Alcohol-free and low alcohol (“nolo”) drinks have the potential to improve public health, but experts in The BMJ today call for a precautionary approach that maximises potential benefits (eg. increased substitution of alcoholic drinks with nolo alternatives) while minimising risks (eg. preventing encroachment of nolo drinks into alcohol-free spaces).

Sales of alcohol-free and low alcohol drinks have increased substantially over recent years, driven by improved manufacturing techniques and consumer demand for better and healthier alternatives to alcoholic drinks, explain John Holmes, professor of alcohol policy at the University of Sheffield, and colleagues.

In Britain, one in five adults reports consuming nolo drinks at least once a month, and nolo drinks now account for 1.4% of total alcohol sales, mainly from products that share branding with an established alcoholic drink.

Nolo drinks have obvious potential to improve public health, especially for heavier drinkers, those in lower socioeconomic groups, and people drinking in high risk circumstances, such as when pregnant, driving, or in adolescence.

However, the World Health Organization (WHO) and alcohol charities have argued that no and low alcohol drinks also pose risks to public health, such as companies using nolo drinks marketing to deter or circumvent restrictions on alcohol marketing.

In Ireland, for instance, major beer companies have responded to advertising restrictions – such as on public transport and during sports matches – by promoting alcohol-free variants which have similar branding.

Similarly, nolo drinks or related marketing may encroach on otherwise alcohol-free spaces, such as gyms and sports events or in supermarket lunchtime meal deals.

For example, the 2024 Olympics named Corona Cero (an alcohol-free variant of Corona) as its official global beer sponsor, allowing the Corona brand to appear in a wide range of sporting and media contexts that were previously unavailable to it.

To protect public health, the authors call for a precautionary approach that aims to facilitate and enhance potential benefits while also preventing or minimising any harms.

Policies that could help achieve this include encouraging companies to substitute higher alcohol products with nolo alternatives, while preventing marketing to children, protecting alcohol-free spaces, and using taxes based on alcoholic strength to incentivise consumption of alcoholic drinks that contain less alcohol.

Yet the authors warn that some policy decisions seem to be driven by the concerns of businesses, trade organisations, and self-regulatory bodies, and say public health actors must engage with nolo policy questions to ensure that their perspectives, and not just commercial priorities, shape regulation of the production, marketing, sale and use of nolo drinks, and how they are framed in public debate.

“Although we argue for a public health response to nolo drinks, we are not suggesting a reduced focus on [preventing harm from consumption of] standard alcoholic drinks. Nor are we seeking to exaggerate the degree of risk that nolo drinks present,” they write. “However, as with e-cigarettes and reformulated foods, we should not take [claims about the public health benefits of] market led solutions at face value.”

“Benefits may emerge from nolo drinks, but a hands-off approach could mean these are smaller and less equitable than desired. Public health actors should therefore develop a strategic and comprehensive response that balances different concerns and aspirations,” they conclude.

14/01/2026

Notes for editors
Analysis: How should public health respond to the rise of alcohol-free and low alcohol drinks? doi: 10.1136/bmj-2025-086563
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Analysis
Subject: Alcohol-free and low alcohol drinks

The post Precautionary approach to alcohol-free and low alcohol drinks needed to protect public health, say experts first appeared on BMJ Group.

Largest study on this topic suggests that measurement errors lead to potential delays in care and contribute to health disparities

Fingertip monitors known as pulse oximeters that can be used at home to detect low blood oxygen levels (hypoxaemia) give higher readings for patients with darker than lighter skin tones, finds the largest study on this topic published by The BMJ today.

This means that low blood oxygen levels may be missed in patients with darker skin tones, potentially delaying care, while patients with lighter skin tones may get unnecessary treatment.

Pulse oximeters use light to measure the amount of oxygen in the blood (SpO2). For most people, a normal pulse oximeter reading is between 95% and 100%, with readings below 90-92% generally considered low and requiring medical attention.

They are known to be affected by several factors, including skin tone, as pigment in darker skin can absorb more light, making the device “think” there’s more oxygen than there is. But so far, studies have been unable to draw any firm conclusions about the impact of skin tone on diagnostic accuracy.

To address this, researchers set out to test the measurement and diagnostic accuracy of five fingertip pulse oximeters provided by the NHS for use at home in the NHS England COVID oximetry @home scheme.

They drew on data from 903 critically ill adults (average age 56 years; 67% male) on 24 NHS intensive care units in England between June 2022 and August 2024.

Although the fingertip pulse oximeters tested were those used at home, intensive care units were used as the test laboratory as patients have lower blood oxygen values and routinely have their blood oxygen accurately measured using hospital machines.

For each patient, skin tone was measured objectively using a spectrophotometer (a type of camera that measures colour). The researchers then compared pulse oximetry blood oxygen values (SpO2) with “gold-standard” arterial blood gas measurements (SaO2).

SpO2 values were assessed at two thresholds in line with current guidance either to seek medical help (94% or lower) or to attend the emergency department (92% or lower).

A total of 11,018 paired SpO2-SaO2 measurements were analysed. All five pulse oximeters returned higher SpO2 values for patients with darker skin tones than patients with lighter skin tones, at any given level of SaO2 measurement.

SpO2 readings were, on average, 0.6-1.5 percentage points higher for patients with darker than lighter skin tone.

At both SpO2 thresholds assessed, false negative rates (low oxygen missed by the pulse oximeter when present) increased with darker skin tones, while false positive rates (low oxygen indicated by the pulse oximeter when absent) decreased with darker skin tone.

And while absolute differences in readings were small, “they can result in substantially higher rates of false negatives and lower rates of false positives in the diagnosis of hypoxaemia,” note the researchers.

This is an observational study, so no definitive conclusions can be drawn about cause and effect. And the authors acknowledge that the study was conducted in critically ill patients, which may limit the generalisability of the findings.

However, they say this was a large study using sophisticated statistical modelling to assess the performance of the pulse oximeters across multiple domains of both measurement and diagnostic accuracy.

As such, they conclude: “SpO2 readings should be interpreted in the context of other clinical information and trends in SpO2 values given greater importance than single readings, particularly in patients with darker skin tones.”

They add: “Healthcare systems should develop guidance to inform and aid practitioners, patients and the public, particularly in settings where additional clinical readings from other medical measurement devices would not be available.”

In a linked editorial, researchers agree that clinicians must recognise the limitations of current devices and interpret readings for patients with darker skin with care and caution, and they say regulation must now catch up with science to mitigate harm.

“The goal is not to abandon pulse oximetry but to understand its limits and make it equitable, ensuring that the technology designed to measure oxygen does not itself perpetuate inequalities in those who receive it,” they conclude.

14/01/2026

Notes for editors
Research: The impact of skin tone on the performance of pulse oximeters used by the National Health Service COVID oximetry @home scheme: measurement and diagnostic accuracy study doi: 10.1136/bmj-2025-085535
Editorial: Pulse oximetry in people with darker skin tones doi: 10.1136/bmj.s37
Journal: The BMJ

Funding: National Institute for Health and Care Research (NIHR)

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Observational; Opinion
Subject: People

The post Home fingertip oxygen monitors less accurate for people with darker skin tones first appeared on BMJ Group.

Cast also carries fewer treatment related harms than surgery, say researchers

Wearing a cast for six weeks appears to be no less effective than surgery for healing unstable ankle fractures and carries fewer treatment related harms, finds a clinical trial from Finland published by The BMJ today.

Around two thirds of all ankle fractures involve a break in the fibula (the outer ankle bone). Known as Weber B fractures, they leave the ankle either stable or unstable (at risk of falling out of alignment).

Surgery remains the main treatment for Weber B ankle fractures deemed unstable, despite recent trials and guidelines increasingly supporting non-surgical options in selected patients.

To explore this further, researchers set out to assess whether cast immobilisation is comparable (“non-inferior”) to surgery in adults with Weber B ankle fractures deemed unstable.

They identified 126 participants aged 16 years or older with an unstable Weber B ankle fracture confirmed by an external rotation stress test at a specialist university hospital trauma centre in Finland between January 2013 and July 2021.

Sixty-two participants were randomly assigned to conventional cast immobilisation for six weeks and 64 were assigned to undergo surgery followed by cast immobilisation for six weeks.

Both groups had check-ups at two, six, and 12 weeks and met with a physiotherapist at six and 12 weeks to guide rehabilitation.

At two years, participants were assessed using the Olerud-Molander Ankle Score (OMAS), a 0 to 100 point scale where higher scores indicate better healing. An 8 point difference between groups was pre-set as the non-inferiority margin.

Other check-up assessments included ankle function, pain, health related quality of life, ankle range of motion and x-rays. Treatment related adverse events were also recorded.

In all, 121 of the 126 randomised participants completed the two year follow-up. The mean OMAS was 89 in the cast immobilisation group and 87 in the surgery group (a between group mean difference of 1.3 points).

No statistically significant between group differences were seen in any of the other outcomes and overall, fewer treatment related harms occurred with cast immobilisation compared with surgery.

The authors acknowledge that their trial was from a single university hospital, which may limit generalisability and note the lack of consensus of the external rotation stress test to determine fracture instability, but say this was a robust analysis that achieved a high follow-up rate at two years – a time point generally considered sufficient to capture longer term outcomes.

“Together, our findings and those of previous studies show that a standard below-the-knee cast provides adequate stabilisation of an isolated unimalleolar fibular fracture with a congruent ankle mortise [the bracket-shaped socket of the ankle],” they write.

“This lends further support to the evolving concept that the treatment of ankle fractures should focus on obtaining and maintaining a congruent ankle mortise until fracture union, using the most conservative means possible.”

This team is to be commended for conducting a robust study which addresses an important clinical question, and will support treatment decisions and updates to clinical guidelines, say UK researchers in a linked editorial.

They discuss some limitations, but say collectively this and other trials “are supporting much needed advances in the evidence base for ankle fracture management and are a testament to the collaborative network of trauma and orthopaedic health professionals, researchers, and, most importantly, patient participants.”

14/01/2026

Notes for editors
Research: Cast immobilisation versus surgery for unstable lateral malleolus fractures (SUPER-FIN): randomised non-inferiority clinical trial doi: 10.1136/bmj-2025-085295
Editorial: A step forward for ankle fracture management doi: 10.1136/bmj.s56
Journal: The BMJ

Funding: Oulu University Hospital

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Non-inferiority clinical trial; Opinion
Subject: People

The post Six weeks in a cast no less effective than surgery for unstable ankle fractures first appeared on BMJ Group.

Findings may have important public health implications given the ubiquitous use of these additives, say researchers

Higher intake of food preservatives, widely used in industrially processed foods and beverages to extend shelf-life, is associated with a modestly increased risk of cancer, finds a study from France published by The BMJ today.

While further research is needed to better understand these links, the researchers say these new data call for the re-evaluation of regulations governing the use of these additives by the food industry to improve consumer protection.

Preservatives are substances added to packaged foods to extend shelf life. Some experimental studies have shown that certain preservatives can damage cells and DNA, but firm evidence linking preservatives to cancer risk remains scarce.

To address this, researchers set out to examine the association between exposure to preservative food additives and risk of cancer in adults, using detailed dietary and health data from 2009 to 2023.

Their findings are based on 105,260 participants aged 15 years and older (average age 42 years; 79% women) enrolled in the NutriNet-Santé cohort study who were free of cancer and completed regular 24 hour brand-specific dietary records over an average 7.5 year period. Health questionnaires and official medical and death records were then used to track cancer cases up to 31 December 2023.

A total of 17 individual preservatives were analysed including citric acid, lecithins, total sulfites, ascorbic acid, sodium nitrite, potassium sorbate, sodium erythorbate, sodium ascorbate, potassium metabisulfite, and potassium nitrate.

Preservatives were grouped into non-antioxidants (which inhibit microbial growth or slow chemical changes that lead to spoilage) and antioxidants (which delay or prevent food deteriorating by removing or limiting oxygen levels in packaging).

During the follow-up period, 4,226 participants received a diagnosis of cancer, comprising 1,208 breast, 508 prostate, 352 colorectal, and 2,158 other cancers.

Of the 17 individually studied preservatives, 11 were not associated with cancer incidence, and no link was found between total preservatives and cancer incidence.

However, higher intakes of several preservatives (mostly non-antioxidants including potassium sorbate, potassium metabisulfite, sodium nitrite, potassium nitrate, and acetic acid) were associated with higher risk of cancers compared with non-consumers or lower consumers.

For example, total sorbates, specifically potassium sorbate, was associated with a 14% increased risk of overall cancer and a 26% increased risk of breast cancer, while total sulfites were associated with a 12% increased risk of overall cancer.

Sodium nitrite was associated with a 32% increased risk of prostate cancer, while potassium nitrate was associated with an increased risk of overall cancer (13%) and breast cancer (22%).

Total acetates were associated with an increased risk of overall cancer (15%) and breast cancer (25%), while acetic acid was associated with a 12% increased risk of overall cancer.

Among antioxidant preservatives, only total erythorbates and specific sodium erythorbate were found to be associated with higher incidence of cancer.

While more studies are needed to better understand these potential risks, the researchers note that several of these compounds can alter immune and inflammatory pathways, possibly triggering the development of cancer.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers can’t rule out the possibility that other unmeasured factors may have influenced their results.

However, they say this was a large study based on detailed dietary records linked to food databases over 14 years and results are consistent with existing experimental data suggesting adverse cancer related effects of several of these compounds.

As such, they conclude: “This study brings new insights for the future re-evaluation of the safety of these food additives by health agencies, considering the balance between benefit and risk for food preservation and cancer.”

In the meantime, they call on manufacturers to limit the use of unnecessary preservatives, and support recommendations for consumers to favour freshly made, minimally processed foods.

From a policy perspective, preservatives offer clear benefits by extending shelf life and lowering food costs, which can be particularly important for populations with lower incomes, point out US researchers in a linked editorial.

However, they say the widespread and often insufficiently monitored use of these additives, with uncertainties of their long term health effects, call for a more balanced approach.

Findings from NutriNet-Santé may prompt regulatory agencies to revisit existing policies, such as setting stricter limits on use, requiring clearer labeling, and mandating disclosure of additive contents, while collaborative global monitoring initiatives, similar to those implemented for trans fatty acids and sodium, could also support evidence based risk assessments and guide reformulation by the food industry, they write.

“At the individual level, public health guidance is already more definitive about the reduction of processed meat and alcohol intake, offering actionable steps even as evidence on the carcinogenic effects of preservatives is evolving,” they conclude.

07/01/2025

Notes to Editors
Research: Intake of food additive preservatives and incidence of cancer: results from the NutriNet-Santé prospective cohort doi: 10.1136/bmj-2025-084917
Editorial: Preservatives and risk of cancer doi: 10.1136/bmj.r2613
Journal: The BMJ

External funding: European Research Council, French National Cancer Institute, French Ministry of Health, IdEx Université de Paris, Bettencourt-Schueller Foundation

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Observational; Opinion
Subjects: People

The post Higher intake of food preservatives linked to increased cancer risk first appeared on BMJ Group.

Average regain is 0.4kg/month and all weight lost likely to be regained in under 2 years
Weight regain faster after stopping weight loss drugs than after dietary weight loss programmes

Stopping weight loss drugs is followed by weight regain and reversal of beneficial effects on heart and metabolic health markers such as high cholesterol and high blood pressure, finds a study published by The BMJ today.

It shows that the average rate of weight regain is 0.4kg/month after stopping treatment, with weight and risk markers for diabetes and heart disease predicted to return to pre-treatment levels in less than two years.

It also finds that the rate of weight regain after stopping weight loss drugs is almost 4 times faster than after diet and physical activity changes, irrespective of the amount of weight lost during treatment.

“This evidence suggests that despite their success in achieving initial weight loss, these drugs alone may not be sufficient for long term weight control,” say the researchers.

The development of highly effective weight management medications such as glucagon-like peptide-1 (GLP-1) receptor agonists including semaglutide and tirzepatide has transformed the treatment of obesity.

Yet it is estimated that around half of people with obesity discontinue GLP-1 drugs within 12 months, so it’s important to understand what happens to body weight and risk markers for conditions like diabetes and heart disease after stopping treatment.

To do this, a team of researchers from the University of Oxford searched registries and databases for trials and observational studies that compared the effects of any medication licensed for weight loss in adults with any non-drug weight loss intervention (behavioural weight management programmes) or placebo.

The studies were designed differently and varied in quality, but the researchers were able to assess their risk of bias using established tools.

Thirty-seven studies published up to February 2025 involving 9,341 participants were included in the analysis. The average duration of weight loss treatment was 39 weeks, with an average follow-up of 32 weeks.

Participants treated with weight loss drugs regained on average 0.4 kg/month after stopping treatment and were projected to return to their pre-treatment weight by 1.7 years. All cardiometabolic risk markers were projected to return to pre-treatment levels within 1.4 years after stopping the drugs.

Monthly weight regain was also faster after weight loss drugs than after behavioural weight management programmes (by 0.3 kg), independent of initial weight loss.

The authors acknowledge several limitations. For example, only eight studies assessed treatment with the newer GLP-1 drugs and the maximum follow-up period in these studies was 12 months after medication stopped. What’s more, few studies were at low risk of bias.

Nevertheless, they point out that they used three methods of analysis and all provided similar results, adding certainty to their findings.

As such, they conclude: “This evidence cautions against short term use of weight management medications, emphasises the need for further research into cost effective strategies for long term weight control, and reinforces the importance of primary prevention.”

“The study findings casted doubt on the notion that GLP-1 receptor agonists are a perfect cure for obesity,” says a US researcher in a linked editorial.

“People taking GLP-1 receptor agonists should be aware of the high discontinuation rate and the consequences of cessation of medications,” he writes. “Healthy dietary and lifestyle practises should remain the foundation for obesity treatment and management, with medications such as GLP-1 receptor agonists used as adjuncts.”

“Such practises not only help prevent excess weight gain but can also lead to numerous health benefits that go beyond weight control,” he concludes.

07/01/2025

Notes for editors
Research: Weight regain after cessation of medication for weight management: systematic review and meta-analysis doi: 10.1136/bmj-2025-085304
Editorial: Weight regain after cessation of GLP-1 drugs doi: 10.1136/bmj.r2586
Journal: The BMJ 

Funding: National Institute of Health and Care Research (NIHR) Oxford Biomedical Research Centre

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Systematic review and meta-analysis; Opinion
Subject: People

The post Stopping weight loss drugs linked to weight regain and reversal of heart health markers first appeared on BMJ Group.

Music provides respite from an uncertain and stressful situation, says expert

Playing soothing live music in intensive care units not only helps parents bond with their baby but also provides a moment’s respite from an uncertain and stressful situation, says a senior doctor in the Christmas issue of The BMJ.

In 2025, Music in Hospitals & Care has delivered more than 90 hours of live music to neonatal intensive care units (NICUs) in the UK, reaching more than 1000 seriously ill babies.

The charity has been providing soothing tunes for babies and parents through its Lullaby Hour sessions since 2017, bringing a sense of calm to intensive medical settings, including adult intensive care units.

Several studies have found a positive effect of music therapy on preterm babies in the NICU – including lowering heart rate and respiratory rate, as well as increasing feeding volume – although a 2021 meta-analysis highlighted the low certainty of the evidence.

Mica Bernard, singer and guitarist, says: “When I’m singing to the baby, I can literally see their heart rate calming down or their oxygen increasing. I think it goes to show just how built in music is for human beings.”

Contrary to some parents’ concerns, research by Music in Hospitals & Care shows that babies are frequently observed falling asleep or staying asleep during the live music. Sometimes it’s played during distressing times such as clinical procedures and nappy changes.

Jay Banerjee, neonatal consultant at the Imperial College Healthcare NHS Trust, says: “These music sessions not only help parents bond with their baby but also provide a moment’s respite from an uncertain and stressful situation. The feedback from families and the clinical team here has been universally positive.”

The bonding element of Lullaby Hour is particularly important for parents who can’t hold their baby who is in an incubator.

Bernard explains: “Often, if it’s the first time I’ve sung to a parent, it’s the perfect outlet for them to be able to cry … The music helps them get in touch with what they’re feeling.”

The music also provides some sense of normality in intensive care wards.

Gail Scott-Spicer, chief executive of Imperial Health Charity, which delivers arts programmes to hospitals, says: “The environment of a neonatal intensive care unit is, of course, quite overwhelming … To be able to bring a bit of ‘normal’ into that situation starts to explain the really positive health outcomes for the babies, and it reduces stress and anxiety for the families.”

17/12/2025

Notes for editors
Feature: Where medicine meets melody—Lullaby Hour brings harmony to the neonatal ICU doi:10.1136/bmj.r2587
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? No
Evidence type: Feature; Opinion
Subjects: Babies and parents 

The post Where medicine meets melody – how lullabies help babies and parents in intensive care first appeared on BMJ Group.

Images do not align with medical workforce statistics and may reinforce prejudice against certain doctors

AI generated images of doctors have the potential to exaggerate and reinforce existing stereotypes relating to sex, gender, race, and ethnicity, suggests a small analysis in the Christmas issue of The BMJ.

Sati Heer-Stavert, GP and associate clinical professor at the University of Warwick, says AI generated images of doctors “should be carefully prompted and aligned against workforce statistics to reduce disparity between the real and the rendered.”

Inaccurate portrayals of doctors in the media and everyday imagery can perpetuate stereotypes and distort how different groups within the medical profession are perceived.

But how do AI generated images of doctors compare with workforce statistics? Do UK doctors appear different from their US counterparts? And does the identity of the NHS influence how doctors are depicted?

To explore this, in December 2025 he used OpenAI’s ChatGPT (GPT-5.1 Thinking) to generate images of doctors across a range of common UK and US medical specialties.

To limit the influence of previous image generations, saved memory was switched off and a fresh chat initiated for each image.

Using a single template prompt, “Against a neutral background, generate a single photorealistic headshot of [an NHS/a UK/a US] doctor whose specialty is [X]”, the first image from each chat was selected. This yielded 24 images, eight each for NHS, UK, and US doctors across different specialties.

Of the 24 images generated, only six (25%) depict female doctors and are confined to the specialties of obstetrics and gynaecology, and paediatrics within the NHS, UK, and US groups.

Meanwhile, six of the eight US doctors (75%) are depicted as white; the two ethnic minority depictions are also the only US female doctors.

There is a notable difference between the NHS and UK images: the “NHS” prompt generated images of doctors who all appear to be from an ethnic minority, whereas the images generated when the term “UK” was used are depicted as white.

These illustrations contrast with recent statistics on the medical workforce, notes the author. According to 2024 data, 40% of doctors on the UK specialist register were female, with obstetrics and gynaecology, and paediatrics being the specialties with most women (63% and 61%, respectively).

In the US, the proportion of female doctors is approaching 40%. Similarly, in the US, obstetrics and gynaecology and paediatrics have a higher proportion of women (62% and 66%, respectively).

Over half (58%) of doctors on the 2024 UK specialist register identified as white, and 28% identified as Asian or Asian British. The image generations created with the “NHS” prompt may prioritise demographic distinctiveness in the workforce rather than proportionality, he suggests.

Across all specialties in the US, 56% of doctors identified as white, and 19% as Asian. Existing literature from the US suggests that AI has a bias towards generating images of doctors who appear white, he adds

“This exploration illustrates how AI generated images of doctors can vary considerably with minor changes to prompts,” he writes. “Although perceptions of sex, gender, race, and ethnicity in AI generated images are highly subjective, this small example highlights how generative AI may default to stereotypes in the portrayal of doctors when simple prompts are used.”

Furthermore, he says stereotypical depictions “may shape patients’ expectations, create dissonance when they encounter genuine clinicians, and reinforce prejudice against certain doctors.”

He concludes: “AI generated images of doctors should be carefully prompted and aligned against workforce statistics to reduce disparity between the real and the rendered.”

17/12/2025

Notes for editors
Feature: What does a doctor look like? Asking AI doi: 10.1136/bmj-2025-088968
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? No
Evidence type: Feature; Opinion
Subjects: Doctors

The post AI images of doctors can exaggerate and reinforce existing stereotypes first appeared on BMJ Group.

Study contributes to ongoing debate about England’s clock change policy

The week after the autumn clock change is associated with a reduction in demand for NHS services for sleep disorders, cardiovascular disease, anxiety, depression, and psychiatric conditions in England, finds a study in the Christmas issue of The BMJ.

However, there is little evidence that the spring clock change has any short term effect on the number of health conditions, say the researchers.

Daylight saving time was introduced during the first world war and involves moving the clocks one hour forward in spring and one hour back in autumn. It operates in around 70 countries and affects a quarter of the world’s population.

Yet some studies (mainly outside the UK) have suggested that the clock changes, particularly the spring clock change, have a detrimental effect on health, leading to calls for them to be abolished.

To obtain a clearer picture, researchers set out to explore the short term (acute) effects of the clock changes on people’s mental and physical health in England.

Their findings are based on linked primary and secondary care records for 683,809 people with at least one of eight health events in the weeks surrounding the spring or autumn clock changes from 2008 to 2019.

The health events analysed were anxiety, major acute cardiovascular disease, depression, eating disorder, road traffic injury, self-harm, or sleep disorder in primary or secondary care or a psychiatric condition in accident and emergency.

The mean daily number of events (per year, per region) in the first week after the clock changes were compared with those in the control period (four weeks before the changes and weeks 2-4 after).

In the week after the autumn clock change, five health conditions had fewer events: anxiety (a 3% reduction from 17.3 events per day to 16.7), acute cardiovascular disease (a 2% reduction from 50 events per day to 48.9), depression (a 4% reduction from 44.6 to 42.7), psychiatric conditions (a 6% reduction from 3.5 to 3.3), and sleep disorders (an 8% reduction from 5.4 to 4.9).

Little evidence was found of reductions in eating disorder diagnoses, road traffic injuries, or self-harm or of changes after the spring clock change.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors note that health records contain only events for which the individual seeks medical help, and the date that a health event is recorded by a clinician, which is not necessarily the date of symptom onset.

However, they say the results are based on 12 years of broadly representative general practice and hospital data, giving a more complete picture of the effect of the clock changes on demand for health services than previous studies.

They suggest that the extra sleep over the Autumn clock change and the abrupt increase in morning sunlight exposure after the transition may be beneficial to health.

And they conclude: “Our study contributes to the ongoing debate about England’s clock change policy. Future research should explore the mechanisms underlying the reduction in health events that we observed after the autumn clock change.”

17/12/2025

Notes for editors
Research: Acute effects of daylight saving time clock changes on mental and physical health in England: population based retrospective cohort study doi: 10.1136/bmj-2024-085962
Journal: The BMJ

External funding: Wellcome

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People 

The post Autumn clock change linked to reduction in certain health conditions first appeared on BMJ Group.

Half a million patients being cared for in temporary spaces, which evidence suggests is becoming a permanent fixture in many hospitals

Most (79%) of NHS trusts in England are treating patients in corridors or makeshift areas in emergency departments including “fit to sit” rooms, x-ray waiting areas, and in one case a café, finds an investigation published by The BMJ today.

Data obtained by The BMJ show that such practices have resulted in at least half a million patients being cared for in temporary spaces and that in some trusts one in four patients in accident and emergency (A&E) departments were cared for in corridors last year.

Corridor care refers to the practice of providing care to patients in hospital corridors or other non-designated areas, owing to overwhelming demand.

Senior doctors say this is having a catastrophic effect on patient care, with end-of-life conversations being held in corridors. One describes the situation as “heartbreaking” and “undignified.”

Freedom of Information (FOI) requests by The BMJ show the extent to which A&E corridor care is becoming normalised, with examples of trusts installing portable sinks on corridors, along with heating, lighting, plug sockets, and toileting facilities to provide long term care to patients in these settings.

Some organisations have even created dedicated “corridor nurses” for shifts, with one trust hiring extra staff to help oversee patients in the “temporary escalation chairs.”

Wes Streeting, the health and social care secretary, promised in October 2024 to “consign corridor care to history where it belongs” and the government recently pledged to publish national data on the situation “shortly,” although NHS England first committed to this back in January.

Ian Higginson, vice president of the Royal College of Emergency Medicine, says: “We hear of persistent stories of patients having cardiac arrests on corridors or of an inability to get resuscitation equipment to patients because everything’s in the way.”

He added: “For staff it’s a real source of moral injury. If this was happening in any other place, in any other walk of life, there would be an absolute outcry. It’s a complete scandal.”

Yet despite the obvious harm corridor care causes to patients and the staff who treat them, evidence shows that temporary caring spaces are becoming a permanent fixture in many hospitals.

For example, Dorset County Hospital said that it had adapted a corridor by adding portable sinks, heating, lighting and plug sockets. University Hospitals of Liverpool told The BMJ it had converted a room on a corridor into an additional toileting facility for patients, and Dartford and Gravesham said it had “dedicated nursing staff to care for patients on corridors.”

The three trusts reporting the highest number of patients in corridor care were Liverpool University Hospitals (37,735, or 18.7% of attendances), Barking, Havering and Redbridge in east London (35,224, 24% of all attendances) and Northern Care Alliance in Greater Manchester (33,987, 11.3% of attendances), although they all cover two or more emergency departments within one organisation.

Lynn Woolsey, chief nursing officer at the Royal College of Nursing, says: “These figures reveal the tragic reality of the frontline, where patients are left in unsafe and undignified conditions and nursing staff are prevented from providing person centred care. The figures are shocking, yet they are the tip of the iceberg. We know that corridor care is not limited to emergency departments.”

“As we head into winter, this situation is only set to worsen,” she adds.

A spokesperson for the Department of Health and Social Care said: “No one should receive care in a corridor in a chair or trolley – it is unacceptable and undignified. We are determined to end this, which is why we’re publishing corridor waiting figures so we can take the steps needed to eradicate it from our health service.”

17/12/2025

Notes for editors
News: Eight in 10 trusts are caring for emergency department patients in corridors, BMJ investigation finds doi: 10.1136/bmj.r2636
Journal: The BMJ

Link to infographic/NHS trust calculator: How many people does each NHS trust treat in corridors? https://public.flourish.studio/visualisation/26745402/

The post Eight in 10 trusts caring for emergency department patients in corridors, finds BMJ investigation first appeared on BMJ Group.

Almost 1 in 5 “recent” references in biomedical articles are at least 10 years old, suggesting the term is less a measure of time than a narrative device, say researchers 

Authors in biomedical journals frequently describe cited evidence as “recent,” yet the actual age of the references behind these phrases has rarely been measured.

To measure how recent the “recent” studies really are, researchers based in Spain analysed 1000 biomedical articles containing 20 predefined “recent” expressions directly linked to a citation.

Their findings in the Christmas issue of The BMJ show that the citation lag ranged from 0 to 37 years, with a median of 4 years and a mean of 5.5 years.

The most frequent lag was 1 year, yet almost one in five “recent” references (177, 18%) cited work that was at least 10 years old. Twenty-six citations had a lag of 20 years or longer, and four articles cited references that were at least 30 years old.

Citation patterns varied across medical specialties. Critical care, infectious diseases, genetics, immunology, and radiology showed shorter median lags (around two years), while nephrology, veterinary medicine, and dentistry displayed substantially longer lags (ranging from 8.5 to 14 years).

Among expressions, “recent approach,” “recent discovery,” and “recent study” were linked to older references, whereas “recent publication” and “recent article” had much fresher citations.

Patterns were stable across world regions and gradually improved over time: articles published between 2020 and 2025 showed the shortest lags. Journals with very high impact factors (12 or higher) also cited more contemporary research.

These are observational findings and the authors acknowledge that they assessed only the age and not the relevance of cited studies, and analysed only the first eligible “recent” expression per article. Still, drawing on a large and systematically reviewed sample, they show that “recent” functions as a remarkably flexible rhetorical device in scientific writing.

They conclude: “This playful analysis suggests that “recent” can mean anything from last season to last century. Readers, reviewers, and editors may want to take “recent” claims with a grain of chronological salt.”

11/12/2025

Notes for editors
Research: How recent is recent? Retrospective analysis of suspiciously timeless citations doi: 10.1136/bmj-2025-086941
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Citations in biomedical articles

The post Biomedical authors often call a reference “recent” — even when it is decades old, analysis shows first appeared on BMJ Group.