Medicine and Science from The BMJ

David Strain, associate professor in cardiometabolic health and Chair of the BMA Board of Science, breaks down the BMA critique of the Cass review and its clinical implications. Benjamin Becker, professor of psychology and neuroscience, discusses accelerated transcranial magnetic stimulation research in childhood autism. They focus on evidence gaps, clinical uncertainty, trial design, safety and how brain-targeted approaches might be combined with behavioral training.

Sally Gainsbury, senior policy analyst at Nuffield Trust, and Karl Claxton, health economics professor at University of York, unpack the US–UK medicines trade deal. They discuss how the deal forces big NHS drug spending rises. They explain changes to NICE thresholds, rebates, and how costs may be shifted from services to pharmaceuticals.

A blockbuster MS drug undergoes FDA re-evaluation. We explore the story of Ocrelizumab, a treatment for primary progressive multiple sclerosis, following a patient petition that highlighted internal disagreements among agency reviewers regarding its efficacy. We look to Sweden, where new research involving sibling pairs separated by adoption investigates how early-life environments shape long-term health and social outcomes. Finally, we revisit the dominant medical narrative on Alzheimer’s disease. Why is it so difficult to move towards comprehensive treatments? Has the focus on amyloid plaques hindered our understanding of other critical factors like vascular health and social inequality? Peter Doshi is a senior editor at The BMJ and an associate professor of pharmaceutical health services research at the University of Maryland. Erik Peterson is an associate professor at the Karolinska Institute in Stockholm, specializing in psychiatric epidemiology and adoption studies. Carol Brayne is a professor emerita of public health medicine at the University of Cambridge and a leading expert in the epidemiology of dementia. Reading List: Multiple sclerosis: Could Roche's bestselling drug Ocrevus be doing more harm than good in women with primary progressive MS? Home environment conditions during childhood and psychosocial outcomes across three generations in Sweden: population based adoption-discordant sibling comparison study  

Matthew Herder, a global health law expert, and Fatima Hassan, a human rights lawyer focused on access to medicines, argue US policy now poses global health dangers. They discuss US withdrawal from WHO, funding cuts harming HIV and TB programs, rising health nationalism, vaccine hesitancy and weakened research institutions. They warn these political shifts have urgent international consequences.

Coming up in this week’s episode: The 15th Strike: As the latest six-day walkout by resident doctors in England concludes, the BMJ's news team examines the state of the ongoing dispute over pay and training places. Iain Beardsell, consultant in emergency medicine in Southampton explain why he thinks reintroducing compassion could be the key to tackling the systemic issues facing emergency departments And finally, The BMA announces major changes to how it represents doctors in private practice - we hear why they think the US has some better legislation around health insurance than the UK.   Reading list: Resident doctor strikes: Streeting demands to “meet with the organ grinders” as latest action ends The BMJ interviews Jack Fletcher  Make compassion visible in emergency medicine again BMA boosts support for private practice as NHS failings prompt more patients to pay for care

Zainab Hussain, a UK health journalist reporting on shisha availability and policy gaps, and Kate Jolly, a professor researching breastfeeding and maternal-child health. They discuss a trial of peer support for breastfeeding that found no major benefit. Then they examine the rise of shisha cafes, health risks, undercounting, cultural drivers, and regulatory gaps in UK law.

Kevin Fong, consultant anaesthetist and major-incident planner, reflects on Module Three of the UK Covid Inquiry. Alexandra Mullock, senior lecturer in medical law, and Danielle Griffiths, law academic on social justice, tackle the surge in invasive cosmetic procedures. They discuss staff experiences, moral injury, preparedness, regulation gaps, normalization of treatments, cross-border risks, and legal enforcement challenges.

Prashant Yadav, supply‑chain expert at the Council on Foreign Relations, explains how Gulf transport hubs and oil affect pharmaceutical logistics. Anny Huang, doctor and journalist, recounts Australia’s multi‑year IV fluid crisis and supplier concentration. Mark Dayan, Nuffield Trust policy analyst, analyses NHS procurement fragility and policy responses. They discuss transport disruptions, rerouting risks, stranded stock, and systemic supply‑chain vulnerabilities.

Nnena Osuji, consultant haematologist and NHS trust CEO, brings clinical and leadership insight. Kamila Hawthorne, former RCGP chair, speaks on general practice and continuity of care. Deborah Cohen, investigative journalist, explores how online platforms reshape health behaviours. They discuss health influencers, AI chatbots, access pressures, digital literacy, and how systems and clinicians shape trust and misinformation.

Dr Katie Bramall, Chair of the BMA’s General Practitioners Committee and practising GP, speaks passionately about the new NHS GP contract. She highlights uncapped online consultations and shifting referral duties back to general practice. She warns this could fracture continuity of care, strain GP–consultant relationships, and jeopardise workforce recruitment and local leadership.