Medical Journal News

The head of the US Department of Health and Human Services (HHS), Robert F Kennedy Jr, announced on 27 March that he would cut 10 000 employees from department agencies as part of government restructuring by Elon Musk’s Department Government Efficiency. Another 10000 HHS employees left through early retirement and buyouts.1 President Donald Trump had previously told Kennedy to “go wild on health.”2Other major changes are also under way in the agencies that sit under HHS. The Centres for Disease Control and Prevention (CDC) will lose about 3500 employees and get a new head, Susan Monarez, current acting director. Trump’s original choice, David Weldon, was withdrawn when it became clear he didn’t have enough votes for approval.3 The CDC will also conduct a large study to investigate a possible link between vaccines and autism, although many studies have debunked such a link.4 Researcher David Geier, who is not a doctor...

What you need to knowPeople experiencing homelessness face multiple barriers to accessing health care and have high mortality and morbidity from preventable or treatable conditionsClinicians should consider preventive care, harm reduction, and the increased rates of multimorbidity and early onset frailty when caring for people experiencing homelessnessTrauma informed practice provides a framework to enable respectful, safe, collaborative, and empowering relationshipsThere has been a worldwide rise in homelessness over the past 10 years.1 On a single night in 2024 roughly 771 480 people in the United States were experiencing homelessness, the highest figure since reporting began in 2007.2 Equivalent figures in England showed that, on a given night in 2024, an estimated 354 016 people were homeless which is 1 in 160 people.3Health and homelessness are closely interconnected, and there is much that can be done by healthcare professionals to improve the lives of people experiencing homelessness. Here, we explore the...

South Africa, HIV/AIDS hit hardHIV/AIDS researchers in South Africa are reeling from the termination or suspension of grants from the US National Institutes of Health (NIH). Science1 reported that the cuts seem linked to a crackdown on grants with components of diversity, equity, and inclusion. Researchers told Science that grants related to LGBTQ+ health in the US were also terminated. Bhekisisa reported a leaked memo that instructed NIH staff to “hold all awards to entities located in South Africa,” listing it as a “country of concern” alongside China.2Modelling analysis published in TheLancet HIV3 this week estimated “an additional 4.43 to 10.75 million new HIV infections and 0.77 to 2.93 million HIV related deaths between 2025 and 2030” because of international aid cuts proposed by various countries. France, Germany, the Netherlands, the UK, and the US provide over 90% of all international HIV funding.NIH will stop funding climate health researchAn internal...

A New York State county clerk has refused to enforce penalties filed by the state of Texas against a doctor in New York State who posted medication abortion drugs to a Texan woman.1The US constitution requires states to enforce judgments against their citizens by another state, so the dispute is almost certain to go to the Supreme Court. The constitutional right to abortion was overturned in 2022 and the decision left to individual states.2 Texas is one of 19 of the 50 states that have almost completely banned abortion.Despite the bans, abortions have increased as women travel out of their home state for the procedure or receive the medication abortion drugs mifepristone and misoprostol by telemedicine.34 The drugs are now used in around two thirds of US abortions.The doctor at the centre of the Texas lawsuit is Margaret Daley Carpenter of New Paltz, north of New York City. She is...

When Susan Cole was pregnant with her third child her HIV viral load started to rise, even though she was continuing to take her antiretroviral treatment. “Initially I was told I probably wasn’t taking my treatment properly, but that wasn’t the case: there just wasn’t enough research about drug levels during pregnancy,” she says.Cole, a health equity writer and advocate, shared her experiences at a webinar organised by the Message project (Medical Science Sex and Gender Equity).1 The project aims to improve the integration of sex and gender considerations across data collection, analysis, and reporting in the UK’s biomedical, health, and care research.Cole’s lived experiences clearly highlight the problem that Message is trying to tackle. She says that a lack of research involving women affects their experiences of illness and treatment, as well as their outcomes.What is the Message project?When it comes to guidance and policies on sex and gender...

Make them feel safeCatriona McVey, final year medical student, says, “Neurodivergent colleagues often bring unique strengths—such as attention to detail and deep focus in specialised areas—but they can also face additional challenges and barriers to success.“Work with them to identify what they personally find difficult, and explore what accommodations can be made at work. Neurodiversity is a spectrum and something that helps an autistic colleague may not be useful for a colleague with attention deficit/hyperactivity disorder (ADHD). Likewise, some people with ADHD might prefer to work alone when they need to concentrate, whereas others find they’re more productive when they can ‘body double’ by working alongside colleagues.“Culture is an important part of supporting neurodivergent colleagues. Neurodivergent problem solving can be unconventional, but still effective. As long as professional standards are met, focus on outcomes rather than rigid processes by being open to different approaches and communication styles. Lack of eye...

The evolution of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) has been shaped by the continuous challenge of balancing ischaemic protection with bleeding risk. While prolonged DAPT confers thrombotic risk reduction, it invariably increases bleeding complications, which are themselves associated with adverse prognostic implications.1 This dilemma has prompted the exploration of de-escalation strategies—gradual tapering of antiplatelet intensity or duration—as a means of optimising patient outcomes. Currently, the concept of DAPT de-escalation refers to the strategy of discontinuing aspirin after a short period of dual antiplatelet therapy after PCI, leaving patients on monotherapy with a potent P2Y12 inhibitor—typically ticagrelor, as supported by available evidence.234 The rationale behind this approach is to maximise ischaemic protection during the initial months after PCI, when the thrombotic risk is highest, while simultaneously mitigating the bleeding risk, which remains relatively constant and is directly associated with DAPT duration.5 In a previous meta-analysis from our...

Tuberculosis (TB) is the world’s oldest pandemic, accounting for around a billion deaths in the past two centuries.1 In the UK, after more than a decade of declining incidence, numbers are on the rise. In 2024, 5480 people became unwell with TB in England—up 13% from 2023, the largest increase recorded since 1970, and reflecting a trend that started in 2021.2 The TB Action Plan for England 2021-263 commits the country to meet the World Health Organization target of eliminating TB by 2035.4 But achieving the required 18% annual rate reduction from 2025 is not certain.TB is linked to conditions of poverty. People who become unwell with the disease face stigma, financial precarity, digital exclusion, language barriers, and housing insecurity.5 They need the scaffolding provided by support networks to enable them to receive the health and social care required to complete treatment successfully. TB exists on a spectrum between asymptomatic...

Over the past two decades my research has centred on systematic reviews. Developing and evaluating statistical and research methodology for reviews has been a focus, but I have also collaborated on many reviews. These collaborations inevitably reveal the importance of complete, clear, and accurate reporting of primary studies. At best, incomplete and inaccurate reporting wastes research investment—often substantial in the case of large randomised trials—and at worst, it may lead to incorrect conclusions with far reaching consequences.Primary studies that are reported well contribute maximally to the evidence base and can be fairly assessed. The opposite is true when reporting is unclear or incomplete. I have spent countless hours scouring trial reports for information that should be present but is not; trying to decipher unclear text; or trying to decide what to do when the information reported is inconsistent within or across reports of the same study. This time adds up...