BMJ

In late June, over 50 grant recipients of the US’s Teen Pregnancy Prevention Program received notice that their funding, used to implement sexual health education initiatives, was being terminated because their programmes didn’t align with the Trump administration’s values. This came just days after the US Department of Health and Human Services released new notices of funding opportunities and laid out guidelines for new applications.12 The new guidelines emphasise abstinence-only education, “parental rights” (a conservative movement that uses the concept as a pretext for restricting young people’s autonomy), and themes of fertility tracking and hormone production favoured by the “Make America Healthy Again” movement.34A federal judge temporarily blocked the new guidelines on 19 August, but terminated funding will not be restored to grant recipients. Although this ruling prevents the new guidelines from being implemented while litigation is ongoing, these actions are yet another threat to evidence based sexual and reproductive...

In 2007 The BMJ’s readers voted vaccination as one of the most important medical milestones since the journal began in 1840. Vaccines are estimated to have saved hundreds of millions of lives worldwide, primarily among children. A robust evidence base has shown vaccines to be safe and effective.1 Who would want to undermine one of the greatest public health achievements?Last week the US president, Donald Trump, and his health secretary, Robert F Kennedy Jr—both long term vaccine sceptics—did just that by signing an executive order to reduce the vaccinations US children receive and to deliver MMR vaccination as separate doses (doi:10.1136/bmj-2026-100549).2 This shows “an ambivalence towards vaccines and the evidence base that supports them,” write Tiago Correia and colleagues, and will reduce uptake and trust in vaccines that won’t be easy to recover, making outbreaks of vaccine preventable diseases certain (doi:10.1136/bmj-2026-100562).3The executive order was issued shortly after a US Senate...

News reports in recent weeks highlight several potential missteps in the implementation of artificial intelligence in healthcare.A patient sued Open AI claiming that ChatGPT gave him harmful medical advice, a whistleblower claimed a major academic medical centre cut corners in evaluating patient facing AI tools, and a large insurer was accused of using reckless algorithms to prematurely discharge patients from postacute care.1Reports like these are likely to continue as healthcare organisations race to implement new AI tools.At the same time, public scepticism about AI is growing, which further raises the stakes of getting AI implementation wrong, particularly where patients are directly affected.2 Trustworthy AI implementation in healthcare entails not only ensuring outputs are accurate and reliable, but also that the processes by which healthcare organisations adopt, implement, evaluate, govern, and communicate about their AI efforts maintain their integrity, including proactively detecting and responding to problems.3As health systems pursue AI integration,...

The UK has entered a new era of climate volatility, in which record breaking temperatures and droughts are expected rather than exceptional events.1On 14 August, 71.3% of England was declared to be in drought, following the driest July on record, with some regions receiving only 10% of their average annual rainfall. Reservoir storage fell to 69% of capacity, 11.6% below seasonal norms, while 78% of England’s rivers are below normal levels, and more than 27 million people face water restrictions.2 It will take more than a few days of rain to bring water levels back to what they should be.The drought has been accompanied by heatwaves to create “compound extreme events” with substantial public health implications. As a result, what is often framed as a water management problem is now a warning that climate change is becoming a food and public health emergency.Droughts progress through four stages: a meteorological drought...

Stroke is a leading cause of death and disability worldwide. Despite improving patient outcomes, reperfusion treatments are time dependent and not universally available. Head positioning is a simple, low cost intervention with a compelling physiological rationale,1 but randomised trials have not demonstrated functional benefit.234 Current guidelines recommend head position based on the individual, rather than routinely keeping patients in either flat or upright head positions.567 However, earlier trials focused on optimising head position to improve cerebral perfusion before reperfusion of the ischaemic penumbra. Whether there is a preferred head position after successful reperfusion remains unclear, especially in those with major strokes where head elevation may attenuate oedema progression.In a linked study (doi:10.1136/bmj-2026-100363), Yuan and colleagues report the HeadSOAR trial, which aimed to determine optimal head position after successful reperfusion.8 HeadSOAR was an investigator led, multicentre, randomised, open label trial with blinded endpoint assessment conducted across 67 stroke centres in China....

A woman in her 30s presented with a two month history of painless, non-itchy reddish purple plaques and nodules which first appeared on her abdomen and gradually spread to her upper body and thighs (fig 1). She had no relevant medical history and was not taking any medication.bmj;394/aug20_5/e100277/F1F1f1Fig 1On examination, there were multiple violaceous patches and nodules on her abdomen, chest, back, upper arms, and thighs. The lesions were indurated and non-tender on palpation.Differential diagnoses included cutaneous metastases from a solid tumour or cutaneous involvement of a haematological malignancy. Given the lack of tenderness, ulceration, discharge, or signs of systemic inflammation, infective and inflammatory dermatoses were considered less likely.Full blood count showed a white blood cell count of 3.06×109/L (reference range, 3.5 to 9.5×109/L). Liver and renal function, coagulation, autoimmune, and immunodeficiency profiles were within normal limits.An abdominal skin biopsy was done. Histopathological examination and immunophenotyping were consistent with a...