associated with higher type 2 diabetes incidence: the first mixture included modified starches, pectin, guar gum, carrageenan, polyphosphates, potassium sorbates, curcumin, and xanthan gum (hazard ratio (HR)per an increment of 1SD of the NMF mixture score = 1.08 [1.02, 1.15], p = 0.006), and the other mixture included citric acid, sodium citrates, phosphoric acid, sulphite ammonia caramel, acesulfame-K, aspartame, sucralose, arabic gum, malic acid, carnauba wax, paprika extract, anthocyanins, guar gum, and pectin (HR = 1.13 [1.08,1.18], p < 0.001). No association was detected for the three remaining mixtures: HR =  0.98 [0.91, 1.06], p = 0.67; HR =  1.02 [0.94, 1.10], p = 0.68; and HR =  0.99 [0.92, 1.07], p = 0.78. Several synergistic and antagonist interactions between food additives were detected in exploratory analyses. Residual confounding as well as exposure or outcome misclassifications cannot be entirely ruled out and causality cannot be established based on this single observational study.

Conclusions

This study revealed positive associations between exposure to two widely consumed food additive mixtures and higher type 2 diabetes incidence. Further experimental research is needed to depict underlying mechanisms, including potential synergistic/antagonist effects. These findings suggest that a combination of food additives may be of interest to consider in safety assessments, and they support public health recommendations to limit nonessential additives.

Trial Registration

The NutriNet-Santé cohort is registered at clinicaltrials.gov (NCT03335644). https://clinicaltrials.gov/study/NCT03335644.

This week is National Public Health Week in the United States and perhaps the saddest one in the 70 years of this celebration. Last week, President Donald Trump’s administration enacted mass firings of staff, or a “reduction in force,” at agencies that form the scaffolding of public health in the US.1 This action continued the attacks on science and health that have quickly become a signature of the new presidency.2The scope and depth of the cuts to staff are vast, including the Centers for Disease Control and Prevention, the National Institutes of Health, the US Food and Drug Administration (FDA), Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, Centers for Medicare and Medicaid Services, and many other offices.Collectively, these cuts impair government functions that are vital to society, including (but not limited to) the ability to ensure the safety of new medications, devices, food, and other...

Patients in hospital emergency departments are being put at risk because they are not getting time critical medication (TCM) for chronic conditions such as diabetes and Parkinson’s disease on time, says a report by the Royal College of Emergency Medicine.1Analysis of data from 136 UK emergency departments on patients with diabetes or Parkinson’s disease who take certain TCM such as insulin injections and levodopa found that two thirds did not receive their drugs around the expected time. This could potentially exacerbate symptoms or complications and lead to deterioration and increased mortality.Just over half (7197) of the 13 478 eligible patients were not identified within 30 minutes of their arrival in the emergency department, the analysis showed, and just 32% of 10 850 doses that patients should have had were administered within 30 minutes of their scheduled time. This proportion was 39% for levodopa and 22% for insulinIn light of the...

My name is Biotic. Andi Biotic.The UK Health Security Agency (UKHSA) has a new superhero in the form of a pill shaped cartoon character known as Andi Biotic. He’s heading up a campaign to tackle misconceptions about antibiotics among 18 to 34 year olds, as part of the ongoing “Keep Antibiotics Working” programme.A dose of good messaging?The agency is piloting this new six week digital campaign, which is being promoted across YouTube,1 Instagram, and Facebook, and by GP practices and pharmacies, to test its “potential to capture people’s attention and imagination” in order to “help raise awareness of good antibiotic stewardship.”A hard pill to swallowIndeed. An Ipsos survey of nearly 6000 UK residents aged 16 and older, commissioned by the UKHSA last year, found that over half of respondents incorrectly believed they either could not do anything personally to prevent antibiotics becoming less effective at treating infections (26%, 1535) or...

bmj;389/apr08_4/r697/FAF1faSheila Bhattacharya (née Burns) was born in St Leonards-on-Sea, East Sussex, in 1924. Her father, Robert Burns, a classics scholar, had been a colonial administrator in St Kitts and West Africa, while her mother, a highly independent Glaswegian woman, had served as a nurse in the first world war.Sheila had a passion for literature and had intended to study English at university, but the onset of the second world war while she was finishing school was the great event of her life, changing her outlook. Encouraged by her mother, she decided to study medicine and got a place at Newnham College, Cambridge, in 1942. She then decided instead to volunteer for war work and was sent to an explosives research laboratory at Woolwich Arsenal where she learnt about life beyond her privileged upbringing. It was dangerous work handling unstable chemicals, and more so during the V1 and V2 missile attacks....

The UK government should train and employ more health visitors and school nurses as part of a package of measures to tackle the rise in mental health problems among children and young people, a charity has urged.1The Centre for Mental Health, a charity that aims to tackle mental health inequalities, noted that one in five 8 to 25 year olds are now affected by mental health problems. It urged the government to invest in evidence based preventative strategies to reverse the trend, spanning the perinatal period and early years to schools and colleges, through to adulthood and employment.Cuts to health visitors and school nurses under successive governments have led to more children falling through the gaps of early support and going on to need specialist care, the report said.Increasing health visitor and school nurse numbers will benefit babies, children, and families for decades to come, alongside other interventions such as...

In January 2025, the UK government announced that an independent commission is to be set up on social care in England led by Louise Casey, a crossbench peer. The commission will explore problems facing social care and provide recommendations for creating a “national care service.”1 The announcement has elicited considerable (tending towards negative) response.2 Some query the basis for a commission, calling it a “cop out” in light of the urgent need for funding and reform.3 Others decry the long duration, with the commission expected to finally report by 2028, and point to a field already crowded with many similar exercises.4I view things somewhat differently. I agree that social care cannot afford to wait but suggest that the necessary change must be profound and that the commission can be justified as a way of proceeding. The organisational and funding issues are substantial, but we must recognise that reform in complex...

The US has reported 6600 cases of whooping cough (pertussis) in the first three months of 2025, more than four times the number at the same point last year and 25 times as many as had been reported at the same point in 2023.If the current trend continues, the country will be on course for the highest number of infections since vaccination was introduced in 1948.The state of Louisiana last week reported that two people had died from pertussis in the past six months. Both were infants, who are most at risk of serious complications. Two other US deaths have been reported this year: a school age child in North Dakota and an adult in Idaho.Pertussis remains one of the world’s deadliest infectious diseases. The World Health Organization estimated that in 2014 there were 24.1 million cases and 160 700 deaths in children under 5 worldwide.The number of cases typically...

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

A consultant surgeon who sexually harassed junior female colleagues has been suspended from the medical register for 12 months after a High Court judge ruled that his original eight months suspension had been too lenient.1James Gilbert was regarded as the “golden boy” of his department at the Oxford Transplant Centre, one of the women who gave evidence against him told the medical practitioners tribunal that suspended him last August. The tribunal found that he had touched female colleagues inappropriately without consent, including squeezing one woman’s thigh between his own thighs under the operating table, and made sexually motivated and racist remarks.2Gilbert had told the tribunal that he was a “different person and a fundamentally changed practitioner from the doctor whose conduct led to complaints being raised.”The tribunal noted that “these incidents did not give rise to concerns about risks to patient safety and that there was evidence that Mr Gilbert...

by Heather Wightman, Elaine Butterly, Lili Wei, Ryan McChrystal, Naveed Sattar, Amanda Adler, David Phillippo, Sofia Dias, Nicky Welton, Andrew Clegg, Miles Witham, Kenneth Rockwood, David A. McAllister, Peter Hanlon

Background

The representation of frailty in type 2 diabetes trials is unclear. This study used individual participant data from trials of newer glucose-lowering therapies to quantify frailty and assess the association between frailty and efficacy and adverse events.

Methods and findings

We analysed IPD from 34 trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP1) receptor agonists, and dipeptidyl peptidase 4 (DDP4) inhibitors. Frailty was quantified using a cumulative deficit frailty index (FI). For each trial, we quantified the distribution of frailty; assessed interactions between frailty and treatment efficacy (HbA1c and major adverse cardiovascular events [MACE], pooled using random-effects network meta-analysis); and associations between frailty and withdrawal, adverse events, and hypoglycaemic episodes. Trial participants numbered 25,208. Mean age across the included trials ranged from 53.8 to 74.2 years. Using a cut-off of FI > 0.2 to indicate frailty, median prevalence was 9.5% (IQR 2.4%–15.4%). Applying a higher threshold of FI > 0.3, median prevalence was 0.5% (IQR 0.1%–1.5%). Prevalence was higher in trials of older people and people with renal impairment however, even in these higher risk populations, people with FI > 0.4 were generally absent. For SGLT2 inhibitors and GLP1 receptor agonists, there was a small attenuation in efficacy on HbA1c with increasing frailty (0.08%-point and 0.14%-point smaller reduction, respectively, per 0.1-point increase in FI), below the level of clinical significance. Findings for the effect of treatment on MACE (and whether this varied by frailty) had high uncertainty, with few events occurring in trial follow-up. A 0.1-point increase in the FI was associated with more all-cause adverse events regardless of treatment allocation (incidence rate ratio, IRR 1.44, 95% CI 1.35–1.54, p < 0.0001), adverse events judged to the possibly or probably related to treatment (1.36, 1.23, to 1.49, p < 0.0001), serious adverse events (2.09, 1.85, to 2.36, p < 0.0001), hypoglycaemia (1.21, 1.06, to 1.38, p = 0.012), baseline risk of MACE (hazard ratio 3.01, 2.48, to 3.67, p < 0.0001) and with withdrawal from the trial (odds ratio 1.41, 1.27, to 1.57, p < 0.0001). The main limitation was that the large cardiovascular outcome trials did not include data on functional status and so we were unable to assess frailty in these larger trials.

Conclusions

Frailty was uncommon in these trials, and participants with a high degree of frailty were rarely included. Frailty is associated very modest attenuation of treatment efficacy for glycaemic outcomes and with greater incidence of both adverse events and MACE independent of treatment allocation. While these findings are compatible with calls to relax HbA1c-based targets in people living with frailty, they also highlight the need for inclusion of people living with frailty in trials. This would require changes to trial processes to facilitate the explicit assessment of frailty and support the participation of people living with frailty. Such changes are important as the absolute balance of risks and benefits remains uncertain among those with higher degrees of frailty, who are largely excluded from trials.

How are AI tools being evaluated?So far, the UK National Institute for Health and Care Excellence (NICE) has evaluated and published reports on five AI technologies. The sixth evaluation, on the first autonomous AI tool, is due to be published later this year.“Most of the AI tech that we have evaluated has been in the diagnostic space and are imaging based technologies,” said NICE’s HealthTech programme director Anastasia Chalkidou. “It’s still a med tech fundamentally.”Chalkidou told NICE’s annual conference on 27 March that most AI tools are currently being evaluated through its early value assessment (EVA) process.1 To be considered for this pathway, technologies with evidence uncertainties must aim to meet an unmet need. If they are conditionally recommended for “early use in the NHS,” an evidence generation plan must then be followed to produce the “evidence that needs to be gathered while it’s in use.” Once this evidence is...

DC and 23 states sue Trump governmentThe District of Columbia and 23 US states have launched legal action against President Donald Trump’s administration after the cancellation of $11bn (£8.54bn; €10bn) in public health funding left over from the covid pandemic.1 The funding was being used in programmes tracking the spread of disease and vaccine rollouts, as well as addiction and mental health services and others.The lawsuit, which asks the court to immediately block the funding cut, says that the federal government did not provide a “rational basis” or facts to support the cuts. The attorney generals representing these states said that the move would lead to “serious harm to public health” and would put states “at greater risk for future pandemics and the spread of otherwise preventable disease and cutting off vital public health services.”California’s attorney general, Rob Bonta, said that Trump and the health secretary, Robert F Kennedy Jr,...

The inequalities in outcomes for pregnant women and babies from black and Asian backgrounds have been improving, but they still persist in Scotland.1A short life working group on racialised health inequalities in maternity care was established in Scotland in January 2023. It took a co-production approach, underpinned by data and evidence, and identified three key deliverables2: an action plan, a best practice toolkit for working with interpreters in maternity and neonatal services, and scoping of data and evidence.Across Scotland, we are fortunate to have organisations—such as Amma Birth Companions (a Glasgow charity that supports women and birthing people from migrant backgrounds; https://ammabirthcompanions.org) and KWISA, Women of African Descent in Scotland (an African women led organisation based in Edinburgh; https://kwisa.org.uk)—advocating for and amplifying the voices of women and families from racialised and marginalised communities.We must continue to listen carefully to those with living expertise and create and maintain the conditions for...

Concerted global efforts to improve maternal healthcare mean that women are far less likely to die in childbirth than they were two decades ago, a new UN report says. But agencies have warned that the gains are already at risk because of to the recent unprecedented cuts to international aid funding.“In the year 2000 nearly half a million women died from giving birth. The figure now in 2023 is just over a quarter of a million,” said Jenny Cresswell, a researcher at WHO’s Department of Sexual and Reproductive Health and Research and the report’s lead author. “This report presents the first time that no countries were estimated to have extremely high levels of maternal mortality.”The report, published by the UN Maternal Mortality Estimation Inter-Agency Group, is the first to assess the global effect of the covid-19 pandemic on maternal health.The 40% decrease in maternal deaths was largely due to better...

Smith is right to acknowledge the admiration that many of us hold for those who make huge personal (and in Patrick Hart’s case, professional) sacrifices by acting in line with their conscience.1But we must avoid framing climate activists as merely acting on “their beliefs.” Hart and others who have been imprisoned for engaging in non-violent climate action are not acting based on beliefs or personal opinions, but rather in the name of decades of well established climate science that evidences the need for urgent action.2 The narrative that such actions are based on personal convictions and opinions has been exploited by the General Medical Council as part of its justification for suspending doctors who have been imprisoned for climate related offences.3Smith also expresses scepticism about the effectiveness of civil disobedience, but research has shown that it leads to greater support for more moderate climate organisations.4 Moreover, even in health circles,...

On 13 February 2025, a few hours after the US Senate confirmed Robert F. Kennedy, Jr as Secretary of Health and Human Services, President Trump issued an executive order establishing a “Make America Healthy Again” (MAHA) Commission. That same day the US House Budget Committee voted to progress a budget bill that targets Medicaid with the biggest share of cuts to finance Trump’s agenda of border security and tax cuts. The House budget proposal includes at least $880 billion in Medicaid cuts—approximately 11 percent of federal Medicaid funding over the 10 year period.1Medicaid is the largest publicly funded source of health insurance coverage, covering 79 million people.2 By comparison Medicare covers 68 million people.3 Medicaid is a federal-state matching programme with the majority of funding (69%) coming from the federal government. States run the programme with federal rules and options. Medicaid is the only source of public financing for long...