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.

If high quality clinical trials confirm lasting benefits and key features, apps could become cornerstone of global tobacco control efforts, suggest researchers

Smartphone apps—particularly those based on psychological theories—are 3 times as effective as no/minimal support at helping people who smoke stub out their tobacco use long term, suggests a pooled data analysis of the available evidence, published in the online journal BMJ Evidence Based Medicine.

If high quality clinical trials can confirm lasting benefits and key features, these apps could become a cornerstone of global tobacco control efforts, suggest the researchers.

Smartphone apps offer an accessible and versatile approach to smoking cessation efforts. But the current body of evidence has been hindered by small study numbers and app obsolescence, say the researchers.

Most currently available smoking cessation apps adopt either traditional behavioural frameworks, focused on directly modifying smoking behaviour, or psychological-behavioural theories, targeting cognition, emotion regulation, and motivation through techniques such as cognitive behavioural therapy (CBT), acceptance and commitment therapy, and mindfulness, explain the researchers.

But it’s not clear which approach might be more effective for improving sustained abstinence.

To strengthen and update the evidence base, the researchers assessed the effectiveness of smartphone apps, when used alone or when combined with traditional approaches, such as nicotine replacement therapy and counselling, for helping people quit smoking and stay away from tobacco long term (6 months continuously).

They trawled research databases for relevant randomised controlled trials published up to August 2025 of people aged at least 15 who planned to quit smoking. Comparisons included: no intervention; minimal smoking cessation support; traditional interventions; and apps based on traditional behavioural interventions.

Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

The data from a total of 31 eligible studies, involving 12,802 participants, were pooled. Low certainty evidence from 4 studies (1402 participants) suggests that smartphone apps used alone may nearly triple the rate of 6-month continuous abstinence, increasing the number of ‘abstainers’ by 40 in every 1000, compared with no or minimal smoking cessation support.

When combined with traditional interventions, these apps may nearly double 6-month continuous abstinence compared with traditional interventions alone (4 studies involving 2163 participants; low certainty evidence).

And based on data from 3 studies (1502 participants; low certainty evidence), these apps plus pharmacotherapy may improve 6-month continuous abstinence by 77% compared with pharmacotherapy alone.

High certainty evidence indicated that apps based on psychological behavioural theories significantly increased abstinence in the short term at 3 months (69%; 2 studies, 2565 participants) and in the long term at 6 months (36%; 4 studies, 3258 participants) compared with apps based on traditional behavioural interventions.

“Smartphone apps can deliver intensive, interactive and real-time behavioural support, exceeding the effect of brief advice. A clear dose–response relationship exists between counselling intensity and quit success, and apps help meet this need while bypassing barriers such as limited clinic capacity, staff time, and declining use of telephone quitlines,” point out the researchers.

“Consequently, smartphone apps represent a scalable alternative or adjunct to traditional cessation services, particularly in resource-limited settings,” they suggest.

But the certainty of the evidence remains low due to limited sample sizes and methodological limitations, including design variations in the apps and their use, caution the researchers, adding that the findings “should be viewed as generating a hypothesis for future research rather than as a definitive conclusion.”

They conclude: “Should future evidence confirm lasting benefits and pinpoint key features, rigorously validated apps could become a cornerstone of global tobacco control efforts.”

13/01/2025

Notes for editors
Research: Efficacy of smartphone apps used alone or with traditional interventions for smoking cessation: a systematic review and meta- analysis Doi: 10.1136/bmjebm- 2025-113971
Journal: BMJ Evidence Based Medicine

External funding: China Association on Tobacco Control for Health

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

Externally peer reviewed? Yes
Evidence type: Systematic review + meta analysis
Subjects: People

The post Phone apps nearly 3 times as good as no/basic support for quitting smoking long term 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.

Improving their living conditions may benefit both health and exam results, say researchers

Children living in substandard housing in England miss 15 more school days and achieve worse test scores in English and maths than their peers living in better quality housing, suggests research published online in the Journal of Epidemiology & Community Health.

Improving their living conditions—specifically reducing overcrowding and damp, and upgrading heating systems—may not only benefit their health, but also their grades,conclude the researchers.

One in 7 families in England live in homes that fail to meet the official decent homes standard, point out the researchers. Housing is a key determinant of child health, yet relatively little is known about how its quality may affect educational outcomes, particularly the number of missed school days and exam grades, they add.

To explore this further, the researchers drew on data for 8992 children, born between 2000 and 2002 participating in the nationally representative Millennium Cohort Study.

Housing quality at the age of 7 was calculated from 6 key indicators: accommodation type; floor level; lack of access to a garden; presence of damp; inadequate/no heating; and overcrowding.

Housing quality was linked to the percentage of missed school days and standardised test results in maths and English at the ages of 7, 11, and 16 in the National Pupil Database.

On average, children missed 5% (86 days) of compulsory schooling (years 1–11). And approximately 16% of them lived in poor quality housing, defined as meeting at least 2 of the 6 indicators.

After accounting for potentially influential factors, including parental educational attainment and ethnicity, analysis of the data showed that children living in poor quality housing missed more school days and achieved worse grades than children living in better quality housing.

These children missed nearly 1.5 more school days, on average, for each of the 11 years of compulsory schooling than their peers living in higher quality housing (based on 7272 children). Damp, overcrowding, and living in a flat were most strongly associated with missed schooling.

Test scores in maths and English during primary and secondary school were between 0.07 and 0.13 points (2-5%) lower for children living in poorer quality housing (based on 6741 children), mainly driven by overcrowding, and to a lesser extent, lack of central heating.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, added to which data on school absences or test results on at least one data collection point were missing for 10% of the participants.

Children exclusively in home schooling and attending private schools (7%) aren’t captured in the National Pupils Database. And housing conditions were subjectively assessed by parents rather than being objectively measured.

Nevertheless there are plausible explanations for the observed associations, suggest the researchers, with living in damp housing increasing the risk of respiratory illness.

“While study participants were not asked directly about the presence of mould, damp conditions are a major determinant of fungal growth which can in turn release hazardous spores, fragments, and microbial volatile organic compounds into indoor air,” they explain.

Overcrowding also creates an unfavourable environment for study, they add. “Crowded housing is linked to behavioural problems and to worse health in children…Living in crowded homes is linked to lower academic achievement due to noise, lack of study space, insufficient sleep, reduced concentration and added responsibilities (eg, childcare).”

They conclude: “Improving housing conditions, especially reducing damp and overcrowding, and updating heating systems and energy efficiency can have significant benefits.

“Given the magnitude of the problem in England, national and local public health and housing policies targeting these features of housing quality could improve children’s health and school outcomes across the country and narrow the health inequality gaps.”

The NHS could also save the £1.4 (€1.6, US$1.8) billion every year it spends on treatment associated with the effects of poor housing, they add.

16/12/2025

Notes for editors
Research: Housing quality and school outcomes in England: a nationally representative linked cohort study Doi: 10.1136/jech-2025-224495

Journal: Journal of Epidemiology & Community Health

External funding: Economic and Social Research Council

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf

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

The post Living in substandard housing linked to kids’ missed schooling and poor grades first appeared on BMJ Group.

Experts warn of a generation learning to form emotional bonds with entities that lack the capacity for empathy and care 

AI chatbot systems, such as ChatGPT, Claude, and Copilot, are used increasingly as confidants of choice, but turning to AI chatbots for companionship and emotional support is a cause for concern, especially in younger people, say experts in the Christmas issue of The BMJ.

They warn that “we might be witnessing a generation learning to form emotional bonds with entities that lack capacities for human-like empathy, care, and relational attunement” and say evidence based strategies for reducing social isolation and loneliness are paramount.

In 2023, the US Surgeon General declared that the nation was experiencing a loneliness epidemic, constituting a public health concern on par with smoking and obesity, write Susan Shelmerdine and Matthew Nour.

In the UK, nearly half of adults (25.9 million) report feeling lonely either occasionally,

sometimes, always, or often; with almost 1 in 10 experiencing chronic loneliness (defined as feeling lonely “often or always”). Younger people (aged 16-24 years) are also affected.

Given these trends, it’s no wonder that many are looking to alternative sources for companionship and emotional support, say the authors. ChatGPT, for example, has around 810 million weekly active users worldwide, and some reports place therapy and companionship as a top reason for use.

Among younger people, one study found a third of teenagers use AI companions for social interaction, with 1 in 10 reporting that the AI conversations are more satisfying than human conversations, and 1 in 3 reporting that they would choose AI companions over humans for serious conversations.

In light of this evidence, they say it seems prudent to consider problematic chatbot use as a new environmental risk factor when assessing a patient with mental state disturbance.

In these cases, they propose that clinicians should begin with a gentle enquiry on problematic chatbot use, particularly during holiday periods when vulnerable

populations are most at risk, followed if necessary by more directed questions to assess compulsive use patterns, dependency, and emotional attachment.

They acknowledge that AI might bring benefits for improving accessibility and support for individuals experiencing loneliness, and say empirical studies are needed “to characterise the prevalence and nature of risks of human-chatbot interactions, to develop clinical competencies in assessing patients’ AI use, to implement evidence based interventions for problematic dependency, and to advocate for regulatory frameworks that prioritise long term wellbeing over superficial and myopic engagement metrics.”

Meanwhile, focusing and building on evidence based strategies for reducing social isolation and loneliness are paramount, they conclude.

11/12/2025

Notes for editors
Feature: AI chatbots and the loneliness crisis doi: 10.1136/bmj.r2509
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: AI chatbots 

The post Concern over growing use of AI chatbots to stave off loneliness first appeared on BMJ Group.

Experts call for coordinated action by governments and platforms to protect the public

Biased or misleading medical advice shared by social media influencers can cause harm and requires coordinated action by governments and platforms to protect the public, argue experts in The BMJ today.

Social media influencers are a growing source of medical advice, say Raffael Heiss and colleagues. More than 70% of young adults in the US follow influencers, and over 40% have purchased products based on their recommendations.

Yet they warn that influencer advice can be subject to four sources of bias: lack of medical expertise or relevant knowledge, industry influence, entrepreneurial interests, and personal beliefs.

“Such advice can cause psychological, physical, financial, and systemic harm—from inaccurate self-diagnosis and inappropriate treatments to unnecessary spending and higher healthcare costs,” they write.

A prominent example is celebrity Kim Kardashian, who encouraged her 360 million Instagram followers to have full body screening with magnetic resonance imaging—a test without proven benefits and linked to overdiagnosis, unnecessary interventions, and costs.

Influencers with health-related credentials can also provide misleading advice. For instance, Eric Berg, a US chiropractor with 14 million YouTube subscribers promotes high dose supplementation while selling his own brand of vitamin D and other supplements, some of which were subject to a legal warning for lead content above safety levels.

The effect of these biases is magnified by influencers’ ability to form real or one sided (often referred to as “parasocial”) bonds with followers, making them highly persuasive communicators, say the authors.

They acknowledge that some influencers do provide useful health advice including doctors and others who help to debunk common misconceptions, while influencers who are patients themselves may also provide valuable peer support, especially for stigmatised conditions, by creating safe spaces and sharing personal experiences, they write.

Nevertheless, they say maximising the benefits and minimising the harms of influencers’ medical advice will require collaboration between multiple stakeholders, particularly governments and social media platforms.

Strategies include effective regulation, stronger platform and influencer accountability, and user empowerment through targeted education and access to reliable, fact checked information.

The authors acknowledge that there is no one-size-fits-all solution, but conclude: “Together, these strategies can help create a safer information environment in which influencers are constructive rather than harmful sources of health advice.”

Regulating and moderating platforms and influencers is necessary, but fostering trust through verified communities, clinician-endorsed forums, and participatory public health campaigns, will be indispensable, say Tina Purnat and David Scales in a linked editorial.

They discuss how digital platforms, clinical encounters, and community spaces, both online and offline, shape what people see, believe, and do, including how evidence is negotiated in clinical consultations.

“Shared decision making must evolve for the digital age,” they write. “The key is structuring interventions around people’s information environments, where exposure, like exposure to physical environments, shapes health and deserves similar care.”

In a linked feature, Stephanie Santos Paulo speaks to ‘patient influencers’ who have amassed large followings on social media by sharing personal stories of their conditions and care that foster a sense of authenticity and emotional connection with followers.

“I think partly people are finding social media better for answers because it’s not easy to get hold of a medical professional,” says Liam Robertson, whose Instagram page @livingwithulcerativecolitis has 9,300 followers. “It’s almost like a strategy to help them,” he adds. “I don’t feel like they should need that, but we do.”

Lily Mae, whose Instagram account @chronicallylil details her life with Ehlers-Danlos syndrome, endometriosis, and vascular compression syndrome, says: “I wish healthcare professionals would listen and engage more with patient communities online. There’s such a wealth of firsthand knowledge being shared—real stories, symptoms, and lived experiences that could help improve care if more providers took the time to understand them.”

Jen Moore, who posts about endometriosis and adenomyosis on her Instagram account @jen.dometriosis, emphasises the role of patient influencers in signposting followers towards medical professionals. “Unless we involve clinicians in what we’re trying to do, nothing’s going to change,” she says.

03/12/2025

Notes for editors
Analysis: Responding to public health challenges of medical advice from social media influencers doi: 10.1136/bmj-2025-086061
Editorial: Health information in the age of social media and influence doi: 10.1136/bmj.r2419
Feature: The social media influencers your patients are turning to before they get to your clinic’ doi: 10.1136/bmj.r2501
Journal: The BMJ

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

Externally peer reviewed? Yes (Analysis); No (linked editorial / feature)
Evidence type: Analysis; Opinion
Subject: Social media influencers 

The post Concern over harmful medical advice from social media influencers first appeared on BMJ Group.

New BMJ series explores how AI is reshaping traditional doctor-patient interactions and considers its implications for healthcare

AI is fast becoming a third party in the consultation room, reshaping the traditional two way doctor-patient relationship with important ethical and practical implications, say experts in The BMJ today.

A new BMJ series provides insights into this technological shift, introducing the concept of ‘triadic care,’ where clinicians, patients, and AI jointly shape clinical encounters.

Yet while this technological evolution has transformative potential for healthcare, the presence of AI can affect the dynamic of trust, empathy, and communication that forms the cornerstone of person-centred care.

As such, safe and effective adoption depends on strong governance and institutional readiness to safeguard trust, ensure patient safety, and maintain clinical standards, say authors.

In an editorial to accompany the series, Sandeep Reddy and colleagues point out that regulatory approaches are emerging globally but remain inconsistent, and many healthcare institutions still lack fundamental AI governance structures, deploying AI tools without adequate oversight, which “poses significant risks to patient safety and clinical quality.”

​Technology companies developing healthcare AI also bear significant responsibility for safe deployment, yet accountability remains limited, they add.

Coordinated governance frameworks are essential, they write, while healthcare institutions should establish comprehensive AI governance structures before widespread deployment, and regulatory bodies need flexible guidelines that can keep pace with AI while upholding rigorous safety and efficacy standards.

Technology companies must also be held to high standards of transparency regarding post-market surveillance and adopt clear accountability mechanisms, they add, while professional associations and licensing bodies must mandate AI literacy training for healthcare professionals and revise liability frameworks to reflect triadic care.

Without urgent and coordinated action, they warn that the benefits of AI “risk being undermined by avoidable harms and loss of public trust.”

In the first article of the series, David Navarro and colleagues explore how AI is already used by both clinicians and patients in consultations, leading to a shift from knowing answers to helping patients interpret AI generated information in context.

They suggest that simple infrastructure, such as documentation standards and transparent technology, can make this shift observable and safe, and say research must examine how AI transforms the doctor-patient relationship and develop frameworks for this evolution.

Other articles will consider the patient experience and the competencies that clinicians need to use AI transparently and effectively within the clinical encounter.

“This series is a step in helping clinicians navigate AI in practice,” says Jocalyn Clark, The BMJ’s International Editor. “The BMJ is committed to publishing evidence and commentaries to further support clinicians in adapting to this technological shift and integrating AI into routine care.”

18/11/2025

Notes for editors
Link to series page: https://www.bmj.com/collections/gen-AI

The post AI is a ‘third party’ in the consultation room, say experts first appeared on BMJ Group.

Academy of Medical Sciences Press Release Labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: Children

This press release draws on the raw, unedited manuscript accepted for publication.
The final version will be posted online on the journal’s homepage in due course.

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Likely stronger determinant of health than education, suggest researchers

Voting behaviour in elections is strongly linked to the future risk of death, and is likely a stronger determinant of health than education—considered a key influence on health—suggests research published online in the Journal of Epidemiology & Community Health.

Over the past several years, voting in national and local elections has increasingly been seen as a potential social determinant of health—the non-medical factors that influence health and wellbeing—explain the researchers.

And previously published research suggests that voters generally have better health than non-voters, but it’s not clear if electoral participation might also be a predictor of future death risk.

To explore this further, the researchers drew on electoral participation information in the 1999 parliamentary elections for the entire electorate of Finnish citizens living in mainland Finland and aged at least 30.

Turnout among this age group was 71.5% for men and 72.5% for women. In all, 3,185, 572 people (1,508,824 men; 1,676,748 women) were included in the study and their survival was tracked from 21 March 1999 (election day) to death or the end of 2020, whichever came first.

Between 1999 and 2020, 1,053,483 people died: 95,350 from external causes (accidents, violent and alcohol-attributable causes); 955,723 from other underlying causes; 2410 people whose cause of death wasn’t known were excluded from the final analysis.

Not voting was consistently associated with a 73% heightened risk of death from any cause among men and a 63% heightened risk of death among women.

After adjusting for education level (basic or unknown; secondary; or tertiary) this reduced to a 64% heightened risk among men and a 59% heightened risk among women.

The difference in the risk of death between voters and non-voters was larger than it was between those with basic and tertiary level education.

The association between voting participation and death was stronger for external causes of death rather than for other causes. And when adjusted for age, this risk was twice as high among both men and women who didn’t vote than it was among those who did.

The difference in the relative risk of death between voters and non-voters was strongest among men under 50. Among 75 to 94-year olds, women who didn’t vote had a higher risk of death than men who voted, whereas the reverse was true for younger age groups.

And among men in the lowest 25% of household income, the risk of death associated with not voting was 9–12% higher than it was for other income groups.

This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge various limitations to their findings, including that some people might have wanted to vote, but were unable to do so, or simply chose not to vote.

Nevertheless, the fact that voting was more strongly associated with the risk of death than educational level “suggests a strong association between voting and mortality, given that a substantial education gradient in mortality is among the most robustly established sociodemographic mortality patterns,” they suggest.

“Voting, as a form of participation, is a type of social capital, which is linked to health benefits. In addition, voting may increase other forms of civic participation,” they explain.

“Health problems and related difficulties in functioning may also negatively affect many important prerequisites of participation, including enhancing resources, motivation to vote, and political mobilisation,” they add.

They conclude: “Information on voting may be useful in clinical settings – for example, abandonment of voting habits may be an early signal of significant health decline – and in monitoring population wellbeing, health, and health disparities. Additionally, a strong association between voting and mortality raises concerns about equal political representation.”

04/11/2025

Notes for editors
Research: Voting is a stronger determinant of mortality than education: a full- electorate survival analysis with 21-year follow-up Doi 10.1136/jech-2025-224663
Journal: Journal of Epidemiology & Community Health

External funding: European Research Council; Strategic Research Council of the Research Council of Finland

About the journal
The Journal of Epidemiology & Community Health is one of 70 journals published by BMJ Group.
https://jech.bmj.com

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

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