Post-war rationing in the UK in 1953 facilitated a natural experiment that now reveals that restricting sugar intake in early life reduces the risk of diabetes and hypertension.

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Addendum to: Nature Medicine https://doi.org/10.1038/nm1161, published online 26 December 2004.

Publications of living systematic reviews (LSRs) are increasing rapidly. Guidance facilitating transparent, complete, and accurate reporting of LSRs is needed. This paper reports the development of an extension of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement for LSRs (PRISMA-LSR). The PRISMA-LSR extension includes the PRISMA-LSR checklist, the PRISMA-LSR

The aim of an integrated neighbourhood team (INT) is to bring medical, nursing, and social care services to the patient’s home (or nearby) in a timely fashion, which should prevent unnecessary hospital admissions and enable earlier discharge, thus saving the NHS money and minimising disruption for patients. These ideas seem so obvious that it’s hard to work out why they haven’t been tried before. They

Harmful industries still exert their influence over health professionals, academia, and health systems; robust change is required, write Chris van Tulleken, Nigel Rollins, and Rebecca Coombes In the 1950s, smoking was proven beyond doubt to cause cancer and yet efforts to curb this pandemic were stalled over the next half century by a network of individuals and institutions with competing interests

A ward round in the intensive care unit ended with more questions than answers for the team. Only after seeing 10 critically ill patients did the hard work start: it was clear what was needed to help patients survive, but working out the “why” was more difficult. We knew that we needed to start steroids in a patient with septic shock—but why? We quickly decided that a patient recovering from a brain

When Labour came to power in July the new health and social care secretary, Wes Streeting, promised a frank report on the current NHS. The report, led by Ara Darzi, pulled no punches about the state of the service and its challenges,12 which led Streeting to say that the NHS was “broken.”3 He also promised a working group to report back next spring on a 10 year plan.4 I want the Labour government to

The General Medical Council emphasises the relevant policies and laws it must follow,1 but tremendous injustices can be committed by unthinkingly “following procedure.” Extraordinary circumstances provide important opportunities to reflect on whether policies remain fit for purpose. The GMC shouldn’t judge the fairness of a law, but it must decide if public trust is damaged when laws are broken. If

I agree with Moreno that society needs a new perspective on time.1 A 24 h workforce is “productivity driven,” a functional necessity embedded in NHS practice. It follows that irregular sleep schedules and sleep deficiency are controlled by commercial actors.2 Seeking to affect policies at all levels of governance, through systems, practices, and pathways,3 commercial determinants influence …

Artificial intelligence (AI) tools such as ChatGPT have hundreds of millions of users—but are they medically safe and reliable? Chris Stokel-Walker asks patients and physicians about the benefits and risks in an AI world In August this year Hayley Brackley lost a large part of her vision, completely out of the blue. She’d gone to her local chemist with eye pain, and a prescribing pharmacist diagnosed

Health, economic, and social progress will stall without urgent global collaborative action Road traffic injuries are the leading killer of children and adults aged 5-29 years globally.1 Low and middle income countries are disproportionately represented in this statistic; Africa has the highest road crash mortality of all global regions. Increasing urbanisation and motorisation in many African countries

Cédric Lemarchand and colleagues highlight weaknesses in the evidence on efficacy and safety of hallucinogens and question the use of expedited regulatory pathways The US clinical market for ketamine, estimated at $3.1bn in 2022 and expected to expand at 10.6% a year until 2030,1 is just one of many signs of renewed interest in the use of psychedelics to treat psychiatric conditions.2 Various mind

Since the discovery of statins and the Scandinavian Simvastatin Survival Study (4S) results three decades ago, remarkable advances have been made in the treatment of dyslipidaemia, a major risk factor for atherosclerotic cardiovascular disease. Safe and effective statins remain the cornerstone of therapeutic approach for this indication, including for children with genetic dyslipidaemia, and are one

Building on the evidence from the first paper in this Series highlighting the fundamental importance of healthy and nurturing environments for children's growth and development in the next 1000 days (ages 2–5 years), this paper summarises the benefits and costs of key strategies to support children's development in this age range. The next 1000 days build on the family-based and health-sector based

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Following the first 1000 days of life that span from conception to two years of age, the next 1000 days of a child's life from 2–5 years of age offer a window of opportunity to promote nurturing and caring environments, establish healthy behaviours, and build on early gains to sustain or improve trajectories of healthy development. This Series paper, the first of a two-paper Series on early childhood

The football-loving medical philosopher, founder of the Italian Cochrane Centre, and former member of the BMJ editorial board Alessandro Liberati died 12 years ago, but he was remembered with great fondness earlier this year when Mariangela, his wife, donated almost 150 of his books to the hospital library of Reggio Emilia Arcispedale, one of the finest and best restored medical libraries in Italy

Like many people, I can no longer find effective dental treatment locally on the NHS. Against my personal preference and political views, I’ve been to a private dentist for some years now. He’s a decent man, charges relatively modest prices, and is conservative (in the best sense) in his interventions. We banter nicely about my need for elephantine quantities of local analgesia, as well as other matters

David Watkin was a firm believer in the importance of teaching, but he felt that the training he received was inadequate. “The number of operations for which a consultant directly supervised me could be counted on the fingers of one hand,” he wrote. He worked tirelessly to do better for his staff—and not just doctors and medical students. Shortly after taking up his consultant post in general surgery

Mulcahy and Smith clearly detail the failure of the United Nations climate change conference (COP) process.1 As they point out, despite all the meetings, emissions still rise. If you plot the rise in CO2 emissions since COP meetings began, you might be forgiven for wondering if they have caused the rise in emissions, or at …

Hoyle and Yassaie discuss whether doctors should be suspended for breaking the law.1 We are, of course, currently on track to face catastrophic warming caused by fossil fuels. Globally, the scientific community is sounding the alarm. The cost to public …

Objectives To assess the efficacy and safety of the non-hormonal, neurokinin 3 receptor antagonist, fezolinetant, to treat moderate-severe vasomotor symptoms associated with menopause in individuals unsuitable for hormone therapy. Design Phase 3b randomised controlled trial. Setting 16 countries. Participants 453 individuals aged 40-65 years with moderate-severe vasomotor symptoms associated with menopause

The Rio de Janeiro declarations chart possibilities in an era of inequity, war, climate change, and pandemics, but their shortfalls must be acknowledged, write Deisy Ventura and colleagues On 31 October 2024, the G20 health ministers met in Rio de Janeiro, Brazil, following a series of preparatory meetings held throughout 2024. A recent series in The BMJ suggested priorities for Brazil’s G20 leadership

Inequalities and restrictions to sexual and reproductive health and rights are endangering women, write Mercedes Colomar and Veronica Fiol In 1994, the International Conference on Population and Development established a groundbreaking framework recognising reproductive rights as human rights.1 This framework prioritised people and human rights in development—rather than population control. Thirty

The latest MBRRACE-UK report on maternal mortality highlights action needed to prevent maternal deaths and reduce underlying inequities—especially for women who are migrants or known to social care, writes Kirsty Kitchen This year’s annual confidential inquiry on maternal deaths–MBRRACE saving lives, improving mothers’ care 2024–finds evidence of high levels of inequality and little progress.1 Many

Jean Carruthers, an ophthalmologist, came home from work one evening and told her dermatologist husband Alastair about a conversation she had had with a patient. As part of a clinical trial1 she was using botulinum toxin to treat patients with dystonia, an involuntary spasm of the eyelids. One of her patients had asked to be treated between her eyes. When Jean told the patient that she had not thought

Mollet and colleagues discuss oral health in children.1 Due attention is paid to oral health as a component of the World Health Organization’s global strategy and action plan, including a focus on a “rights based approach” to motivate and challenge policy makers to tackle the root causes of poor oral health. Domestically, children’s …

Mollet and colleagues call for a rights based approach to children’s oral health.1 There is an established link between poor oral health and lower socioeconomic status. Poor paediatric oral health is associated with education delay and increased morbidity in adulthood.2 Unfortunately, these associations are not new and have been known for at least 150 years. In 1905, James Kerr, a medical doctor, and

The editorial on children’s right to oral health mentions that 514 million children have untreated carious lesions in their primary teeth.1 It emphasises the importance of upstream policies such as reducing sugar consumption but makes no mention of water fluoridation. As Niger Carter, chief …

A grassroots food assistance programme in Brazil that grew out of the pandemic is now trying to counter obesity and other diseases of poverty. Rodrigo de Oliveira Andrade reports “When the covid-19 pandemic began, I knew Brazil would face a battle against hunger,” says Adriana Salay Leme, a historian in the city of São Paulo. So when their restaurant was forced to shut during the pandemic, Leme and

Leadership by southern countries is focusing attention on health equity Countries in the Group of 20 (G20) represent two thirds of the world’s population, and it is a major forum for international cooperation. In recent years it has intensified its focus on global health, starting with the creation of a G20 health working group in 2017. The G20 presidency rotates annually. It is currently held by Brazil

Women need better coordination between primary and secondary care Endometriosis affects as many as 10% of women of reproductive age, or 190 million women globally.1 It can cause debilitating chronic pelvic pain and infertility, with treatment, work loss, and healthcare estimated to cost £12.5bn annually in the UK alone.2 The 2024 National Confidential Enquiry into Patient Outcome and Death (NCEPOD)

A new treatment option for women unable to take hormone replacement therapy Up to 80% of women experience vasomotor symptoms, including hot flushes and night sweats, during menopausal transition.1234567 These symptoms can persist for years before and after menopause, substantially impacting quality of life by impairing sleep, mood, and cognitive functioning.23456789101112 Approximately 32-46% of women

Katie Bramall-Stainer’s name was …

It’s natural to want to be included, but there are things you can do when you don’t feel part of the team, Abi Rimmer hears Kirsty Shires, salaried GP, GP appraiser, coach, and mentor, West Midlands, says, “For many of us, fitting in at work is important to our sense of self, identity, and belonging. When this is lacking, it can affect our confidence and ability to perform well—which in healthcare

BACKGROUND Danon disease is a rare, X-linked, monogenic cardiomyopathy caused by mutations in the lysosomal-associated membrane 2 gene (LAMP2), which encodes the LAMP2 protein. In male patients, the predominant phenotype is progressive cardiac hypertrophy, cardiac dysfunction, and early death. There are no directed therapies for the disease. METHODS In this phase 1 study, we evaluated the safety and

BACKGROUND Achondroplasia is a genetic skeletal condition that results in disproportionately short stature and medical complications throughout life. Infigratinib is an orally bioavailable FGFR1-3 selective tyrosine kinase inhibitor in development for achondroplasia. METHODS In this phase 2 dose-finding study, we evaluated the safety and efficacy of oral infigratinib in children with achondroplasia

ImportanceElevated lipoprotein(a) increases the risk of atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis.ObjectiveTo evaluate the effects of zerlasiran, a small-interfering RNA targeting hepatic synthesis of apolipoprotein(a), on lipoprotein(a) serum concentration.Design, Setting, and ParticipantsA multicenter trial in patients with stable ASCVD with serum lipoprotein(a) concentrations

ImportanceMuvalaplin inhibits lipoprotein(a) formation. A 14-day phase 1 study demonstrated that muvalaplin was well tolerated and reduced lipoprotein(a) levels up to 65%. The effect of longer administration of muvalaplin on lipoprotein(a) levels in individuals at high cardiovascular risk remains uncertain.ObjectivesTo determine the effect of muvalaplin on lipoprotein(a) levels and to assess safety

Importance Success rates of pulmonary vein isolation (PVI) are modest for persistent atrial fibrillation (AF). Additional linear ablation beyond PVI has not been proved superior to PVI alone in randomized trials. Ethanol infusion of the vein of Marshall (EIVOM) facilitates ablation at the mitral isthmus and may lead to improved effectiveness of a linear ablation strategy. Objective To determine whether

This JAMA Insights explores harm reduction strategies for people who use drugs and the clinicians who treat them to help reduce the risk of unintentional drug overdose and infection.

This study compares differences in caregiver-reported hospice quality across categories of ownership, including for-profit private equity firm (PEF)/publicly traded company (PTC)–owned and non-PEF/PTC–owned hospices as well as not-for-profit–owned hospices.

This Viewpoint summarizes how the US Preventive Services Task Force specifies target populations for its recommendations and highlights 3 problems—including exacerbation of health inequities—posed by the proposed use of more complex risk models to better identify target populations and increase effectiveness and efficiency of prevention efforts (“precision prevention”).

ImportancePolycythemia vera (PV), a myeloproliferative neoplasm characterized by an increased red blood cell mass and increased risk of thrombosis, affects approximately 65 000 people in the US, with an annual incidence of 0.5 to 4.0 cases per 100 000 persons.ObservationsErythrocytosis (hemoglobin >16.5 mg/dL in men or >16.0 mg/dL in women) is a required diagnostic criterion, although thrombocytosis

This JAMA Insights explores how clinicians can use the harm reduction communication framework to engage with patients who have opioid use disorder, which could help prevent overdose and other substance use–related harms.

BACKGROUND Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain. METHODS In this multicenter trial with a 2-by-2 factorial design, we randomly assigned patients with myocardial infarction who had undergone percutaneous

Correction to: Nature Medicine https://doi.org/10.1038/s41591-024-03076-6, published online 17 June 2024.

Fraudulent academic activities that I have referred to as “felonies” comprise fabrication (defined by the US Office of Research Integrity as “making up data or results and recording or reporting them”), falsification (“manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record”), and plagiarism

BACKGROUND Transthyretin amyloidosis with cardiomyopathy (ATTR-CM) is a progressive, often fatal disease. Nexiguran ziclumeran (nex-z) is an investigational therapy based on CRISPR-Cas9 (clustered regularly interspaced short palindromic repeats and associated Cas9 endonuclease) targeting the gene encoding transthyretin (TTR). METHODS In this phase 1, open-label trial, we administered a single intravenous