Medical Journal News

Although the words “prevention is better than the cure” are often said, this still largely remains a mantra. The UK government has committed to a shift from “sickness to prevention” in the NHS.1 However, there is vagueness about how programmes that will improve health outcomes will be implemented.Twenty years ago, Derek Wanless, a former banker, was appointed by Gordon Brown, then Chancellor of the Exchequer, to conduct a review of the NHS’s future needs and the likely costs. The Wanless review proposed a “fully engaged scenario,” which placed health improvement and prevention as a crucial element of a strategy to relieve demand on the NHS.If anything, the opposite has happened since the report was published in 2002. On many measures, including life expectancy, the health of the British population has stagnated or has got worse. But part of the problem was that it was never clear how the iconic “fully...

The year is 1828. Anaesthesia is yet to be invented and tethered to an operating table in the centre of a crowded, putrid theatre at Guy’s Hospital, a patient screams at his surgeon to stop the procedure. An hour into a lithotomy—which should have been over within minutes—the flustered surgeon, determined to retrieve the stone, refuses to stop, until he can hold the stone aloft in front of his audience. His patient endured over an hour of excruciating pain to stoke this surgeon’s ego and died days later.One of the spectators in the onlooking crowd is “The honourable doctor,” our protagonist James Lambert, a doctor who is appalled by what he is watching. From his early training, he has recognised that corruption and malpractice is rife within the medical profession. He joins forces with a group of reformers to challenge the establishment and stand up for what is right.Nick Black,...

A month before Mahmoud Abu Nujaila, a doctor who worked with Médecins Sans Frontières at Gaza's Al-Awda hospital, was killed by an Israeli airstrike along with his colleagues, he wrote on a hospital whiteboard:“Whoever stays until the end will tell the story. We did what we could. Remember us.” 1Doctors working in Gaza have made urgent pleas, saying that they feel abandoned by the world amid renewed Israeli airstrikes.2 More recently, the United Nations reported that several paramedics and rescue workers were killed and buried in a mass grave by Israeli forces in southern Gaza.3 Over 18 months of relentless attacks, thousands have died,4 and the healthcare infrastructure has been almost entirely dismantled.56 Access to vital medical supplies has been systematically restricted, and basic necessities for life—clean water, food, sanitation, and energy—have also been destroyed.178The Israeli military’s conduct plausibly violates the Geneva Conventions, which prohibit attacks on medical facilities and...

Over the past six months, I’ve worked in primary care, emergency care, and paediatrics. Every day I see people in mental distress—from depression to psychosis to post traumatic stress disorder.Recently, the UK Labour government doubled down on inaccurate, stigmatising, and offensive narratives around mental health. In the Spring Statement, the government announced more than £5 billion cuts in benefits support—a move that will push thousands of people into poverty.1 The government used two primary narratives to support its approach. Firstly, that mental health conditions are overdiagnosed and that people are unjustifiably claiming sickness benefits on this basis. Secondly, that the way to improve the lives of people living with physical and mental health conditions is to cut state support and “encourage” them back into employment.We tend to think of ill health, especially mental health, as an individual issue. This couldn’t be further from the truth. Many aspects of poor mental...

Campaigners who are taking the General Medical Council (GMC) to court alleging failure to properly regulate physician associates (PAs) and anaesthesia associates (AAs) have been cleared to submit new patient safety evidence.A judge has granted Anaesthetists United’s bid to submit two reports that were published after it began its legal case, and which the GMC had argued were inadmissible, for a judicial review in the High Court on 13 and 14 May.One report is a systematic review published in The BMJ in March 2025, which found little evidence supporting the safety and efficacy of PAs and AAs in the UK.1The other is a coroner’s regulation 28 “prevention of future deaths” report published in February 2025, regarding the death in 2024 of Pamela Marking, who was seen by a PA and died after having a nosebleed misdiagnosed. The coroner highlighted a lack of national and local guidelines and regulation of the...

The global conversation is locked into trade deficits. While tariffs can be temporary, as we’re seeing, debt has a longer term impact. The question is, if we truly believe that people and countries should have an opportunity to flourish and prosper, how do our finance systems—that hardwire debt—support those ambitions? Debt is the deficit that requires some serious thinking and an enlightened response.A medical student in the UK can end up with debt of £100 000 before earning a penny as a qualified doctor. Is this fair? Is it how we want young people to start their working lives? From the US to India, a medical career is once more the domain of rich and privileged people. Many countries are unable to widen access to a medical career despite championing it. Some countries don’t care. They should. A diverse workforce delivers better care. A diverse workforce also offers greater prospects...

by Ming Jun Kuck, Eef Hogervorst

Ming Jun Kuck and Eef Hogervorst consider the data on the safety and potential cognitive effects in later life of midlife menopausal hormone treatment in women.

by David Horner, Jens Richardt Møllegaard Jepsen, Bo Chawes, Rebecca Vinding, Julie B. Rosenberg, Parisa Mohammadzadeh, Yang Luo, Birgitte Fagerlund, Trine Flensborg-Madsen, Thomas Ragnar Wood, Janine F. Felix, Louise Monnerup, Birte Y. Glenthøj, Klaus Bønnelykke, Bjørn H. Ebdrup, Jakob Stokholm, Morten Arendt Rasmussen

Background

Early life is a critical period for neurodevelopment, where factors such as maternal nutrition and breastfeeding duration significantly impact the growth of head circumference and cognitive development in children. Our study aimed to explore the associations between maternal dietary patterns during pregnancy, duration of breastfeeding, and their impacts on child head circumference and cognitive outcomes.

Methods and findings

Our study utilised data from the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort, which enrolled 700 mother–child pairs between 2008 and 2010 with 86% clinical follow-up at age 10. Pregnancy dietary patterns, described as ‘Varied’ and ‘Western,’ were derived from food frequency questionnaires and used to model quantitative metabolite scores via sparse partial least squares modelling of blood metabolome data. Cognitive development was assessed using the Bayley Scales of Infant Development at 2.5 years and the Wechsler Intelligence Scale for Children at age 10. Head circumference was measured from 20 weeks gestation to 10 years, and calibrated using related anthropometric measures. Growth trajectories were evaluated using linear mixed models and latent class trajectory models. Parental and child genetic influences for cognition and head circumference were controlled by including polygenic risk scores derived from genomic data. We found that a Western dietary pattern during pregnancy was associated with lower cognitive scores at age 2.5 (β −1.24 [−2.16, −0.32], p = 0.008) and reduced head circumference growth (p-interaction < 0.0001). We found that a Varied dietary pattern during pregnancy was associated with higher estimated intelligence quotient (IQ) at age 10 (β 1.29 [0.27, 2.3], p = 0.014). Additionally, head circumference growth was associated with higher cognitive scores at age 10 (β 3.40 [1.21, 5.60], p = 0.002), and it partly mediates the association between the Varied dietary pattern and estimated IQ (proportion mediated 13.5% [0.01, 0.71], p = 0.034). Extended breastfeeding duration was also independently associated with increased head circumference growth (p-interaction < 0.0001). These patterns and correlations were consistent even after adjusting for potential confounders and accounting for genetic influences.

Conclusions

Our findings reveal that a Western dietary pattern during pregnancy is associated with lower cognitive scores at age 2.5 and decreased head circumference growth, suggesting potential adverse impacts on early neurodevelopment. Conversely, a Varied dietary pattern is linked with a higher estimated IQ at age 10, with head circumference growth contributing to this positive outcome. These findings highlight the critical role of maternal nutrition during pregnancy, and duration of breastfeeding, in promoting optimal neurodevelopmental outcomes. Effective public health strategies should therefore focus on enhancing maternal dietary practices to support better cognitive and physical development in children.

The health and social care secretary, Wes Streeting, has said that he is reviewing the “bizarre situation” of UK medical graduates having to compete with doctors from overseas for jobs in the NHS.Speaking on GB News on 8 April, Streeting said that he would tackle the health service’s “over-reliance” on overseas workers.“We’ve got this bizarre situation where graduates from UK medical schools are competing on an equal basis with overseas applicants for the same jobs. I think that is a crazy position for our country to be in,” he said. “As we speak, I am looking at the changes we need to make to end that situation, so that students who are going through UK medical schools, people whose training we’ve invested in as a country, make sure that they get those jobs that are available in our NHS.”The BMJ recently reported that the total number of applications for specialty...

The family of a doctor who took his own life within hours of receiving an email from the General Medical Council (GMC) has failed in their bid to sue the GMC for damages over his death.1Sridharan Suresh, a consultant anaesthetist, drowned himself in the river Tees in May 2018 after receiving an email from the GMC telling him that he would be called before an interim orders tribunal over allegations that he had inappropriately touched a 15 year old female patient.2He had given the girl midazolam, which can have hallucinatory side effects. He strongly denied the allegation, her description of the perpetrator was strikingly different from his appearance, and the police later dropped the case for lack of evidence.Suresh was suspended from work at North Tees and Hartlepool NHS Foundation Trust for an initial period of two weeks but was told by the medical director that the trust would not...

If health really is part of all policies,1 then we in the public health community can’t ignore what might seem like arcane and complex discussions in other policy areas. A pertinent example is the recent dispute over a proposal to tackle potential inequalities in sentencing by the courts in England and Wales.2 The lord chancellor and justice secretary, Shabana Mahmood, has intervened,3 raising issues that have potential consequences for those working to reduce health inequalities. This sentencing guideline dispute is a concerning example of government interference in what should be an independent expert process.The dispute concerned the Sentencing Council, an independent body with a majority of judicial members and a remit to promote greater transparency and consistency in sentencing.4 It arose when the council published guidance on pre-sentence reports prepared by the probation service to give the courts additional information on people being sentenced. These pre-sentence reports should be requested...

Throughout my time as Children’s Commissioner, I have heard from a million children and young people about their hopes, ambitions, and concerns. An issue which frequently comes up in these conversations is how they can spend time online safely and protect themselves from distressing or harmful content. Children are digital pioneers, and the adults in charge of online platforms should put the protection of children before profit.As a former teacher and headteacher, I have witnessed the spike in children’s time spent online during the past 20 years. Research conducted by Ofcom in 2021 found that by the age of eight, a child would typically spend 2 hours and 45 minutes online a day. The figure rises to more than four hours a day by age 11-12.1 Just this week, my own nationally representative poll of children aged eight to 15 backed these findings—25% of children spent two or three hours...

Academic medicine is in urgent need of a revolution,1 now more than ever following recent attacks on it in the United States.23 Academic medicine brings together science, humanities, social science, health, and social care to improve the health and wellbeing of people and planet in an equitable manner. For decades, its role has been to train doctors who have led on generating research and provide services to improve health outcomes in a growing global population.4 Some countries such as France, Germany, and India offer domestic students free or minimal tuition fees. However, the past decade of rising costs of publicly and privately funded medical education in many countries disproportionately favours a minority of students who can fund themselves through medical training.5 For example, current total costs (excluding living expenses) for private medical education for international students to the US, UK, and Australia or domestic students who do not qualify for...

Last month the UK government announced that it planned to abolish NHS England and move many of its functions back into the Department of Health and Social Care.12 An estimated 20 000-30 000 jobs are expected to be lost in the restructuring.Appearing before MPs on the Health and Social Care Committee on 8 April, the health secretary, Wes Streeting, was asked whether he recognised a figure first reported in the Observer3 that the total cost of redundancy payouts could reach £1bn. He said that it was too early to know the precise numbers but that £1bn was not an “unreasonable ballpark figure.”Streeting faced a series of other questions from MPs.Why abolish NHS England before the 10 year plan?The government had acted because “we know where we’re headed” in terms of the upcoming 10 year plan for the NHS, Streeting told MPs. “Abolishing an arm’s length body of this size and...

AbstractObjectiveTo investigate the reporting and evolution of patient and public involvement (PPI) in randomised controlled trials published over time in major medical journals and in their trial protocols.DesignMeta-epidemiological evaluation.Data sourcePubMed was searched for articles reporting randomised controlled trials published since 2015 in four major medical journals and their corresponding peer reviewed protocols.Eligibility criteria for selecting studiesThe first 10 randomised controlled trials published each year in each journal were included.Data extractionData extraction focused on involved stakeholders, description and extent of PPI activities/processes, and recognition of PPI contributions. Published articles and protocols were assessed for consistency of the reported PPI in both.ResultsOf the 360 published articles reporting randomised controlled trials and 299 respective protocols, PPI was only reported in 64 (18%) articles and 56 (19%) protocols. When PPI was reported, patients and their representatives were mainly involved, with the most common PPI activity being participation in trial committees (44/64 PPI reporting articles; 39/56 protocols). PPI primarily occurred during the trial development phase, including feedback on study design, review of study materials, and assessment of feasibility. Protocols occasionally had more detailed information than the published articles, but in most cases the PPI contributions were often vague without detailed information on specific outcomes and the effect on decision making within the randomised controlled trial. Recognition of PPI contributions was more frequent in published articles (n=37; 58%) than in protocols (n=18; 32%), mainly in the acknowledgment section.ConclusionThis study found limited PPI reported in randomised controlled trials published in major medical journals and in their respective protocols, underscoring the need for consistent, detailed, and transparent PPI reporting practices in clinical research.Study registrationhttps://doi.org/10.17605/OSF.IO/4EQG2.

Patient and public involvement (PPI) has become a key part of health and social care research in many countries with a focus on working with or by patients rather than to, about, or for them, aiming to coproduce knowledge that is relevant, appropriate, and acceptable for patients.12 Patient and public contributors can and should be included at all stages of research, including identifying key questions, designing, recruiting, selecting outcomes, and implementing findings.1Patient involvement in a study should be reported within a paper to ensure that this knowledge contributes to building the PPI evidence base for practice. While reporting PPI might seem obvious, the reporting of PPI in research remains more elusive than we might expect. Past studies have identified poor and inconsistent reporting,34 which resulted in development of the GRIPP2 reporting guidance specifically for PPI.56 GRIPP2 is supported by journals that request authors to report PPI, including The BMJ and...

bmj;389/apr10_1/r708/FAF1faStephen was born in Bristol in 1933, the son of a carpenter. He won a scholarship to Queen Elizabeth’s Hospital School before studying medicine at Bristol University. After graduation he worked at Leeds General Hospital and then as a registrar at the National Heart Hospital in London.He moved back to Bristol, became a paediatric cardiologist at the Bristol Royal Hospital for Children, and was instrumental in making it a hub for paediatric cardiology in the West Country and South Wales. As well as his patient work Stephen was active in fundraising for the hospital, especially in the then emerging areas of echocardiography through the Bristol Heart Circle. Of note during his tenure was the expansion of the special care baby unit in Bristol and the visit of Diana, Princess of Wales, to open the new facility in 1983.He also pioneered the use of computers for helping with clinical record keeping...

New England Journal of Medicine, Ahead of Print.