The BMJ (British Medical Journal)

The BMJ (British Medical Journal)

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The BMJ (British Medical Journal)

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

Healthcare's moral emergency: reconnecting healthcare with its mission and purpose
http://www.bmj.com/content/393/bmj.s969.short?rss=1

Something is wrong that the metrics do not fully capture. Healthcare systems across the world have never possessed greater diagnostic precision, therapeutic capability, or computational power. And yet patients increasingly report feeling processed rather than cared for; clinicians speak of moral distress and hollowed out meaning; and the workforce is haemorrhaging people at a rate it cannot sustain. The paradox of healthcare today is that we have accumulated extraordinary technical power while quietly losing the human, moral, and relational foundations on which its effectiveness ultimately depends. There are powerful structural forces at work. In the United States and increasingly globally, what has been called salve lucrum, the glorification of profit, has become a stranglehold on healthcare’s moral purpose.1 No sector is immune, from pharmaceutical companies to insurers to physician practices. But the distortion runs deeper than finance. Montori and colleagues identified a complementary pathology almost two decades ago: industrial healthcare has...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

When risk becomes disease
http://www.bmj.com/content/393/bmj.s942.short?rss=1

Diagnosed with a melanoma in situ at the age of 17, Davies reflects on the damages of living with an apparently elevated risk of cancer.1 Although considered cured, she was advised to monitor her body regularly. Her testimony reveals the persistent tension of “lifelong vigilance,” a state that resembles the experience of active surveillance for low risk cancers and precancerous lesions. Here lies the blurred boundary between risk and disease. As argued by Aronowitz, “one underappreciated consequence of modern clinical and public health practices is that the experience of being at risk for disease has been converging with the experience of disease itself.”2 This experience of being at risk involves regular medical visits and tests—accompanied by the anxiety of waiting for results—as well as preventive treatments. Quality of life and ability to work are affected, and the economic burden can also be considerable. This is particularly true for conditions such as...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

Health self-testing kit crackdown: Tougher regulations set to remove harmful products from the UK high street following BMJ studies
http://www.bmj.com/content/393/bmj-2026-410896.short?rss=1

Tougher oversight of popular health self-testing kits sold on the high street, including a clampdown on “misleading or unsubstantiated claims” is being planned by the UK's medicines and devices regulator. It follows research and a major investigation published in The BMJ,12 which found that many high street health tests-including for serious diseases like cancer-are unsafe for patients. This work also found that most self-test manufacturers either refused or ignored requests to provide reports of the studies supporting their claims. Self-testing has become increasingly popular, with a growing range of tests available directly to consumers without the need for medical involvement. The UK self-test market is projected to generate £660m in revenue by 2030. Many health tests are sold in major retailers such as Tesco and Superdrug at prices ranging from £1.89 to £39.99. But the ease with which manufacturers get these products on the shelves in the UK could soon change. The Medicines and Healthcare Products...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

Dumbor Ngaage: surgeon who led trial on speeding up rehabilitation for postoperative cardiac patients
http://www.bmj.com/content/393/bmj.s884.short?rss=1

bmj;393/may21_5/s884/FAF1faA clinical trial that could validate the halving of the recovery pathway for postoperative cardiac patients would be a fitting legacy for Dumbor Ngaage.1 The inspiration for the research, as Ngaage freely acknowledged, came from frustrated patients questioning what they saw as unnecessary delays between surgery and starting rehab. A colleague and friend recalled how the trial was much on Ngaage’s mind in the final conversation the two shared just days before his death. The study, which is backed by £1.7m funding from the UK National Institute for Health and Care Research (NIHR), is due to report next year. Earlier work led by Ngaage, including a smaller scale NIHR funded study, found that reviewing patients at three weeks (rather than six), followed by cardiac rehabilitation from four weeks (rather than eight), improves recovery and is more cost effective.2Enoch Akowuah—a colleague at Hull University Teaching Hospitals NHS Trust, where Ngaage was a...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

Fiona Haslam: doctor who researched the depiction of medicine in art and literature
http://www.bmj.com/content/393/bmj.s883.short?rss=1

bmj;393/may21_4/s883/FAF1faWhile still working as a doctor Fiona Haslam began research into the relation between medicine and art, which resulted in her being awarded a doctorate from the University of St Andrews in 1992. Drawing on contemporary medical treatises, letters, newspaper reports, journals, and diaries, her studies focused on works by artists such as William Hogarth and Thomas Rowlandson that were dense with medical imagery.“These artists produced art from a lay view of contemporary attitudes held towards members of the medical profession, who were coming under increasing scrutiny, along with their colleagues in law and in the church,” wrote Haslam. Among the areas she studied were medical images in Hogarth’s early satires, the innovation of vaccination, bloodletting and surgery, midwifery and birth, medicine and morality, madness, and death. In 1996 Haslam used this extensive knowledge when writing her first book, From Hogarth to Rowlandson: Medicine in Art in Eighteenth Century Britain,...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

WHO's nuclear war assessment needs an update to reflect current threats
http://www.bmj.com/content/393/bmj-2026-558495.short?rss=1

In May 2025 the World Health Assembly voted 86-14 to instruct the World Health Organization (WHO) to reassess what a nuclear war would mean for people, health systems, and societies.123 The UK government voted against the resolution, citing duplication of UN processes and budgetary concerns.24Given new evidence on the climate effects of a nuclear war and rising geopolitical tensions, this position is scientifically and ethically untenable. Global health policy must align with evidence, and the UK should officially support WHO's mandate at the 79th World Health Assembly and engage constructively with its findings. Our understanding of nuclear risk has fundamentally shifted since WHO's last report on the subject in 1987.5 A renewed arms race, collapsing treaties, and explicit nuclear threats from conflict between Russia and Ukraine and the nuclear standoff between Iran, Israel, and the US have reshaped the risk landscape. The 1987 report found that health services would be overwhelmed,...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

Scottish government fails to understand the medical employment crisis
http://www.bmj.com/content/393/bmj.s903.short?rss=1

Manton-Roseblade and Payne are right to declare the recent Scottish workforce planning announcement both illogical and insulting.1 Requiring Scottish medical graduates to either remain in Scotland to work for a minimum of five years after graduating or to repay their tuition loans respects neither the autonomy of the people in question nor the substantial amount of sacrifice already required of doctors.2 Imposing further restrictions would contribute to an already disillusioned, morally injured, and burnt out cohort of early career doctors.3That this proposal is being considered suggests that the Scottish government and workforce planning officials do not understand the nature of the current medical employment crisis across Scotland and the rest of the UK. As a resident doctor early in my career (EAD), I have experienced the difficulties obtaining any training post, let alone in the location of one’s choosing. Competition ratios have been climbing for several years, and reports of unemployed...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

Hubris syndrome: a clinical lens on intoxication of power
http://www.bmj.com/content/393/bmj.s950.short?rss=1

Destructive behaviours by leaders, both in politics and in business, are often attributed to these powerful people being affected by mental or physical illness1; recent debates about President Trump’s fitness for office show this tendency. Whether it is appropriate or ethical to link dysfunctional behaviours, such as hubris and its destructive consequences, to a leader’s health remains contested. Rather than be drawn into debates about diagnosis,2 we offer a framework—“hubris syndrome”—for understanding how and why leaders’ performance, and its effects on others, can become progressively impaired by the power they wield. Hubrists have a grandiose sense of self; they are overconfident, arrogant, and proud; they show contempt towards the advice and criticism of others; they overestimate the likelihood of positive outcomes from their decisions and actions and underestimate the likelihood of negative outcomes.3 In the absence of the necessary checks and balances, they create conditions which invite negative consequences.4 Hubrists are...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

PMOS: What's in a name? Everything.
http://www.bmj.com/content/393/bmj-2026-079749.short?rss=1

First, do no harm. It is medicine's most foundational principle. Yet for decades, a four letter acronym has been quietly violating it-not through malice, but misdirection. Polycystic ovary syndrome (PCOS) told clinicians, researchers, funders, and patients the wrong story. And patients paid the price. This month, that changed. PCOS is now PMOS-polyendocrine metabolic ovarian syndrome-after the most comprehensive medical renaming process ever undertaken: 14 years of global collaboration, 22 000 survey responses, 56 organisations, and 97% consensus.1 Patients were integral from the beginning: instigating action, shaping governance, co-designing surveys, co-chairing workshops, and interpreting and disseminating outcomes alongside health professionals. We listened, challenged and reframed together. I was on stage representing those affected at the European Congress of Endocrinology when we announced this change alongside Helena Teede, Terhi Piltonen, Aled Rees, and Stephen Franks, all experts in the field. PMOS is the most common endocrine disorder worldwide affecting women-with 1 in 8 (more...

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The BMJ (British Medical Journal)

May 24, 2026, 01:38 AM

Calcium, vitamin D, or combined supplementation to prevent fractures and falls
http://www.bmj.com/content/393/bmj.s913.short?rss=1

About 30% of people aged 65 years and older, and more than half of those living in nursing homes, experience falls at least annually, 5% of which result in fractures.1 Admission to hospital because of fractures leads to functional decline for many; in Canada, about 17% of older adults admitted to hospital for a fall subsequently require admission to long term care.2 Increases in fall related deaths and disability are being observed in ageing populations, as well as associated costs to national health systems.1 Globally, the incidence of falls and disability adjusted life years resulting from falls increased by 182% and 142%, respectively, from 1990 to 2021, and both are projected to rise further.3 Clearly, effective interventions are needed to reduce falls and their sequelae among older adults. Many factors, including biological, behavioural, environmental, and socioeconomic, contribute to fall risk, with low body mass index and low bone density increasing the...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

Identifying and managing pregnancy-related pelvic girdle pain
http://www.bmj.com/content/393/bmj-2025-088930.short?rss=1

What you need to knowPregnancy-related pelvic girdle pain is common, but not a normal sequela of pregnancy; consider the diagnosis in pregnant women with pain in the lumbosacral region, sacroiliac joints, and symphysis pubis jointDiagnosis is clinical and supported by focused examination, such as by simple provocation tests when performed by trained clinicians, without neurological deficitProvide information, reassurance, and practical advice on activity pacing, sleep, and adaptations, and offer simple analgesia such as paracetamolIn line with local referral processes, offer referral to pelvic health physiotherapy for women with persistent, functionally limiting, or worsening symptoms; physiotherapy may include education, exercise, and movement strategiesA 28 year old nulliparous woman complains of gradual onset pelvic pain at 30 weeks’ gestation of pregnancy. The pain is aching in nature and worse on climbing stairs and turning in bed. She denies any urinary or bowel symptoms and has not noticed any fluid or blood loss...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

How US fetal tissue research was sacrificed on the altar of politics
http://www.bmj.com/content/393/bmj.s767.short?rss=1

The annual March for Life, the high point of the US anti-abortion movement’s calendar, took place in Washington DC on 23 January 2026. The day before, US President Donald Trump’s administration had announced that research using fetal tissue would no longer be supported by the National Institutes of Health (NIH).1 The marchers were told that applications for new studies in that field were frozen on 22 January, pending a review that could soon lead to a ban.2The mood among marchers was, however, sombre, suspicious, and resentful. Almost every field of disease research could be affected by the ban. Among the 77 studies involving fetal tissue approved by the NIH last year were more than a dozen on HIV as well as others looking at viral infections, rhabdomyosarcoma, type 1 diabetes, Gaucher disease, and paediatric embryonic http://tumours.US/ health secretary Robert F Kennedy Jr said the Department of Health and Human Services (HHS)...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

Asthma: Blue inhaler use falls as over a million now use combination treatment
http://www.bmj.com/content/393/bmj.s867.short?rss=1

More than a million people in England now use a combination inhaler for asthma, surpassing for the first time the number of patients who use solely a blue inhaler. The National Institute for Health and Care Excellence (NICE) published new clinical guidelines in November 2024,12 advising doctors to stop prescribing short acting β2 agonists (SABAs) such as salbutamol on their own for new patients with asthma. SABAs are administered through recognisable blue inhalers, but experts3 say that these are flawed for asthma treatment because they help only to alleviate the condition rather than tackling the underlying cause. As such the new guidelines recommend combination inhalers to tackle the inflammation that triggers asthma attacks, as well as relieving symptoms. Overuse of the blue “reliever” inhalers has also been linked to a higher risk of asthma attacks, hospital admission, and death, said NICE. Experts said that the “milestone” shift signalled a major improvement in...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

Michael Johannes Gopfert
http://www.bmj.com/content/393/bmj.s805.short?rss=1

bmj;393/may06_1/s805/FAF1faBorn in Munich in the post-war years, Michael initially studied nursing, moving on to medicine and becoming part of a political youth movement confronting the legacy of Nazism. Alienated by an oppressive culture in Germany and attracted by the NHS and new developments in community psychiatry, he moved to London in 1978. He completed his child psychiatry training in Toronto, where he also discovered the Canadian wilderness, kayaking, and First Nations culture. When he returned to the UK he took up a post in Liverpool and made Merseyside his home, while also studying for a master’s in family therapy at the Tavistock Institute in London. There he met Julia, a child of German Jewish and political refugees. They married in 1989 in the Canadian wilderness and lived together in Merseyside with their three children. In 1989 Michael set up a new psychotherapy service at the Royal Liverpool Hospital with integration at its...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

Mohammad Azizar Rahman
http://www.bmj.com/content/393/bmj.s804.short?rss=1

bmj;393/may06_2/s804/FAF1faAziz Rahman was born in 1935 in the village of Paschim Belpukur, in the north of what is now Bangladesh. After excelling at school, he was one of the small number of people selected for entry to the only medical school in the country at Dhaka. Very active in student politics, he also joined teams who travelled to villages vaccinating people against smallpox. He qualified in 1959 and then practised in Dhaka for a few years before moving to the UK with his wife in 1963. His initial interest was in dermatology, but over the next 10 years he moved to Bristol, where he became a GP in Patchway. For over 30 years he worked either single handed or with one partner, providing all services from delivering babies to end-of-life care, as was the norm in those times. He was dedicated to the care of his patients, once sleeping at the...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

Gaza: Israel extends detention of Palestinian doctor despite torture concerns and lack of charges
http://www.bmj.com/content/393/bmj.s848.short?rss=1

An Israeli court has extended the detention of the prominent Palestinian paediatrician Hussam Abu Safiya, who has spent more than 450 days in prison, reported Medical Aid for Palestinians (MAP). This is despite no charges being filed against him during his imprisonment of more than a year, the charity said. Abu Safiya, 52, was seized by Israeli forces in December 2024 after they raided Kamal Adwan Hospital in Gaza, where he was the director.1He is one of an estimated 14 Palestinian doctors currently being held by Israel, who include the MSF orthopaedic surgeon Mohammed Obeid.2Several human rights organisations have called for his release, including UN experts, who issued a statement in March after reports that he had undergone “severe torture.”3They wrote, “We have received reports that Dr Abu Safiya has been subjected to torture and other cruel and degrading treatment, and that his health condition remains dire.”They added, “He has been systematically...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

Expansion of medical school places: focus on retaining doctors instead
http://www.bmj.com/content/393/bmj.s827.short?rss=1

In The BMJ’s news story on the delay to expansion of medical school places, Katie Petty-Saphon, chief executive of the Medical Schools Council, indicates that increasing the number of medical students trained in “under-doctored areas” would increase the number of doctors working in these areas.1 Although past studies have shown that doctors tended to practise close to their place of birth or medical school, little research has been conducted on this in recent years despite drastic changes in workforce allocation.2The NHS increasingly allocates jobs at a national level, irrespective of birthplace or medical school location, forcing doctors to move to areas they would otherwise not have chosen to live. This is further compounded by rising competition ratios, which may require doctors to take any job offered to them for fear of otherwise being unemployed.3 The removal of priority foundation programmes, which previously offered financial incentives for posts in under-doctored areas,...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

Resident doctors v Wes Streeting: How a potential deal broke down, as BMA lead says Streeting must dial down “name calling”
http://www.bmj.com/content/393/bmj.s736.short?rss=1

Health Secretary Wes Streeting needs to stop trying to “politic” his way out of the dispute with resident doctors and focus on negotiating, the doctor tasked with leading talks with the government says. BMA Resident Doctors Committee (RDC) chair Jack Fletcher made the comments to The BMJ as resident doctors in England wrapped up their 15th strike since 2023.1Fletcher said that before the walkout negotiations with the Department of Health and Social Care (DHSC) had been going well.“We were moving in the right direction,” he said. The government’s latest offer included pay structure reform, reimbursement of royal college exam fees, contract reform for locally employed doctors, and up to 4500 more specialty training places over the next three years (including 1000 this April). Looking back on those conversations, Fletcher said that discussions about jobs and training numbers and trying to tackle the “gig economy”—which many doctors outside of training find themselves working in—were...

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

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The BMJ (British Medical Journal)

May 9, 2026, 04:20 PM

Palantir: MPs call for “shameful” NHS data deal to be scrapped
http://www.bmj.com/content/393/bmj.s738.short?rss=1

MPs have urged the UK government to scrap a “dreadful” and “shameful” £330m NHS contract with the controversial US tech giant Palantir during a Westminster debate.1Palantir, which also provides services to US immigration enforcement and the Israeli military, is contracted to create a federated data platform (FDP) for NHS England to help streamline health service data. But the deal has proved controversial, with concerns raised by the BMA2 and others over risks to patient trust, data security, and Palantir’s background with military and surveillance contracts. Earlier this week—amid reports that ministers were mulling scrapping the contract3—The BMJ revealed how data from pilots of the FDP, run at Chelsea and Westminster Foundation Trust and promoted as a Palantir success story, were flawed.4Against this backdrop MPs debated the FDP on 16 April, with several Labour and Liberal Democrat MPs urging the government to remove Palantir as the contract supplier. The debate was led by...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

Addressing the dual challenge of treatment access and innovation in anxiety disorders
http://www.bmj.com/content/393/bmj.s673.short?rss=1

Anxiety disorders are the largest class of mental health disorders and highly prevalent,1 yet substantial treatment gaps exist. Despite there being well established first-line treatments, only 25% of affected people globally receive treatment,2 ranging from about a third in high income countries34 to less in low and middle income countries.5 Of those receiving treatment, systematic reviews show overall response rates of about 50% for cognitive behavioural therapy (CBT)6 and medication.7 This stagnation in new effective treatments and response rates is exacerbated by a historic innovation drought in psychopharmacology: while the global burden of anxiety is projected to intensify—driven by evolving socioeconomic instabilities and the long-tail effects of the covid-19 pandemic—the development of novel psychotropic medications has remained disproportionately scarce. A new review in The BMJ provides a timely analysis of the emerging therapeutic landscape.8 However, while innovation is important, we must also target the barriers inhibiting equitable access to existing...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

The medical regulation process is unfit to handle the complex challenges of our time
http://www.bmj.com/content/393/bmj.s722.short?rss=1

In July 2025 I took part in a protest against the proscription of Palestine Action.1 I am now among more than 2000 people who have been arrested for peacefully holding a sign reading “I oppose Genocide. I support Palestine Action,” and who now await prosecution for an action designed to highlight both the human cost of the genocide in Gaza, and the inappropriate use of antiterrorism legislation against the direct-action group Palestine Action. After my arrest, the GMC (General Medical Council) opened an investigation into my conduct and referred me to an interim orders tribunal to decide if my practice should be restricted while it “completes its investigation.”By contrast, the GMC took no immediate action when I was charged in 2022 for criminal damage after a protest undertaken to highlight JP Morgan’s role in driving the climate crisis, a case which has since resulted in my acquittal.2In the UK over...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

Streeting vows to tackle “medical misogyny” with new women’s health strategy
http://www.bmj.com/content/393/bmj.s721.short?rss=1

The UK health secretary has promised to end “outdated and misogynistic practices” in healthcare that leave many women feeling “gaslit” and in pain. The government’s relaunched women’s health strategy, published on 15 April, will tackle problems such as a lack of adequate pain relief during invasive gynaecology procedures, said Wes Streeting.1“The NHS has a problem with everyday sexism and an appalling culture of medical misogyny,” Streeting said at the strategy’s launch. “Being ignored, gaslit, humiliated, and disrespected are all too common experiences for far too many women.” He pledged to put women’s voices centre stage and “ensure no woman is left fighting to be heard.”The strategy sets out plans to tackle a crisis in gynaecology waiting lists, which in January stood at 565 000.2 Some conditions, such as endometriosis, can take nearly a decade to diagnose.3The strategy also pledges to redesign clinical pathways for heavy periods, urogynaecology, and menopause to speed...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

England left behind on effective alcohol policy
http://www.bmj.com/content/393/bmj.s703.short?rss=1

Wales will increase its minimum unit pricing (MUP) of alcohol from £0.50 a unit to £0.65 from October, following in Scotland’s footsteps to help ensure its effectiveness is not eroded by inflation.1MUP is a targeted policy focusing on cheap, high strength, store bought alcohol.2 The largest falls in alcohol consumption and related harms with MUP have occurred in heavier drinkers—although there is limited evidence of benefit for those with alcohol dependence, where wider support is recommended.23 MUP disproportionately benefits people who are more deprived.23 Most stakeholders in the UK, including the alcohol industry, support MUP.4England has been left behind on effective alcohol policy and needs to act. Policymakers should learn lessons from MUP delivery and evaluation in Scotland, Wales, and other forward thinking regions. A future proofed mechanism to set the level of MUP, such as an inflation linked floor price, is important.5 Policymakers should also consider a minimum unit...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

Healthcare and humanitarian aid are being used as political pawns in conflict settings
http://www.bmj.com/content/393/bmj.s718.short?rss=1

Humanitarian aid and healthcare share a commitment to treat all lives equally. That promise is strained in war but should not be conditional. Since 2023, a record number of attacks have been recorded against healthcare infrastructure, health workers, and, more recently, medical research and pharmaceutical manufacturing capacity in Lebanon and Iran.1 Healthcare infrastructure, hospitals, and emergency services are no longer protected in conflict settings, in violation of international law.2 Healthcare services and humanitarian aid are increasingly treated by governments and armed groups as leverage to manage, pressure, and punish civilian populations.3In January 2026, Israeli authorities moved to deregister and suspend dozens of international non-governmental organisations in Gaza and the West Bank unless they complied with new registration requirements. The demands included disclosing identifying information about Palestinian staff and members of their families. This threatens humanitarian assistance at scale: international organisations run about 60% of field hospitals and deliver much of...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

Recognising cardiac syncope
http://www.bmj.com/content/393/bmj-2025-085720.short?rss=1

What you need to knowMost syncope is not cardiac in aetiology, but cardiac syncope is a high risk subgroup with causes including arrhythmias, structural cardiac, and great vesselAlthough diagnostic tests have a low yield in undifferentiated syncope, history is important to identify the high risk features of cardiac syncopeA structured approach to interpreting electrocardiograms can help to identify some causes of cardiac syncopeA 30 year old patient presents to the emergency department with recurring fainting during a flu-like illness. The patient has a history of syncope in the context of fevers, for which they had previously been given a diagnosis of vasovagal syncope without undergoing any investigations. The patient is worried because they recall a cousin who died suddenly at a young age. What is syncope? Syncope is defined as transient loss of consciousness due to cerebral hypoperfusion, with rapid onset, short duration, and spontaneous recovery. Presyncope describes the prodromal symptoms before...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

Managing resistant hypertension . . . and other research
http://www.bmj.com/content/393/bmj.s645.short?rss=1

Cardiovascular benefits of lower LDL targetsThe National Institute for Health and Care Excellence (NICE) guidelines recommend a target low density lipoprotein cholesterol of 2.0 mmol/L for secondary prevention of cardiovascular disease. An open label trial set in South Korea assessed cardiovascular outcomes in two groups of patients; those randomised to an intensive low density lipoprotein cholesterol target of 1.4 mmol/L compared with a target of 1.8 mmol/L, and found a marked difference in outcomes between the two groups. 100 out of 1526 in the conventional targeting group versus 147 out of 1522 in the intensive targeting group experienced death from cardiovascular causes, non-fatal myocardial infarction, non-fatal stroke, any revascularisation, or hospitalisation for unstable angina at three years (hazard ratio 0.67, 95% confidence interval 0.52 to 0.86). N Engl J Med doi:10.1056/NEJMoa2600283AI: targeting the areas that don’t need targetingA prospective, multicentre, randomised controlled trial assessed whether immediate AI prioritisation of primary care...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

Swollen, erythematous earlobe after cosmetic filler injection
http://www.bmj.com/content/393/bmj-2025-087189.short?rss=1

A woman in her 30s presented with a five day history of a swollen, erythematous, and painful earlobe (fig 1, left). The symptoms developed immediately after a cosmetic earlobe augmentation procedure, in which 0.5 mL of hyaluronic acid filler was injected into each earlobe using a 27 gauge needle.bmj;393/apr16_2/e087189/F1F1f1Fig 1On examination, the left earlobe was oedematous and erythematous, with dusky mottling. It was tender and warm to the touch, with a capillary refill time of more than three seconds. A diagnosis of vascular occlusion secondary to hyaluronic acid injection was made. Vascular compromise is a complication of hyaluronic acid injection arising from intravascular obstruction or extravascular compression of blood vessels. Sharp tipped needles generally require less force to penetrate arterial walls than blunt tipped cannulas and may increase the risk of vascular penetration; however, this difference diminishes with smaller gauge instruments.1Hyaluronic acid induced vascular occlusion can be treated with hyaluronidase, which directly...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

National statistics . . . and other stories
http://www.bmj.com/content/393/bmj.s642.short?rss=1

Muscular strengthMuscular strength in older women predicts survival. In a longitudinal study of 5000 women aged 63 to 99 years, higher grip strength and better chair stand performance were associated with lower all cause mortality over eight years of follow-up (JAMA Netw Open doi:10.1001/jamanetworkopen.2025.59367). Women in the top quarter of the strength distribution had a 30% lower mortality risk than those in the bottom quarter, even after adjustment for accelerometer measured physical activity and sedentary time, as well as walking speed and C reactive protein. Birth order differences in early neurodevelopmentFirstborn children tend to outperform their later born siblings in cognitive and developmental measures, and differences appear early. Among 2000 sibling pairs in Japan, second born infants had lower developmental scores than their firstborn siblings by six months (JAMA Netw Open doi:10.1001/jamanetworkopen.2026.1265). Some differences diminished by 12 months, but deficits in fine motor and personal-social domains persisted. Parental engagement was also...

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The BMJ (British Medical Journal)

May 2, 2026, 08:30 AM

Treatments for opioid use disorder during pregnancy
http://www.bmj.com/content/393/bmj.s593.short?rss=1

Opioid use disorder during pregnancy poses substantial risks of harm to maternal and fetal health, including overdose, preterm birth, neonatal complications, and maternal and fetal death.12 Methadone and buprenorphine are the recommended medications for opioid use disorder (MOUD).123 Methadone has been the standard treatment in pregnancy for more than three decades, but buprenorphine is increasingly used in many settings.3 This shift reflects buprenorphine’s pharmacological advantage as a partial opioid agonist2 with a lower risk of sedation and respiratory depression, together with early evidence suggesting favourable neonatal outcomes.12 Yet, uncertainty has persisted about the comparative effects of opioid use on the neurodevelopment of children. The linked study by Friedrich and colleagues (doi:10.1136/bmj-2025-087321) addresses this evidence gap.4 Using nationwide Medicaid data from the US, the authors compared the risk of neurodevelopmental disorders during the first eight years of life among children prenatally exposed to buprenorphine versus methadone. Their findings are reassuring: exposure to...

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