BMJ - British Medical Journal

Rates of cancer are now rising in Americans under 50, and particularly among women, a report from the American Cancer Society has said.12While overall cancer mortality in the US continues to decline, “future gains are threatened by rampant racial inequalities and a growing burden of disease in middle aged and young adults, especially women,” the society’s annual report says. About 80 000 young people aged 20 to 39 are diagnosed with cancer every year in the US and cancer is the fifth leading cause of death in this age group.3The society predicted that this year there will be over 2 million (2 041 910) new cases of cancer and 618 120 cancer deaths in the US, based on data from central cancer registries and collected by the National Center for Health Statistics.Cancers in women under 50 are now 82% higher than men of the same age (141.1 v 77.4 per...

When the previous Trump administration announced its withdrawal from the World Health Organization (WHO), the decision sent shockwaves throughout the world.1 While that decision was reversed by the incoming Biden administration, Trump has done it again. And this time around, he has sufficient time to complete the 12 month withdrawal process. This severing of ties between the world’s largest economy and its foremost public health body represents a major setback for health diplomacy, scientific collaboration, and funding. The repercussions will ripple across borders, leaving WHO weaker and the US isolated when global health challenges demand unity.For decades, WHO has stood as a beacon of international cooperation, coordinating outbreak responses, fostering scientific exchange, setting norms, and providing invaluable technical assistance. The benefits of membership are immense, including disease surveillance, health system strengthening, and health diplomacy. The US helped create WHO and has been a core funder and leader for over 75...

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), used to treat diabetes and for weight loss, may be linked with a reduced risk of substance use and neurocognitive disorders, a US study in people with type 2 diabetes found, but could also carry an increased risk of gastrointestinal disorders and drug induced pancreatitis.1Researchers from the Veterans Affairs St Louis Healthcare System in Missouri used US Department of Veterans Affairs databases to follow 1.96 million people with type 2 diabetes for a median period of 3.7 years and to map associations between GLP-1RA use and 175 health outcomes.The study, published in Nature Medicine, included 215 970 people who used a GLP-1RA, comparing these with 159 465 people who used sulfonylureas, 117 989 who used dipeptidyl peptidase IV (DPP4) inhibitors, 258 614 who used sodium glucose cotransporter-2 (SGLT2) inhibitors, and 1.2 million who used (“usual care”) any non-GLP-1RA antihyperglycaemic drug. Participants were enrolled between October...

The longest running study to date of the effects of diet on cognition appears to support widespread suspicions that processed red meats, such as bacon, hot dogs, sausages and salami, are associated with an elevated risk of developing dementia.Published in Neurology, the journal of the American Academy of Neurology, the study tracked 133 771 US health professionals for an average 40 years, during which time 11 173 cases of dementia were recorded.1Researchers used regular questionnaires to record the eating habits of participants and divided them into three categories based on their consumption of processed red meat. The low group ate on average fewer than 0.1 servings a day, the medium group consumed 0.1 to 0.24 servings a day, and the high group averaged over 0.25 servings a day.In repeated tests administered by telephone, the high consumption group’s global cognition scores trailed those of the low group to a degree consistent...

The conflict in Gaza has been more than a geopolitical and humanitarian crisis—it is a profoundly human tragedy with severe consequences for an entire generation of Palestinian children and young people. Over a year of Israeli airstrikes, bombing, and ground level violence have killed more than 45 000 Palestinians and destroyed infrastructure and essential services. In the leadup to the recent ceasefire deal, which is in place at the time of writing, there had been no safe place left in Gaza. Families are struggling to meet their basic needs. Continuous attacks have obstructed humanitarian efforts, further limiting the delivery of crucial aid. The ceasefire is a critical moment to protect civilians, secure the release of hostages, and scale up humanitarian aid—a glimmer of hope to restore some sense of normalcy for families who have struggled to survive over the past fifteen months and to pave the way for lasting peace.Today,...

The recent systematic review and meta-analysis by Zimmermann and colleagues presents crucial insights into the ongoing gender disparity in physician suicide rates.1 While the overall reduction in suicide among physicians is commendable, the persistently elevated risk in female physicians is a concern that warrants attention.In the Indian context, the challenges faced by female physicians are exacerbated by societal expectations, professional discrimination, and the demanding nature of the medical profession. Psychological stressors, including burnout and depression, are particularly prevalent among female doctors in tertiary care settings in North India.2 These stressors are further compounded by cultural stigmas that hinder help seeking behaviours.2Recent studies underscore the severity of this problem, with nearly 40% of female doctors reporting high stress levels.3 This degree of stress correlates with an increased risk of mental health disorders, including suicidal ideation.To combat this ongoing problem it is essential that healthcare systems implement gender sensitive strategies. One promising...

The US Food and Drug Administration (FDA) has proposed a rule to restrict the amount of nicotine in cigarettes and other tobacco products to non-addictive levels. If the rule is approved the US would be the first country to do so.1The FDA said that cigarettes and other combustible tobacco products such as cigars and pipe tobacco are the most harmful tobacco products. “Cigarette smoking is the leading cause of preventable diseases and death in the US and is a major driver of chronic diseases nationally. Each year, cigarette smoking alone is estimated to kill nearly half a million people nationally and has been estimated to cost the country more than $600bn (£492bn; €581bn) annually in healthcare costs and lost productivity,” the FDA said.The rule is open for comments until 15 September 2025, after which the agency will decide on future action. That decision will be made under the new administration...

The Health Services Safety Investigations Body (HSSIB) report1 on out-of-area mental health inpatient placements provides a welcome spotlight on the problem.2 Psychiatrists have, however, repeatedly raised concerns since the Royal College of Psychiatrists set up the Commission on Acute Adult Inpatient Care in 2015, and the Department for Health and Social Care committed to eliminate out-of-area admissions in 2016.3 The HSSIB report highlights several reasons for the failure to achieve this aim, including governance, legal frameworks, and financial arrangements between health and social care services. What is missing, however, is a more fundamental understanding of why the problem has arisen.Much can be attributed to the consequences of the unstated and unevidenced UK mental health policy principles that have held sway for over 20 years: that hospital admission is a failure of least restrictive care by mental health services; that early intervention will prevent the development of most serious mental illness;...

Prioritising keyworkers for vaccinationGiving evidence to the inquiry on 15 January, Jean Rossiter, who set up the group Covid-19 Bereaved Families for Justice UK, questioned if key workers such as teachers and transport workers should have been prioritised for early access to vaccination.1Rossiter’s son Peter was a music teacher who only received his first vaccine dose in May 2021, five months after the first vaccine was given in the UK. He contracted covid-19 soon after a delay in receiving his second dose in July. He was admitted to intensive care in hospital and died on 11 August.Covid inquiry chair Heather Hallet said, “You had a fit and healthy young son, under 40, and so it helps to remind people that we’re not just about protecting people who some may think have had a good innings, we’re about protecting the whole population.”Concern about delivery of vaccines in ScotlandMelanie Newdick, from Scottish...

All US women over 65 should be screened for osteoporosis to identify those needing treatment to prevent fractures, the US Preventive Services Task Force has recommended.1The task force also recommends screening postmenopausal women younger than 65 who are at risk for osteoporotic fractures because of risk factors such as low weight, parental history of hip fracture, cigarette smoking, or excess alcohol consumption.But the final recommendation concluded that more research was needed to determine whether men should be screened for osteoporosis.Esa Davis, task force member and professor of medicine and family and community medicine at the University of Maryland School of Medicine, said, “Too often, the first sign of osteoporosis is a broken bone, which can lead to serious health issues.” In the US about 27.1% of women over 65 and 5.7% of men over 65 have osteoporosis.The recommendation is based on a review, published in JAMA,2 which evaluated the evidence...

Medical organisations have welcomed an initial six week ceasefire agreement in the Gaza Strip that should end 15 months of war and allow the territory’s broken health system to be rebuilt.On 15 January Israel and Hamas agreed for hostilities to cease, hostages to be released, and eventually, for Israeli forces to withdraw from Gaza. The provisional agreement also stipulates that 600 trucks of humanitarian aid will enter Gaza each day from 19 January, when the agreement is initiated.1In a statement the humanitarian organisation Plan International said that the arrival of aid will help meet urgent medical needs and is a “moment of hope.” In the longer term it should lay the groundwork for the huge task of rebuilding essential infrastructure, such as hospitals.2“The destruction of homes, infrastructure, hospitals, schools, and essential services by the Israeli military has left Gaza in an unliveable condition,” the organisation said. “The few remaining hospitals...

“We need more activity, and less waste,” says Wes Streeting in his introduction to NHS England’s plan to reform elective care.1 The recently published proposals set out how this will be achieved via: “productivity-boosting tools,” a “focus on improving experience and convenience,” and paying £20 to GPs who use the advice and guidance system to seek a secondary care opinion before, or instead of, making a formal onwards referral. The plan was illustrated by the story of a patient named Sarah, whose convoluted route to receiving a diagnosis of rhinitis and a hearing aid exposes the risks of focusing on itemisable activity instead of solutions to the deeper problems overwhelming the health service.The case study featuring Sarah was quietly removed from the document after a flurry of GPs pointed out that her treatment managed to be both idealistic and wholly inappropriate. But the most bemusing fact about her meandering clinical...

In mid-March 2020 and into April 2020, paediatric wards in England—usually full with children needing medical care due to respiratory diseases and other illnesses—were empty. The UK, and other countries in the world, were in a covid-19 lockdown. Schools were closing and children were staying at home and not mingling. The usual infectious disease mix that would result in children needing hospital care had a break. Paediatricians expected a quiet few months while NHS resources were directed towards the mounting wave of covid-19 hospital admissions, which were expected to be largely in the older and middle-aged population.And then incredibly unwell children started showing up in hospital.1 First one, then another one, and then several more. The children all had symptoms similar to the rare Kawasaki disease, an autoimmune disease, which can cause cardiac arrest and result in children being admitted to intensive care (ICU). Within the span of 10 days...

Médecins Sans Frontières (MSF) has withdrawn from a key hospital in Sudan’s capital Khartoum following months of violent attacks on patients and staff.1The aid organisation announced the “very difficult decision to suspend all medical activities” at Bashair Teaching Hospital—which is in an area controlled by the paramilitary Rapid Support Forces—on 9 January. It said extensive engagement with all sides in the conflict regarding keeping the hospital safe had failed.In November a patient was shot and killed inside the hospital, and in December attackers fired weapons inside the emergency ward and threatened medical staff. Bashair Teaching Hospital is one of the last functioning hospitals left in south Khartoum that offers free medical care. MSF has had a team working there since May 2023, the month after the civil war between the Sudanese Armed Forces and the Rapid Support Forces began.Claire San Filippo, MSF emergency coordinator, said, “Intense and extreme violence continues...

Providing calorie information labels on menus and food products has a small but important effect at a population level on the choices that people make, a large Cochrane review has concluded.1UK researchers analysed findings from 25 studies and found that calorie labels on supermarket products and on menus in restaurants lead people to select food with a smaller number of calories. They identified a 1.8% reduction in calories selected when labelling was in place, which they calculated meant 11 fewer kilocalories for a 600 kilocalorie (2.5 MJ) meal.Their results indicated that there may be a bigger effect of labelling on the food that people actually consumed (rather than just selected), with a 5.9% reduction, but the evidence to support this finding was weaker.A previous Cochrane review published by the same team suggested a bigger effect of calorie labelling,2 but more high quality research has been done since then. If sustained...

Wilkinson and colleagues1 and Simpson2 argue that the General Medical Council should overlook criminal behaviour when it aligns with their personal beliefs. Wilkinson and colleagues question the fairness of suspending a doctor involved in unlawful protests, while Simpson advocates sabotaging infrastructure. Both letters downplay the importance of professional accountability and public trust, prioritising personal views over professional obligations.The GMC’s role is to uphold public confidence in doctors, not to excuse criminal activity because it aligns with a specific cause. Activism does not require unlawful behaviour, and public trust in the medical profession depends on adherence to ethical and legal standards. Excusing criminal acts for any kind of activism sets a dangerous precedent. Would the public accept doctors going unsanctioned by the GMC for engaging in illegal activity while protesting against the tobacco industry, for example, despite its demonstrable harm to public health?Wilkinson and colleagues and Simpson must also recognise that...

In the UK, 2.8 million people are economically inactive and in receipt of health related welfare benefits.1 Almost a million young people aged 18-24 years are not in education, employment, or training, and one in five of those receives health related benefits, largely for mental health conditions.2 Following a decade of austerity, and exacerbated by the covid-19 pandemic, ill health and health inequalities have worsened in the UK such that it is the “sick (wo)man of Europe.”3The UK has far higher rates of health related worklessness than most other comparable economies (including Germany, Sweden, and France).4 It faces a serious economic challenge because of stagnating growth and widening inequalities in productivity, which contribute to rising rates of poverty and further inequalities in health.5Health related worklessness became a problem for the UK in the 1980s when rapid deindustrialisation led to mass unemployment, particularly in the north of England, Scotland, and Wales.1...

A nurse forced to change an incontinent patient with dementia beside a vending machine and a patient dying from a cardiac arrest who couldn’t be given adequate cardiopulmonary resuscitation (CPR) because of overcrowding in the corridor are just two examples from a stark new report from the Royal College of Nursing.1The report is based on a survey of 5408 UK nursing staff carried out from 18 December to 11 January 2025, in which more than two thirds (66.8%) said they had on a daily basis treated patients in inappropriate settings such as a corridor, bathroom, cloakroom, bereavement room, or converted cupboard. More than nine in 10 of those surveyed believed that patients’ safety was being compromised. Nurses reported caring for up to 40 patients in a corridor but unable to access oxygen, cardiac monitors, and other vital equipment.The report also highlights serious concerns about infection prevention and control. One nurse...

bmj;388/jan16_7/r92/FAF1faWhile he was a senior house officer in Ashington, Northumberland, Mike Snow developed open tuberculosis. He had a considerable amount of time off work, including 100 days of intramuscular injections of streptomycin.This experience may have coloured his choice of career. Despite infectious diseases being prevalent in the 1970s the specialty was in its infancy and most patients, apart from the most serious cases, were treated by general physicians.In 1978 Snow was appointed to a new post at Newcastle General Hospital, where most of the serious infectious diseases were treated. There was a small isolation unit to which any consultant in Newcastle could refer patients for nursing care, while their medical care would be delivered by the referring consultant. Snow took a strong interest in developing the unit.He completed his training as a physician and then spent six months in Birmingham with Alastair Geddes, a specialist in infectious diseases. HIV and...

Next week the US president elect, Donald Trump, will take office with a mandate to make radical changes to the government’s approach to medicine and public health.Health insurance coverage in particular faces massive, potentially harmful, reform (doi:10.1136/bmj.q2801).1 Republicans in Washington plan to shrink Medicaid, the programme for people on low incomes, potentially leaving millions of Americans uninsured. Traditional Medicare (for people over 65 and those with disabilities) could also reduce to the point that it covers only a small fraction of the current Medicare population.In the meantime, public frustration with insurers has been evident after the murder of Brian Thompson, chief executive of UnitedHealthcare (UHC) (doi:10.1136/bmj.q2879).2 It has exposed the healthcare giant’s high rate of insurance coverage denial and the misery this has caused. The fact that Luigi Mangione, who is accused of the murder, left a note accusing the US healthcare system of corruption and greed has been widely...