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{"title":"How Uganda became an advanced nation in palliative care","authors":"Yemisi Bokinni","doi":"10.1136/bmj.r2099","DOIUrl":"https://doi.org/10.1136/bmj.r2099","url":null,"abstract":"Uganda is the only low income country to attain “advanced” status in a global ranking of palliative care services, just one place behind the US. Yemisi Bokinni reports on what other countries can learn Abigail Simon-Hart has seen the deaths of both her mother and her brother, in very different circumstances. “I grew up with a mother who had cancer four different times, all unrelated,” she says. “Four different times the doctors told us it was terminal, that there was nothing they could do—and she lived for 33 years after the last time they told her she was going to die.” Simon-Hart’s mother died of leukaemia in an Australian hospice in 2013. She recalls, “I was quite shocked as to how much say we had in everything, how much say she had in everything. She got to do some of the things on her bucket list—whatever made her feel slightly more normal within some reasonable level, they were allowed to do. And that kind of humanised everything.” Almost a decade later, in 2022, her brother died after complications from surgery in Nigeria. He remained on a ventilator in the intensive care unit for two and a half months until he went into cardiac arrest. There had been no discussion of what might happen if things didn’t go well, considering his multiple pre-existing comorbidities, and no DNR (do not resuscitate) order was in place. “I don’t blame [the doctors], because I think they honestly thought they could save him. I really think that they felt they were acting in his best interest,” Simon-Hart reflects. “I wasn’t going to tell them to switch the machine off, and that was the trauma. You’d go there and say, God, please either heal him or take him.” The extent of global inequalities in palliative care …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"110 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI supported diagnostic innovations for impact in global women’s health","authors":"Nina Linder, Dinnah Nyirenda, Andreas Mårtensson, Harrison Kaingu, Billy Ngasala, Johan Lundin","doi":"10.1136/bmj-2025-086009","DOIUrl":"https://doi.org/10.1136/bmj-2025-086009","url":null,"abstract":"Nina Linder and colleagues examine how artificial intelligence could be applied to diagnostic methods that rely on highly trained experts, such as cytological screening for cervical cancer, enabling implementation even in resource limited settings Screening and diagnostic methods are essential for secondary prevention, early detection, and appropriate treatment across a range of women’s health conditions. Cervical cancer provides a compelling example of how screening and timely diagnosis can substantially improve outcomes and drastically reduce mortality, while also reflecting how women’s health priorities have historically been underfunded and under-innovated, especially in low and middle income countries (LMICs). The disease is considered preventable through human papillomavirus (HPV) vaccination and various screening modalities, but there has been limited investment in novel diagnostic tools, and inequities in access to evidence based, cost effective screening prevail, particularly in low resource settings.12 Cervical cancer screening ever in lifetime among women aged 30-49 years, for example, was reported to be 84% in high income countries and 11% in low income countries.1 Artificial intelligence (AI) supported tools, such as cytological cervical cancer screening, self-sampling combined with HPV testing, or AI analysis of cervix images, show great promise and have been successfully implemented at scale in research and clinical settings.3456 Yet their impact in LMICs remains constrained by persistent health system barriers to implementation and scale-up. Uptake of digital technologies is often hindered by systemic barriers including regulatory uncertainty, infrastructure constraints, and competing economic priorities.78 In parallel, molecular HPV testing capabilities and HPV vaccine coverage remain limited in many LMICs, with approximately one in five eligible girls receiving the full course of preventive immunisation.910 Given the 10-20 year lag time before HPV vaccination has a measurable impact on cervical cancer rates, scalable and effective screening remains critical for …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"391 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing clinical practice guidelines for equitable, inclusive, and contextualised care","authors":"Awa Naghipour, Eva Becher, Marcel Gemander, Sabine Oertelt-Prigione","doi":"10.1136/bmj-2025-085684","DOIUrl":"https://doi.org/10.1136/bmj-2025-085684","url":null,"abstract":"Sabine Oertelt-Prigione and colleagues argue that European clinical practice guidelines need standardised, inclusive, sex and gender sensitive development to not only guide healthcare but also drive innovation and research agendas As the global governance of healthcare is being reshaped, a timely opportunity and an urgent need exist to institutionalise standardised, equity focused approaches that embed innovation in the design and delivery of care.1 Clinical practice guidelines (CPGs) are essential to this transformation—they are not only endpoints that translate research into care but can also function as upstream influencers that shape research agendas, funding priorities, and innovation pathways.2 Through inclusive sex, gender, and context sensitive processes, CPGs can act as catalysts for advancing women’s and gender sensitive healthcare by identifying and highlighting persistent gaps in data and care, potentially driving innovation in research and service provision. CPGs can thus have a systemic impact beyond their essential role in clinical care. To successfully enact this upstream role, the CPG development process needs to build on strong, inclusive evidence guaranteed by structural and methodological premises and possibly embrace some technological innovations. Women and gender diverse individuals are under-represented and underserved in clinical research and care. Although sex and gender sensitive medicine is expanding and knowledge gaps are being filled as a result of structural interventions such as funding mandates, policy reforms, and publishing prerequisites,3 implementation into clinical practice is lagging behind. Previous reviews from Canada, the US, and Australia have shown the limited attention to sex/gender in national guidelines.456 Sex and gender were either not systematically mentioned in recommendations or used interchangeably—for example, by using “gender” when considering biological sex. Incorrect use of terminology can reduce the target specificity of healthcare interventions, ultimately disadvantaging already underserved populations.7 Furthermore, a lack of adequate inclusion of female participants …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tax hikes on general practices would deepen GP unemployment \"crisis,\" warns outgoing college chair.","authors":"Ella Hubbard","doi":"10.1136/bmj.r2143","DOIUrl":"https://doi.org/10.1136/bmj.r2143","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"37 1","pages":"r2143"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaping misperceptions must be challenged","authors":"Sarah E Jackson, Hazel Cheeseman, Katherine East, Jamie Brown","doi":"10.1136/bmj.r2117","DOIUrl":"https://doi.org/10.1136/bmj.r2117","url":null,"abstract":"Mahase reports on the increasing number of people in England who smoke both cigarettes and e-cigarettes (vapes).1 Despite substantial evidence that vaping exposes users to much lower levels of toxicants than smoking,2 most adults in Britain who smoke think that vaping is equally or more harmful.34 This widespread misperception is not just an issue of misinformation—it has important implications for public health. Evidence indicates that it can prevent people from switching completely from smoking to …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective regulation of technology in women’s health and healthcare","authors":"Sara Raza, Sara Gerke, Eric Bressman, Carmel Shachar","doi":"10.1136/bmj-2025-086300","DOIUrl":"https://doi.org/10.1136/bmj-2025-086300","url":null,"abstract":"Carmel Schachar and colleagues argue that femtech requires robust and stringent privacy and security safeguards because of the sensitivity of the data The rise of direct-to-consumer technologies has produced rapid expansion of women’s health innovation in a sector popularly known as femtech. Femtech encompasses a “range of technology-enabled, consumer-centric products and solutions” targeted at female health needs,1 including maternal health, menstrual health, pelvic and sexual health, menopause, contraception, and many other health conditions that disproportionately affect women.2 One example highlighting the promise of femtech is an at-home cervical cancer screening tool that showed comparable effectiveness to traditional clinic based testing.3 Use of the tool could bridge screening gaps and improve health outcomes for women. Other examples of femtech include wearables and mobile applications such as period and fertility trackers that monitor menstrual cycles, biometric data, ovulation, and related reproductive and sexual health data.4 The femtech industry has grown tremendously, reaching an estimated value of $60bn (£44bn; €51bn) in 20245 and projected to reach $103bn by 2030.6 This expansion reflects both unmet health needs and rising awareness about female specific conditions, but it also shows the urgent need for thoughtful regulation to ensure transparency, safety, and accountability. Social undercurrents and the broader political climate can make women’s health data (particularly reproductive or sexual health information) more vulnerable than other health data. Although femtech may not require separate regulation from other digital health technologies, heightened privacy and security protections are urgently needed for femtech data as well as steps to mitigate bias. Femtech is used worldwide, but access and experience differ for women in the global north and south. This article, part of the BMJ Collection on Women’s Health Innovation (bmj.com/collections/womens-health-innovation), focuses on the global north, partly because these jurisdictions have been leaders in the regulation …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When I use a word . . . On the origins of medical words","authors":"Jeffrey K Aronson","doi":"10.1136/bmj.r2145","DOIUrl":"https://doi.org/10.1136/bmj.r2145","url":null,"abstract":"In English medical vocabulary Greek words, Latin words, and hybrid combinations contribute about 76% of the total. In contrast, they contribute only about 40% of general vocabulary, the rest being largely derived from Old English and French. Furthermore, many fewer other languages contribute to medical than to general vocabulary. The development of English general vocabulary was influenced first by the Roman invasions between 55 BC and 43 AD, followed by over 360 years of Roman presence, and then later, after the Romans had left, by the arrival of St Augustine as Archbishop of Canterbury in 597 AD, bringing Latin from Rome. The arrival of Angles, Saxons, and Jutes, at the end of the 6th century AD, brought Anglo-Saxon or Old English into the general mix, and the Norman conquest in 1066 added Old French. In contrast, the domination of Greek and Latin in medical vocabulary was partly due to the influence of Greek science, mathematics, and philosophy and partly due to the fact that many Latin words derived directly from Greek. Studying classical languages exposes us to classical thought in both sciences and humanities. It teaches us about history. It helps us in acquiring a rich English vocabulary and understanding how our language is constructed. It trains us in logic and systematic thinking. Its rich and highly entertaining literature and mythology is much better read in the original than in translation. Furthermore, having read it we are better equipped to understand the classical allusions that occur in later authors. I have previously commented on a strapline, published under the heading of a recent article in the online version of The Time s newspaper titled “How to become a doctor—a step-by-step guide by those who’ve done it.”1 It began “The entry criteria is tough and the course even tougher ....” …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"338 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"South African Medical Association severs ties with Israeli counterpart and calls for wider shunning of the group.","authors":"Kate Bowie","doi":"10.1136/bmj.r2129","DOIUrl":"https://doi.org/10.1136/bmj.r2129","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"85 1","pages":"r2129"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"John Goldsmith: refugee from Nazi Germany who became a pioneer of kidney dialysis","authors":"Jon Goldsmith","doi":"10.1136/bmj.r2122","DOIUrl":"https://doi.org/10.1136/bmj.r2122","url":null,"abstract":"John Goldsmith overcame a tumultuous childhood and adolescence, first as a refugee from Nazi Germany and later as an interned “enemy alien,” to become an early pioneer in kidney dialysis, setting up the UK’s second home dialysis service. He was born Hans Goldschmidt in 1924 in Oberkassel near Düsseldorf, Germany, to Jewish parents. His mother, Malli, was a dentist, and his father, Hermann, a grain importer. His parents divorced and he moved with his mother to Düsseldorf in 1928. Malli married a Jewish dentist and Hans enjoyed a happy childhood until 1933 when his stepfather, Alfred, was kidnapped and murdered by a rival dentist and Nazi party member. Hans and his mother fled to his uncle in Amsterdam, where Hans went to school and learnt Dutch, while Malli was forced to find work in Brussels. Here she met a woman from the Cambridge Refugee Committee who found dental work for her in Cambridge and secured Goldsmith, who spoke no English at that point, a place at the Methodist Leys School at a reduced fee. After they arrived in England in 1938 Malli worked hard to help friends and family get out of Germany, although many were unable to escape and were killed in the Holocaust. On his 16th birthday in 1940 Goldsmith (now known as John) was at school writing an English essay when …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lived experience must be properly recognised","authors":"Araya Gautam, Sanath Johnson","doi":"10.1136/bmj.r2089","DOIUrl":"https://doi.org/10.1136/bmj.r2089","url":null,"abstract":"As a patient and public involvement contributor and a woman of colour, I (AG) have been part of various research panels over the past couple of years. I welcome Walker and colleagues’ call to acknowledge lived experience as expertise.1 But being “included” in the room does not always translate to being heard, especially for people of colour or marginalised contributors. We are often invited into projects that lack emotional …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}