In this narrative medicine essay, a primary care physician learns of her son’s Angelman syndrome diagnosis and finds comfort that her son chose her to love him, laugh with him, and celebrate his resilience.

This Viewpoint discusses the recommendations of the Secretary’s Advisory Committee on Human Research Protection on creating a more equitable and representative body of research with improved inclusion of LGBTQI+ participants, overcoming disconnection between institutional review boards and research sites, and addressing potential bias among institutional review board members.

Hidradenitis suppurativa is a chronic inflammatory disease characterised by painful, deep-seated nodules, abscesses, and draining tunnels in the skin of axillary, inguinal, genitoanal, or inframammary areas. In recent years, the body of knowledge in hidradenitis suppurativa has advanced greatly. This disorder typically starts in the second or third decade of life. The average worldwide prevalence is

Brian J. Druker describes how his research on imatinib validated protein kinases as therapeutic targets for cancer and led to a life-saving treatment for leukemia.

As Nature Medicine celebrates its 30th anniversary, we reflect on the challenges ahead and what the future holds for medicine — and for our journal.

Announced in this Comment and in collaboration with Nature Medicine is the convening of the Access to Dialysis in Low- and Middle-Income Countries Commission, which will explore Thailand’s experiences with changing its dialysis coverage policy, offering lessons for other countries with universal health coverage systems.

Announced in this Comment and in collaboration with Nature Medicine is the convening of the Quality Health Information for All Commission, to promote equitable access to quality health information from trusted sources and affirm the practice of health communication as a distinct public health discipline.

Objective To assess the effect of dapagliflozin plus calorie restriction on remission of type 2 diabetes. Design Multicentre, double blind, randomised, placebo controlled trial. Setting 16 centres in mainland China from 12 June 2020 to 31 January 2023. Participants 328 patients with type 2 diabetes aged 20-70 years, with body mass index >25 and diabetes duration of <6 years. Interventions Calorie restriction

Objective To estimate the relative efficacy of individual and combinations of prehabilitation components (exercise, nutrition, cognitive, and psychosocial) on critical outcomes of postoperative complications, length of stay, health related quality of life, and physical recovery for adults who have received surgery. Design Systematic review with network and component network meta-analyses of randomised

Sue Fletcher-Watson describes the pressures of constant monitoring in a pregnancy deemed high risk Earlier this year I gave birth to a bouncing baby girl, an 8 lb 4 oz bundle of joy. The euphoric moment was made even more special by its contrast with a gruelling pregnancy. This was my third pregnancy but my first experience of following a high risk care pathway. Although I’ve rarely had a body mass

Payne R, Clarke A, Swann N, et al. Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis. BMJ Quality and Safety 2023;0:1–14. To read the full NIHR Alert, go to:

Tom Nolan reviews this week’s research Exercise for 30 minutes three times a week on an exercise bike for a month; then make the sessions an hour long and add resistance training with two sets of 12-15 reps on seven different weight machines, and keep that up for a whole year. No, this isn’t my overly ambitious new year’s fitness regimen, but the intervention in a study of combined endurance and resistance

The role of physician associate is not new. It was first introduced in the US more than 50 years ago. The model has since been adopted in many countries, alongside other medical associate professional roles (MAPs). In the UK, PAs were first mentioned in the NHS Plan 20001 and these and other MAPs have been part of workforce transformation since 2013. In all healthcare economies, medical associate professionals

BRAC In 1967 newly qualified doctor Richard Cash was sent to East Pakistan (now Bangladesh) to respond to one of the many cholera epidemics that swept through the region. The treatment at the time was intravenous therapy to replace lost fluids, but such a resource intensive process was inappropriate in a country where funding and trained personnel were not available at anywhere near the scale needed

The UK government’s Eatwell Guide advises that people drink six to eight glasses of water or sugar free liquids per day (https://www.gov.uk/government/publications/the-eatwell-guide). Given the wide individual variation in size, weight, activity, and health—not to mention the numerous physiological mechanisms that regulate fluid balance—a single recommendation on the optimal amount of water to be consumed

This middle aged woman presented with a 40 year history of a gradually expanding itchy rash on her left leg. She had no relevant personal or family history and took no regular medications. On examination, extensive well defined, erythematous, plaques with raised edges and …

Articles in The BMJ ’s Christmas issue rightly call for death to be demedicalised, urging healthcare systems to focus on compassion and care for people who are dying.1 This conversation has centred on palliative care, but an important specialty is often overlooked—radiology. Postmortem imaging, using computed tomography and magnetic resonance imaging, is a non-invasive way to determine causes of death

GLP-1 agonists for weight loss are now commonly used for adults, but might they also be an effective treatment for younger people? Katharine Lang reports Obesity in children and adolescents is a growing problem. In 2022, according to NHS data, 15% of children aged between 2 and 15 were living with obesity in the UK.1 In the US the figure is closer to 20%, or one in five of those aged under 19.2 Untreated

A teenage boy presented to the emergency department three hours after he injured his left shoulder when he fell while running. He had persistent pain and was unable to move his left shoulder. There was noticeable skin puckering at the proximal end of the humerus near the shoulder, accompanied by subcutaneous bruising (fig 1). On examination there was tenderness in the shoulder joint, limited shoulder

Combined strategy is effective but questions remain The view that the hyperglycaemia associated with type 2 diabetes is inexorably progressive was challenged by the publication of the DiRECT study in 2018.12 Through a mean weight loss of 10 kg achieved by a period of total diet replacement (often referred to as the “soups and shakes” diet), 46% of participants achieved remission of type 2 diabetes

It’s been a tough start to the year for the NHS. This month, 24 NHS trusts in England declared a critical incident owing to overwhelming demand in emergency departments. Pressures were exacerbated by a “quad-demic” of winter viruses, particularly rising rates of flu (doi:10.1136/bmj.r99 doi:10.1136/bmj.r77).12 A report by the Royal College of Nursing showed the extent of the crisis.1 More than 400

Next-generation sequencing has revealed the disruptive reality that advanced/metastatic cancers have complex and individually distinct genomic landscapes, necessitating a rethinking of treatment strategies and clinical trial designs. Indeed, the molecular reclassification of cancer suggests that it is the molecular underpinnings of the disease, rather than the tissue of origin, that mostly drives outcomes

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The rise of anti-DEI legislation and rhetoric threatens representation in the medical workforce and patient outcomes, says Naeema Hopkins-Kotb I still remember receiving my first letter from Harvard Medical School—and no, it wasn’t an acceptance letter. I was a student in the thick of pre-med requirements, trying to decide on the next institution I would trust with my dream of becoming a doctor. The

Dawn P Richards challenges some of the common objections to patient engagement in research I have been in a lot of spaces over the years where people were not convinced about patient engagement in research. They often feel that they already have enough to do, or that this is “yet another” hoop that funding agencies are requiring them to jump through. I am writing this for you. I am not entirely sure

Eric was born in Dundee, first son to William and Annie Mackay and one of eight children. He was brought up in the city, attending Morgan Academy. At the tail end of the second world war Eric trained to “tattie rogue”—finding potatoes that are diseased—progressing to work as a potato inspector. He then studied medicine at St Andrews, where he found he preferred the practical side, becoming a sharp

Sanath graduated in 1997 and obtained a diploma in orthopaedics in 1999 from Manipal Academy of Higher Education, Mangaluru, India. He trained and worked at St John’s Medical College, Bangaluru, from 1999 until 2003. He married his classmate, Usha Rao, in May 2000 and they came to the UK in 2003. Sanath did further training in orthopaedics and …

It is right to highlight that NHS staff felt the “strain and trauma” of caring for patients with covid-19.1 Although the risks of this viral infection have lessened, it is still a hazard for healthcare workers and their patients. Recent advice from the Joint Committee on Vaccination and Immunisation (JCVI)2 does not make provision for healthcare workers in forthcoming rounds of covid-19 vaccination

Boytchev and colleagues investigate the fossil fuel industry’s influence on medical research.1 We deeply appreciated The BMJ ’s bold decision in 2020 to ban advertising and research funded by companies producing fossil fuels—a ban now being extended to other BMJ Group journals.23 This principled action sets an important precedent for medical …

In December it emerged that the medical apprenticeship programme had been paused—a move that has implications for the institutions spearheading courses and for the future of medical education more broadly, Erin Dean hears For the past 18 months staff at Plymouth University’s Peninsula Medical School have been working hard to develop a medical apprenticeship programme, an alternative route into medicine

In this paper by Dell-Kuster and colleagues ( BMJ 2020;370:m2917, doi:10.1136/bmj.m2917, published 25 August 2020), the author name …

This study uses National Health and Nutrition Examination Survey data to examine national trends in preventive aspirin use among populations at low and high atherosclerotic cardiovascular disease (ASCVD) risk and with existing ASCVD.

This JAMA Insights explores how considering clinical factors and/or potential exposures during the premigration, migration, and postmigration phases of immigration could help clinicians more effectively treat patients born outside the US.

This Viewpoint discusses the ways in which incarcerated individuals are negatively impacted by the consequences of climate change and steps carceral facilities and policymakers can take to mitigate extreme heat risks.

ImportanceChronic obstructive pulmonary disease (COPD) is often undiagnosed. Although genetic risk plays a significant role in COPD susceptibility, its utility in guiding spirometry testing and identifying undiagnosed cases is unclear.ObjectiveTo determine whether a COPD polygenic risk score (PRS) enhances the identification of undiagnosed COPD beyond a case-finding questionnaire (eg, the Lung Function

This Viewpoint discusses the 2025-2030 Dietary Guidelines for Americans report and highlights some of the topics reviewed, including ultraprocessed foods and reduced-fat vs whole-fat dairy.

Long-term, immunosuppression-free allograft survival has been induced in human and nonhuman primate (NHP) kidney recipients after nonmyeloablative conditioning and donor bone marrow transplantation (DBMT), resulting in transient mixed hematopoietic chimerism. However, the same strategy has consistently failed in NHP heart transplant recipients. Here, we investigated whether long-term heart allograft

Chimeric antigen receptor (CAR)–T cell therapies have revolutionized the landscape of cancer treatment, in particular in the context of hematologic malignancies. However, for solid tumors that lack tumor-specific antigens, CAR-T cells can infiltrate and attack nonmalignant tissues expressing the CAR target antigen, leading to on-target, off-tumor toxicity. Severe on-target, off-tumor toxicities have

In patients with cystic fibrosis (CF), repeated cycles of infection and inflammation eventually lead to fatal lung damage. Although diminished mucus clearance can be restored by highly effective CFTR modulator therapy, inflammation and infection often persist. To elucidate the role of the innate immune system in CF etiology, we investigated a CF pig model and compared these results with those for preschool

In Alzheimer’s disease (AD), amyloid-β (Aβ) triggers the aggregation and spreading of tau pathology, which drives neurodegeneration and cognitive decline. However, the pathophysiological link between Aβ and tau remains unclear, which hinders therapeutic efforts to attenuate Aβ-related tau accumulation. Aβ has been found to trigger neuronal hyperactivity and hyperconnectivity, and preclinical research

Oxygen is essential for human life, yet a growing body of preclinical research is demonstrating that chronic continuous hypoxia can be beneficial in models of mitochondrial disease, autoimmunity, ischemia, and aging. This research is revealing exciting new and unexpected facets of oxygen biology, but translating these findings to patients poses major challenges, because hypoxia can be dangerous. Overcoming

Brain–computer interfaces are expanding from functional to recreational applications, as evidenced by a study in which a person with tetraplegia controlled a recreational virtual drone, but their clinical utility is still uncertain.

A study detected hidden cancers in almost half of all pregnant people who were referred for cancer screening following an abnormal or unreportable prenatal blood test result.

Correction to: Nature Medicine https://doi.org/10.1038/s41591-024-02807-z, published online 4 March 2024.

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### What you need to know A 45 year old man presents to his general practitioner with a three month history of hoarse voice. The onset was over a short time and was predated by five days of coryzal symptoms. He has no past medical history, takes no regular medications, and smokes 10 cigarettes a day. A change in voice, or dysphonia, describes a perceived alteration in vocal function and can include

Children are facing the consequences of the conflict in Gaza. Ulrike Julia Wendt explains the IRC’s role in supporting children and families, and delivering life saving aid and essential services The conflict in Gaza has been more than a geopolitical and humanitarian crisis—it is a profoundly human tragedy with severe consequences for an entire generation of Palestinian children and young people. Over

In a major blow to global health, the US administration has announced plans to withdraw from the World Health Organization. Kent Buse and colleagues propose urgent actions for the international community to mitigate the damage. When the previous Trump administration announced its withdrawal from the World Health Organization (WHO), the decision sent shockwaves throughout the world.1 While that decision

When I started in general practice we’d already made the switch to an electronic patient record. We still pulled the paper notes before each surgery—even though the chances of finding a relevant previous entry and being able to read the handwriting were slim—and laboratory results arrived on slips of paper to be stuck in the notes. These were soon replaced by electronic messages, which arrived more

The new plan to improve NHS elective care includes creating and expanding surgical hubs.1 As a surgeon, I feel conflicted. It’s positive if patients with treatable conditions can move forward from the waiting list. But we need to do this with great care to avoid negatively affecting the rest of the NHS, especially for patients deemed ineligible or due to the diversion of staff, training capacity, and