BMJ - British Medical Journal

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...

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...

Almost 700 medical students in the UK have been given “placeholder” jobs, meaning that they know the deanery they will be in when they start foundation training in August but not the hospital where they will work.Some deaneries cover huge geographical locations, or even nations, as in Wales, Scotland, and Northern Ireland—leaving new doctors little time to plan where they will live, the BMA said.Phil Banfield, BMA chair of council, and officers from its Medical Students Committee have written to the health and social care secretary, Wes Streeting, calling on him to meet the contractual obligations of hiring these doctors and certainty for the placements to be provided at least eight weeks before the start of the foundation programme.The UK Foundation Programme Office (UKFPO) introduced “placeholder jobs” in 2023 after 800 new doctors were placed on the reserve list for jobs in 2022, up from just 25 in 2017. A...

The movement to dismantle diversity, equity, and inclusion (DEI) initiatives in healthcare threatens to reverse decades of progress towards tackling systemic inequities that harm marginalised patients and providers. Critiques of bureaucratic or performative DEI efforts should not justify abandoning the mission altogether. Instead, the solution lies in reforming DEI to prioritise evidence based strategies. Studies show that racial concordance between patients and physicians improves trust, communication, and adherence to treatment plans, directly enhancing clinical outcomes.1 Yet, as Hopkins-Kotb notes,2 only 2.8% of physicians are black women, a stark under-representation that perpetuates inequities.Too often, DEI initiatives rely on superficial workshops led by facilitators lacking clinical expertise. These programmes fail to tackle the realities of healthcare, such as racial disparities in pain management or diagnostic delays. Effective DEI requires clinician-educators with dual expertise in anti-racist pedagogy and medical practice. Workshops led by physicians, for example, can show how implicit biases affect treatment...

Children born in 2008 in the UK have not yet hit their 18th birthday but have already lived through a global financial crisis, a period of austerity, a pandemic, and now a cost-of-living crisis. Inequality has widened in that time, and local authority budgets have been dramatically cut.Before last year’s election the Labour Party set out its health mission, where it acknowledged that much of what made people healthy sat outside the remit of the NHS. It set out plans for jobs, housing, and policies around unhealthy food, alcohol, and tobacco.1 But with a laser focus on fiscal policy, many public health experts believe that the government is simply not being ambitious enough.Since gaining power the Labour government has announced a ban later this year on TV advertising of unhealthy food before the 9 pm watershed,2 as well as £125m for trailblazer programmes to help people with long term chronic...