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The NHS is on the brink of something important. The federated data platform (FDP), combined with the accelerating use of artificial intelligence (AI), offers the possibility of a health system that’s more coordinated, predictive, and efficient. Although this is the right direction of travel, one question isn’t receiving enough attention: who ultimately controls the data?That question matters because of a little-known piece of US legislation: the CLOUD Act. The Clarifying Lawful Overseas Use of Data Act allows US authorities to compel US companies such as Palantir, the technology company currently contracted to deliver the FDP, to provide data within their “possession, custody, or control.” This is required regardless of where the data are physically stored.This means that data held on UK servers may still fall under US legal jurisdiction if controlled by a US company. This doesn’t mean arbitrary access to NHS patient records, but it does establish a lawful...

I received a diagnosis of type 1 diabetes at the age of 5. I vividly remember hearing my mom being told that type 1 diabetes would be cured by the time I was 30. Because of these conversations, I spent much of my childhood believing that a cure was on the horizon. The idea was reassuring at first, but gradually diabetes became my everyday life, and at age 10, when I got my first insulin pump, I stopped anticipating a cure. Getting the pump made my diabetes feel permanent. Before that, insulin injections had happened in a single moment. Wearing a medical device attached to my body at all times made diabetes feel more real and no longer intermittent. I now carried it with me everywhere.Building knowledge and trustAs a child, I managed my diabetes only because my mom made me or did it for me. Often I heard only...

England now has national strategies for women’s1 and men’s health,2 marking an important policy moment in which sex and gender are being treated more explicitly as health equity concerns. Early coverage has already cast the strategies as competing for limited funding,3 turning the focus from equitable service design into a contest over priority. The task is not choosing between them but using both strategies to change mainstream care.What matters is not weighing women’s and men’s health harms against each other but recognising the shared weaknesses they expose in a health system built around assumptions about whose needs count, how people present to healthcare, and what support they are likely to use.4Overlapping weaknesses make the competition framing particularly damaging. Concern about underinvestment in women’s health is well founded given the historical under-recognition of women’s symptoms, pain, and reproductive health.5 But attention to men’s health is not a competing claim. The renewed...

Pancreatoduodenectomy is one of the most complex procedures in abdominal surgery, removing tumours of the pancreatic head and surrounding organs. Traditionally performed as open surgery, pancreatoduodenectomy carries substantial risks of complications and a long recovery. Robotic surgery has emerged as a promising minimally invasive procedure. However, evidence on its safety and effectiveness remains limited, leaving unresolved which patients benefit most and whether robotic surgery’s better outcomes justify the higher costs.In the linked paper by Jin and colleagues (doi:10.1136/bmj-2026-319692), the Robotic Versus Open Pancreatoduodenectomy for Pancreatic and Periampullary Tumours (PORTAL) trial adds important evidence to randomised literature evaluating minimally invasive pancreatoduodenectomy.1 To date, nine randomised controlled trials have addressed this question.123456789 Of these nine trials, only three (EUROPA, Liu et al, and PORTAL) directly compared robotic pancreatoduodenectomy (RPD) with open pancreatoduodenectomy (OPD).189 The other trials evaluated laparoscopic and open surgical approaches, or, like DIPLOMA-2, included both laparoscopic and robotic techniques, with...

Ambrose Bierce’s collection of satirical definitions, The Devil’s Dictionary, has had many modern imitators, of which Michael O’Donnell’s collection A Sceptic’s Medical Dictionary, is one. Together they add a sixth entry in my collection of types of skepticism, previously limited to five: philosophical, Voltairian, scientific, dogmatic, and nihilistic. I have called the sixth type satirical skepticism.SkepticismIf you look up the word “skepticism” in any good English dictionary you will find that it has an alternative spelling, “scepticism.” In some cases, you’ll be told that the spelling with a /k/ is “usually US.”The word comes from the hypothetical Indo-European root SPEK, to see or regard. In Greek, metathesis of the P and K led to the verb σκοπεῖν, to look, see, watch, or regard, its related deponent verb σκέπτεσθαι, to consider, and the adjective σκεπτικός, thoughtful.In Latin, however, the Greek word σκεπτικός became scepticus, the two Greek kappas being turned into...

The UK government should introduce a legal maximum safe working temperature for hospitals and GP surgeries, the Doctors’ Association UK (DAUK) has said.The campaign group has written to the health secretary, James Murray, calling for a range of cooling measures in the NHS, such as air conditioning, to create safer working temperatures.The group made the call after its survey found that most healthcare workplaces were very hot or dangerously hot during the latest heatwave.1 And a government backed report from the UK Climate Change Committee said in May that UK hospitals urgently need cooling systems, as deaths and admissions were set to rise because of global heating.2The DAUK conducted its survey of healthcare workers from 25 to 29 June. The highest ever June temperature in the UK was recorded on 26 June, at 37.7°C.3Of the 1111 healthcare workers who responded to the survey, including 728 doctors, 83% (925) described their...