Medical Journal News

Christopher Burton and colleagues1 conducted an unblinded trial of a consultative intervention for 354 people with persistent physical symptoms but no identifiable “organic” cause. Patient Health Questionnaire-15 (PHQ-15) score, which is a brief, subjective, self-administered screen of severity of somatic complaints, was the primary outcome. This kind of trial design can be expected to produce modest positive outcomes, via expectation bias alone.2 No real-life, objective assessment of functioning was conducted.

We thank Joan S Crawford and David Tuller for their interest in our Article.1 Persistent physical symptoms are heterogeneous and, by definition, do not tend to go away easily. In the absence of perfect knowledge about their pathophysiology, we believe that interventions to help people with multiple persistent physical symptoms should apply the knowledge that we currently have.2

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. Lancet 2024; 404: 2077–93—In this Article, Patricia Varona-Pérez should have been included in the collaborator group list in the end matter and appendix. This correction has been made to the online version as of April 3, 2025.

Wong K, Pitcher D, Braddon F, et al. Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort. Lancet 2024; 403: 1279–89—For this Article, the RaDaR consortium list has been updated. This correction has been made to the online version as of April 3, 2025.

Pancreatic cancer is frequently a lethal disease with an aggressive tumour biology often presenting with non-specific symptoms. Median survival is approximately 4 months with a 5-year survival of 13%. Surveillance is recommended in individuals with familial pancreatic cancer, specific mutations, and high-risk intraductal papillary mucinous neoplasm, as they are at high risk of developing pancreatic cancer. Chemotherapy combined with surgical resection remains the cornerstone of treatment. However, only a small subset of patients are candidates for surgery.

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 BMJ points out the changed trajectory of life expectancy: after generations of improvement, progress on longevity has stalled.1 The situation is even more alarming if one looks at not just survival times but also “disability-free” life expectancy. Covid-19 greatly increased the proportion of adults living with disability.The news article focuses on cardiovascular disease and cancer and relates these fatal conditions to modifiable diet and exercise. Poor diet and inactivity are bad for health but are often embedded in social determinants like loneliness or deprivation. Social inequalities can kill.2 There is a strong “social gradient” for fatal heart attacks, with poor people in poor neighbourhoods most at risk.Policy makers in the UK seem reluctant to mention inequalities in relation to the new prevention agenda. The news article reports that life expectancy stalled after 2011. In 2012 the Conservative health secretary Andrew Lansley passed a Health and Social Care Act. This...

More than 4000 doctors face having to pay a tax charge on their pensions as a result of the nationally agreed pension discrimination remedy, data have shown.Various official delays and problems over pensions and tax calculations are also making it difficult for doctors to make plans about their work and retirement.NHS data obtained by financial advisers under the Freedom of Information (FOI) Act show that 4120 doctor and dentist members of the NHS Pension Scheme may have exceeded their annual allowance—the amount by which doctors’ pensions can be deemed to grow before being subject to additional tax charges—in certain tax years after rules are applied.The data emerged as the government confirmed a delay in NHS pension remedial service statements due to have been issued to doctors by 1 April that will affect the value of their pension benefits.“McCloud remedy”The government made changes to the NHS Pension Scheme in 2015, but...

On 16 March the health and social care secretary, Wes Streeting, made headlines by declaring in an interview that there was an “overdiagnosis” of mental health conditions. The comment was made in the context of discussing reforms to the welfare system that would focus on getting sick and disabled people off benefits such as Personal Independence Payments and into work. Streeting acknowledged that there was a spectrum of mental ill health but believed that overdiagnosis was part of the problem, with too many people being “written off.”Overdiagnosis describes a diagnosis that doesn’t benefit the person in question and makes people into patients unnecessarily. It can happen when diagnostic thresholds are expanded to include large groups of people with increasingly mild symptoms or when conditions are diagnosed that are unlikely to progress to cause harm.1Concerns about overdiagnosis have been raised in a number of areas of medicine, including ongoing debates about...

At the beginning of November 2024, during a spell of exceptionally hot weather, 35 year old Mizanur Rahman developed a high fever. Rahman, an electrician in Cox’s Bazar, Bangladesh, couldn’t afford to miss a single day’s work, so the next morning he set off again. That evening his fever worsened. Five days later Rahman was admitted to Sadar Hospital and was diagnosed with “Dacca fever,” otherwise known as dengue.Sadar is one of the largest government hospitals in the region, and a designated specialist dengue hospital. An entire floor is filled with patients with dengue and their families, sleeping in corridors, next to the stairs, and even in front of the toilets, wherever they can find room.“There are a lot of dengue cases every year, especially during the November to January period,” says Kamruzzaman Juwel, a medical officer at the hospital. “There are limited beds and we aren’t able to accommodate...

New testimony gathered by the BMA details instances of physician associates (PAs) and anaesthesia associates (AAs) making incorrect clinical decisions, dangerously prescribing medication, introducing themselves as doctors, and taking part in surgical procedures for which they were not qualified.1The BMA said that the scale of the evidence it had gathered through an online reporting portal between November 2023 and February 2025 showed that the NHS had failed in its duty to ensure patient safety. The 600 reports of serious concerns gathered by the BMA have been submitted as evidence to the government commissioned Leng review.23 But the BMA said that the NHS must introduce urgent interim measures while the review is ongoing, including an immediate halt to recruitment of PAs and AAs, implementation of the BMA’s safe scope of practice and supervision guidance,4 and an immediate investigation into PAs and AAs being placed on doctor rotas.The BMA has now published...

This man in his early 70s presented with a two year history of an itchy rash on his lower limbs. He had initially had a diagnosis of psoriasis and was treated with topical clobetasol propionate. Although the itch improved with this treatment, the rash persisted and worsened. On examination, there was clearly demarcated erythema on both feet and lower legs, and thickening, deformation, and discoloration of the toenails (fig 1). Fungal cultures of the skin identified Trichophyton rubrum, and the diagnosis was revised to tinea incognito with onychomycosis.bmj;389/apr03_7/e082105/F1F1f1Fig 1Tinea incognito refers to a superficial dermatophyte infection that has been inappropriately treated with topical steroids, leading to an atypical clinical appearance.1 This patient was treated with itraconazole (200 mg twice a day for seven days each month) orally for six months, and topical antifungal cream twice a day for one month, with substantial clinical improvement. This case highlights that tinea incognito...

The studyKhalaf Z, Bush A, Saglani S, et al. Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma. Thorax 2024;79:112-119.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/schoolchildren-with-asthma-face-different-risks-at-different-ages/

Countries across Africa are facing more frequent and concurrent infectious disease outbreaks, straining pandemic surveillance and control systems amid cuts to aid. These challenges warrant empowered leadership from the Africa Centres for Disease Control and Prevention (Africa CDC), rapid capacity building, and new financing initiatives.The Africa CDC recently recommended maintaining mpox as a public health emergency of continental security owing to intense spread and the emergence of a new highly transmissible clade Ia variant.1 Mpox remains uncontrolled in 22 countries, with weekly cases tripling between August 2024 and February 2025.1 Vaccine supplies, surveillance systems, and health services are insufficient, exacerbating the risks to public health.Concurrent outbreaks of Ebola, Marburg, measles, cholera, and other diseases add further strain to fragile health systems. In January 2025, Tanzania reported a Marburg outbreak with 100% case fatality rate.2 Also in January a new disease outbreak in the Democratic Republic of the Congo (DRC) affected...

A child was found to have noticeably decreased vision in his left eye during a routine optometry examination after showing normal vision six months previously. He did not self-report any eye symptoms (such as redness, pain, or tearing), headache, or dizziness, and had no personal or family history of eye diseases or other medical conditions. His parents reported that a green laser pointer (wavelength 532 ±10 nm, maximum output power <50mW, Class III) had been purchased six months previously and the patient had been playing with it frequently. The patient reported looking directly at the laser pointer light on several occasions. He did not report that anyone else had shone the laser into his eyes. There was no history of trauma to either eye.On examination, his best corrected visual acuity was 20/32 in the left eye and 20/20 in the right eye. Fundus colour photography showed multifocal, yellowish, faceted lesions...