BMJ - British Medical Journal

“Readers should not have to infer what was probably done; they should be told explicitly.” Douglas G Altman 1The 2024 update to the Declaration of Helsinki states: “Researchers have a duty to make publicly available the results of their research on human participants and are accountable for the timeliness, completeness, and accuracy of their reports. All parties should adhere to accepted guidelines for ethical reporting.”2 In an era where health research influences everything from clinical practice to public policy, ensuring the reliability and trustworthiness of scientific findings is critical. For clinicians, well reported studies provide the evidence they need to make informed decisions about patient care. For policy makers, they offer a reliable basis for shaping public health interventions. For patients, they ensure that the treatments they receive are grounded in robust and transparent science.Yet weak study design, inappropriate methods, and incomplete reporting continue to plague health research.13 These limitations...

First published in 1996, CONSORT (Consolidated Standards of Reporting Trials) emphasised the importance of accurate and complete reporting of randomised clinical trials.1 Journal articles were the only public records of many randomised clinical trials, and the CONSORT reporting guidelines described the minimum information those articles should include. Most recommendations focused on methods and results. At the time, articles were published on paper and supplements were limited. Infrastructure to register clinical trials and to share other artefacts (eg, data, code) had not been invented. The first CONSORT update in 2001 described trial registration as desirable, but not essential.2 When a CONSORT update in 2010 added trial registration as a checklist item,3 opportunities for sharing data and code were still relatively new.4 SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013, the first reporting guidelines for trial protocols, introduced recommendations about data and code sharing.5CONSORT 2025 (doi:10.1136/bmj-2024-081123) and the soon-to-be published SPIRIT...

Kennedy claims ignorance of cuts in first TV interviewIn his first sit-down television interview the US health secretary, Robert F Kennedy Jr, claimed that he was “not familiar” with the ongoing cuts to state and local public health programs, adding that any cuts were “mainly” related to diversity, equity, and inclusion programmes.1 Recorded for CBS News just before he attended the funeral of an 8 year old who died of measles,2 he said, “People should get the measles vaccine, but the government should not be mandating those.” Kennedy then added, “We don’t know the risks of many of these products because they’re not safety tested.” Georges Benjamin, executive director of the American Public Health Association, has called for Kennedy to resign, citing “implicit and explicit bias and complete disregard for science.”3Trump rolls back NIH scientific integrity policyThe Trump administration has rescinded the scientific integrity policy of the National Institutes of...

The UK National Institute for Health and Care Excellence has recommended a targeted twice daily drug treatment that could help around 3000 women a year with advanced breast cancer in England and Wales.In final draft guidance published on 11 April,1 NICE said it was recommending capivasertib (also called Truqap) with fulvestrant as an option for around 1100 adults with hormone receptor positive HER2-negative breast cancer that has certain genetic mutations and that has spread.The Institute of Cancer Research said that the new drug was also suitable for patients whose tumours have mutations or alterations in the PIK3CA, AKT1, or PTEN genes, found in around half of patients with this form of breast cancer, bringing the total number of people who could eventually benefit from capivasertib to around 3000 a year.The recommendation marks a change of heart from NICE, which initially rejected the drug but which said it had worked with...

People with long term health conditions are being left vulnerable to harm and burnout because of inadequate coordination of care across the NHS and care system, England’s patient safety watchdog has said.The Health Services Safety Investigations Body (HSSIB) looked at the coordination of primary and community care for patients with long term conditions and found that health and care systems often failed to support coordination across multiple care pathways, focusing instead on individual diseases or problems. This has left many patients at a greater risk of harm from uncoordinated care, said an HSSIB report published on 10 April.1For its investigation the HSSIB spoke with patients and carers through focus groups and one-to-one interviews and engaged with healthcare providers, integrated care boards, national bodies, and charities and the voluntary sector. In England 41% of adults and 17% of children have at least one long term medical condition.One focus of the investigation...

Long queues are snaking outside pharmacies in major cities across Colombia as patients try to collect their drugs, only to be told that even basic medications are unavailable, as the country’s health system suffers as a result of growing debt and political turmoil.Clinics are also turning away patients who request urgent treatment, despite having medical insurance.Leydy Julieth Gómez recently sought urgent treatment for her 2 month old baby, who was on oxygen after contracting a severe infection, when his condition deteriorated. Despite paying a monthly premium for a health insurance plan, Gómez was told that an ambulance would take eight hours to arrive and several clinics nearby would not receive her on the basis that her healthcare provider was too heavily indebted to them.When Gómez found a clinic that would treat her baby it had no basic supplies of drugs and her baby contracted a second infection because of a...

At the 2024 UN climate change conference (COP 29), developed nations pledged $300bn in climate finance annually to support “an insurance policy for humanity.”1 This falls far short of the trillions required to enable vulnerable nations to adapt to the increasingly severe impacts of climate change.2COP 29 failed to meaningfully address the systemic inequities that underpin the climate crisis: legacies of imperialism, extractivism, and atmospheric colonisation (the process by which a small number of high income countries have appropriated substantially more than their fair share of the atmospheric commons)3 at the heart of vulnerability to climate change.The most vulnerable nations are being offered paltry sums that are disproportionate to both the loss and damage endured and their contribution to the climate crisis. An example is the 2022 floods in Pakistan, which affected more than 33 million people, destroyed or damaged over two million homes, and resulted in the deaths of...

The UK’s health and social care services are increasingly strained by rising demands and widening health inequalities—in life expectancy, infant mortality, mental health outcomes, childhood obesity, early childhood development, rates of children entering care, educational attainment, vaccination coverage, and more. Our NHS needs “resuscitation,” with a £37bn shortfall compared with peer countries.1 New data show that 4.5 million children in the UK, more than 31%, are in relative income poverty.2 The government has decided to cut welfare benefits for people with disability,3 with the minister for intergovernmental relations defending the cuts by saying you can’t “tax and borrow your way out of the need to reform [the] state.” This is in the world’s sixth largest economy, where private fortunes continue to grow. Could taxing wealth be a viable approach to address these critical challenges and promote equity across the population?In simple terms a wealth tax is a tax on a...

BiographiesClare Owen is director of policy at the Medical Schools Council. Her work focuses on medical education, and over the past 10 years she has led a programme to widen participation in medicine.Victor Adebowale has been chair of the NHS Confederation since April 2020 and is former chief executive of Turning Point, a social enterprise. A crossbench peer since 2001, he has led commissions on mental health and housing and is co-chair of the BMJ Commission on the Future of the NHS. He holds an MA in advanced organisational consulting and serves as chancellor at the University of Lincoln and as a leadership coach.VA: We’re talking at a time when DEI [diversity, equity, and inclusion] is under attack. Lots of people are saying that it’s a waste of money, even in the health services. Why is it important?CO: We know that there are differential outcomes for people at our medical...

Be kind to yourselfDivpreet Sacha, general practice specialty registrar, Birmingham and Solihull, says, “In vitro fertilisation (IVF) is becoming increasingly common, yet the mental and emotional toll it takes is rarely discussed. The physical effects of IVF drugs are well known, but the mental struggles—stress, anxiety, and emotional fatigue—often get overlooked. IVF isn’t a straightforward process; each person’s response is different and delays or complications can add even more pressure. As the number of people undergoing IVF grows, it’s important to raise awareness about the physical and mental challenges, especially when trying to balance the demands of work.“I struggled with balancing work and IVF. The emotional weight and physical exhaustion were overwhelming and eventually I had to take sick leave to focus on my mental health. As a doctor, especially in the NHS, there’s a culture of just getting on with it. Workplace pressures can make it harder to admit...

The beauty of wordsIt has been reported that when the US philologist Willard R Espy (1910–99) was asked to compile a list of the 10 ugliest words for a book of lists his initial reaction was “I know no ugly English words. I consider them all bundles of shimmering loveliness.”1 Nevertheless, he eventually agreed to assemble “the most abhorrent stench of words that ever made its way to the human brain through the human nostril.”This emphasises, were emphasis needed, that beauty is in the eye of the beholder. Or rather, where words are concerned, in the ear and mind of the beholder. Because the extent to which a word is regarded as being beautiful or ugly depends partly on how euphonious or cacophonic the word sounds and partly on the pleasant or unpleasant ideas it conjures up in one’s mind. Why else would the word “felicity” find its way into...

The announcement that NHS England (NHSE) will be scrapped may have surprised the mainstream media, but for many insiders there were indications of the direction of travel. The absence of any serious defence from political parties suggests this move was overdue.The proposed 50% job cuts across NHSE and the Department of Health and Social Care (DHSE) appear arbitrary—more of a political signal than a feasible strategy. However, reductions are inevitable. At its onset NHSE’s mission was wide and included driving the delivery of safe and high-quality healthcare for all; supporting NHS staff with training, data, and tools; and delivering value for money. The key concerns in getting rid of NHSE are what gets eliminated, what remains, and how resulting gaps will be tackled. Where will the “slack” be taken up, and duplication avoided, in an already stretched system within the DHSC.Integrated Care Boards (ICBs) will experience the most significant administrative...

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...

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...