Neimark cites estimates that the first 14 days of the Iran war produced more than five million tonnes of carbon dioxide, exceeding Iceland’s total climate pollution in 2024. He also cites an estimate of almost 311 million tonnes released during five years of war in Ukraine, described as equivalent to France’s annual emissions. For Gaza, the commentary reports that carbon emissions during the first 15 months of the conflict exceeded 30 million tonnes. Neimark compares that quantity with the amount of carbon absorbed by 33 million acres of forests in one year. These figures are estimates presented in the commentary to illustrate the potential scale of emissions associated with recent conflicts.

The emissions considered by Neimark have both direct and indirect sources. Direct emissions include fossil fuels burned by fighter jets, cargo planes, tanks and naval ships. Indirect emissions can arise from activities such as powering military bases, making weapons, deploying troops and reconstruction after conflicts. Since the 2015 Paris agreement, military reporting of conflict-related emissions has been voluntary. As a result, researchers must conduct their own assessments of how much carbon was emitted during a conflict. Neimark argues that governments should establish mandates requiring militaries to report emissions during both peacetime and active conflict, creating a more consistent basis for evaluating the military sector’s climate footprint.

The proposal is presented against a developing legal framework. In 2025, the International Court of Justice issued an advisory opinion affirming that governments have legal responsibilities to protect the climate system, prevent harm to the best of their abilities and cooperate internationally. The commentary notes that the opinion did not directly address military emissions, but a supplementary declaration said state obligations include responsibility to address impacts resulting from armed conflict and other military activities. Several climate cases have subsequently been brought against major polluters in domestic and international courts, but Neimark says that no legal action had been taken against militaries specifically for climate-related emissions.

Emissions data could provide evidence of conflict-related environmental costs in legal proceedings, help set targets for reductions and strengthen mechanisms for accountability, according to the commentary. Such data could also distinguish the economic consequences of war from its costs to people and the climate system on which they depend. Because the source is a commentary and not an empirical evaluation of a reporting policy, it does not demonstrate that mandatory reporting alone would reduce emissions or establish the result of any future court case. Its central claim is more limited: dependable emissions measurements are a necessary foundation for documenting the climate effects of military activity, identifying responsibility and setting reduction targets.

Subject of Research: Measurement and legal accountability for greenhouse gas emissions from military activity and armed conflict

Article Title: Data vital in holding militaries accountable for the environmental toll of war

Article References: Data vital in holding militaries accountable for the environmental toll of war. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

DOI: Not provided

Keywords: military emissions, armed conflict, greenhouse gases, carbon dioxide, climate accountability, emissions reporting, The BMJ, Paris Agreement, International Court of Justice, Data, vital, holding

The scale of the market illustrates how quickly this sector has grown. In 2024, the UK testosterone replacement market was valued at around 205 million dollars, with projections suggesting it could reach 365 million dollars by 2032. Official NHS figures show that community dispensing of testosterone increased by 52 percent between 2020/21 and 2024/25. Alongside this, there was a ten-fold rise in testosterone gel prescriptions for women aged 50 and older in England between 2015 and 2022, reflecting growing off-label use of the hormone for menopausal symptoms.

One of the central problems, the authors explain, is that private prescriptions are not recorded in any national system, so the true scale of private testosterone provision is unknown. Nevertheless, several indicators point to rapid growth. There has been a proliferation of private and online clinics offering testosterone services, many built around subscription pricing models ranging from 100 to 375 pounds a month. These subscriptions typically cover ongoing monitoring, remote consultations, and home-delivered medication. Heavy marketing through social media platforms, influencers, and outdoor advertising has amplified demand, targeting men who may simply be experiencing the natural effects of ageing.

The potential market is substantial. Declining testosterone levels and reduced libido are natural aspects of ageing, and up to a fifth of men over 50 may report symptoms consistent with deficiency. Yet fewer than 1 percent of these men receive treatment through the NHS, where prescribing is reserved for those with confirmed clinical need. This gap between symptom prevalence and NHS treatment rates represents the commercial opportunity that private providers are increasingly moving to fill, often with diagnostic and monitoring standards that differ from those applied in conventional medical practice.

Diagnosing genuine testosterone deficiency is not a simple matter. It requires time, careful clinical assessment, and repeated testing to confirm consistently low levels alongside characteristic symptoms. The authors note that it is not established how consistently private providers follow this rigorous process. They warn that rapid-access subscription models built around marketing to non-specific symptoms are unsuitable to handle the complexity of the diagnostic process, and that such models risk unnecessary lifelong treatment and a resulting NHS monitoring burden. Fatigue, low mood, and reduced libido, the symptoms most commonly marketed in advertising campaigns, can have many causes and do not by themselves justify hormone replacement.

Another layer of complexity arises from the absence of a single unified standard for treatment. For testosterone therapy in men, clinicians rely on professional society guidance that uses differing thresholds for diagnosis and treatment initiation. This inconsistency means that NHS clinicians may encounter patients who have already started taking testosterone prescribed against a more permissive private threshold, creating difficult decisions about whether to continue, adjust, or withdraw treatment that was initiated outside NHS pathways. The lack of harmonised criteria complicates continuity of care and makes it harder to evaluate whether individual patients are receiving appropriate therapy.

The long-term risks of testosterone therapy add further weight to these concerns. Treatment can be associated with heart and kidney problems that require ongoing monitoring, and the authors argue that this follow-up work will likely fall to the NHS regardless of where treatment began. There are also growing concerns about private off-label testosterone prescribing for women, mainly for low libido associated with menopause. While testosterone can be a valuable treatment for carefully selected patients of both sexes, the expansion of commercial prescribing raises questions about whether selection criteria and safety monitoring are being applied consistently across the private sector.

Responsibility for care is another flashpoint. As stated in official guidance, the responsibility of care rests exclusively with any private sector clinician who initiates treatment, unless an NHS GP formally agrees to a shared care arrangement. In practice, however, patients who started treatment privately may return to their GP informally for blood tests or help with managing side effects. This informal transfer creates a situation in which the NHS absorbs the workload without any formal agreement, shouldering the clinical and administrative consequences of prescribing decisions made elsewhere. GPs are left managing the downstream effects of treatment they did not initiate, often without complete records of dosing, monitoring history, or the original diagnostic rationale.

The authors stress that testosterone replacement remains a valuable treatment for carefully selected patients, and their criticism is not of the therapy itself but of the commercial structures growing around it. They call for national data to close the evidence gap on private prescribing of testosterone, arguing that without systematic information, neither regulators nor the NHS can accurately assess the scale of the issue or its impact on patient safety and health service resources. Reliable data would allow policymakers to distinguish between appropriate private provision and practices that generate avoidable harm.

To address the gap, Atkin and Kilpatrick propose a concrete solution. A reporting framework for private prescribers and dispensing pharmacies could capture indications, patient numbers, monitoring, and transfers of care, they write. Such a framework would lead to transparent prescribing and demonstrable adherence to evidence-based care, protecting patients while preserving access to effective treatment. As the private testosterone market continues its projected growth toward 365 million dollars by 2032, the authors argue that establishing robust oversight now, before the sector expands further, is essential to prevent a widening divide between commercial incentives and clinical standards, and to ensure the NHS is not left carrying the consequences of a trade it neither authorised nor recorded.

Subject of Research: Commercial and private testosterone prescribing in the UK and its implications for the NHS

Article Title: Rise in private testosterone prescribing risks overtreatment and more strain on the NHS

Article References: Rise in private testosterone prescribing risks overtreatment and more strain on the NHS. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: testosterone, testosterone replacement therapy, private prescribing, NHS, The BMJ, hypogonadism, menopause, off-label prescribing, health policy, patient safety, hormone therapy, UK healthcare

The researchers examined two of the most prominent post-hoc evaluations of national Covid-19 responses, published between 2022 and 2024 by two leading medical journals: The Lancet and The BMJ. The Lancet Commission on lessons for the future from the Covid-19 pandemic, released in 2022, provided a comprehensive analysis of government responses and recommendations for future pandemics. The BMJ published three separate series—one informing the United Kingdom’s Covid-19 Inquiry, one on accountability for Canada’s response, and one on lessons for future health protection and preparedness in the United States—comprising 25 analyses, opinions, and editorials. These journals played a critical role in shaping global policymaking during the pandemic, publishing some of the most important studies on Covid-19 and evaluating the effectiveness of non-pharmaceutical interventions such as mask mandates and lockdowns.

What the team found was striking. Across all 25 articles in the three BMJ series, references to the harms of public health interventions accounted for less than 1 percent of the total content. In the Canadian series, only one article out of seven mentioned harm at all, and just two sentences—38 words out of 13,033 total words, or 0.29 percent of the text—addressed the issue. In the US series, four sentences in the series editorial indirectly described harms, representing 101 words out of 16,299 total words, or 0.62 percent. The UK series fared marginally better, with nine sentences totaling 207 words out of 25,003 words, or 0.83 percent. None of the BMJ articles incorporated any form of cost-benefit analysis. The Lancet Commission mentioned harms in a few sections—briefly noting effects on marginalized individuals, the poor, displaced children, and refugees—but did not discuss them systematically, made only a minor and cursory reference to policy trade-offs, and failed to incorporate them into its recommendations.

The authors argue that this omission is both surprising and consequential. The field of harm-benefit analysis is well established in public health, and the notion that interventions involve trade-offs between benefits and harms should be uncontroversial. Cost-benefit analysis is routinely employed in other fields—environmental, consumer, and financial regulation—areas that also impact the well-being of large populations. Yet public health scholars have largely avoided applying a benefit-harm framework to Covid, partly for moral reasons: such analysis often involves assigning a monetary value to life. The authors contend that this natural reluctance, while understandable, impedes sound policy analysis in a world of limited resources, and that acknowledging that interventions can cause harms—even if inadvertent—is essential for restoring trust in public health authorities.

The harms of pandemic interventions were real and increasingly documented. Lockdowns disadvantaged low-income populations and young people. Social isolation measures harmed those struggling with addiction and mental health disorders. School closures hurt children and their families, with evidence from the United States showing substantial learning losses associated with remote and hybrid schooling, with larger declines in districts serving more Black students and effects that may be long lasting. A comprehensive framework has recently been published identifying the range of harms of non-pharmaceutical interventions and reviewing their magnitude. Another framework focused on health inequalities shows that several interventions not only perpetuated and exacerbated pre-existing inequities but also created new ones. Policies designed to improve public health can disproportionately harm disadvantaged populations, contributing to unequal socio-economic outcomes.

Ignoring these harms and trade-offs, the authors argue, erodes public trust in health authorities. The history of epidemics teaches that overly paternalistic interventions can lead to conflict and mistrust. As historian of epidemics David Jones noted, epidemic responses such as quarantine or compulsory vaccination generally involve people with power and privilege imposing interventions on people without power or privilege—a dynamic that fuels social conflict. Trust is critical in public health because it facilitates consent, a necessary condition for widespread adoption of measures such as immunization programs. Lack of trust increases non-compliance and vocal opposition to health authorities. The erosion of trust may already be visible: in the United States and parts of Canada, routine childhood vaccination requirements are increasingly challenged, exemptions are rising, and outbreaks of preventable diseases such as measles have re-emerged.

The global dimension of this blind spot is particularly severe. Data from the World Bank and UN agencies showed that over 400 million people fell below their national poverty line in 2022, with low-income countries experiencing a disproportionate share of the drop. UNICEF estimates a 13 percent global increase in learning poverty—the share of children who cannot read a simple text with comprehension by age 10—disproportionately higher in low- and middle-income countries, essentially erasing all educational gains since 2000 and estimated to cost the current generation of students $21 trillion in lost earning potential. Millions of children missed essential vaccines, with nearly four million more unvaccinated children than in 2019. Country-level evidence illustrates the severity: in Uganda, lockdowns were associated with disruptions to family stability, housing, schooling, food security, and increased gender-based violence and child labour. In Angola, where 77 percent of the population worked in the informal economy, unemployment in September 2020 was 34 percent higher than in 2019, and a survey of informal-sector operators in Luanda found that 95.8 percent reported significant or marginal reductions in income. In India, the March 2020 nationwide lockdown abruptly disrupted migrant workers’ livelihoods, prompting large numbers to return to their home states.

To explain why these assessments failed, the authors draw on the disproportionate policy response literature from political science, which holds that governments can either over-react or under-react to situations requiring a policy response. Over-reaction occurs when a policy’s net cost exceeds its benefit—when the scale, stringency, or breadth of intervention is disproportionate to the problem. Under-reaction occurs when a policy’s net benefit is lower than the relevant status-quo counterfactual—when action is weaker or narrower than warranted by the risk. The BMJ and Lancet inquiries focused almost entirely on the under-reaction perspective, highlighting failures to act while largely ignoring the possibility of over-reaction. This narrow framing, the authors argue, prevents a thorough investigation of trade-offs and leaves policymakers with a flawed toolkit for future emergencies.

Recent scholarship offers explanations for why over-reaction may have occurred. National committees advising governments were dominated by public health officials who lacked the expertise to evaluate the costs of non-pharmaceutical interventions and had little inclination to do so. As Francis Collins, a member of the White House Coronavirus Task Force, commented, decision-makers attached infinite value to stopping the disease and saving a life, and zero value to whether measures actually disrupted people’s lives, ruined the economy, and kept children out of school. The media focused too heavily on disease spread and deaths rather than the costs of prevention measures. Academics willing to investigate trade-offs often found themselves subjected to invective, character attacks, and reputational damage. Political science literature also identifies conditions favoring major policy change: high issue salience, especially during crises when the public feels anxious and vulnerable, and a low number of veto players—during the pandemic, major decisions were taken almost exclusively by executive branches insulated from meaningful oversight by other government bodies.

The authors conclude that accountability inquiries must assess the harms as well as the benefits of public health interventions and weigh them against each other—something that, so far, has not been done. The need to address trade-offs should be made explicit in the terms of reference of any inquiry, and invitees to hearings should reflect a broad range of views, placing pressure on committee members to consider the appropriate balance in their recommendations. Diversity of thought, free from ideological bias, is key to assessing the adequacy of government responses. Low-income countries, which often have younger populations at lower risk of serious harm from Covid-19 and lack necessities like clean water and food, may benefit from less restrictive approaches, and the most appropriate national policies are conditional on national demographic, social, and economic conditions. To improve public health outcomes, prevent the recurrence of policy mistakes, and restore trust in public health authorities, the authors argue that future pandemic preparedness must begin by acknowledging that interventions involve trade-offs—and by building the systematic evaluation of those trade-offs into decision-making from the start.

Subject of Research: Public Health Policy

Article Title: Incomplete Assessments: Including Harms and Trade-offs in Assessing Policy Approaches to Covid-19

Article References: Bavli, I., Sutton, B., Bardosh, K., & Galea, S. (2026). Incomplete Assessments: Including Harms and Trade-offs in Assessing Policy Approaches to Covid-19. SSM – Population Health, Article 101983. https://doi.org/10.1016/j.ssmph.2026.101983

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101983

Keywords: Covid-19, public health, policy trade-offs, harm-benefit analysis, lockdowns, school closures, The Lancet, The BMJ, public trust, health inequities, low-income countries, disproportionate policy response

England’s genomic diagnostics are coordinated through seven NHS Genomics Laboratory Hubs, or GLHs, each responsible for clinical genomics services in its region, including genetic testing, molecular diagnosis, treatment planning, and counselling for families affected by inherited conditions. Since 2024, these hubs have been required under guidance from the Association for Clinical Genomic Science, the professional body representing clinical genomics scientists in the United Kingdom, to submit the variants they identify to public databases such as ClinVar. That guidance is explicit about why the obligation matters: prompt and accurate molecular diagnosis is crucial for targeting treatment and optimising patient care, and it is therefore described as the professional responsibility of the clinical genomics community to ensure that data is shared appropriately and responsibly.

ClinVar, maintained by the US National Center for Biotechnology Information, functions as a shared clinical evidence base for variant interpretation. When a laboratory identifies a change in a patient’s DNA, the clinical significance of that change, whether it is pathogenic, benign, or of uncertain significance, depends on the accumulated evidence from every patient in whom it has previously been observed. Each new submission strengthens the collective ability to interpret variants accurately, supports the reclassification of variants as knowledge evolves, and feeds directly into research on rare disease. When laboratories withhold their findings from this shared pool, they create structural blind spots that selectively limit the evidence available to every other diagnostic service, clinician, and researcher who depends on it.

The freedom of information responses indicate that three of the seven hubs, the South East hub led by Guy’s and St Thomas’ NHS Foundation Trust, the South West hub led by North Bristol NHS Trust, and the North East and Yorkshire hub led by The Newcastle upon Tyne Hospitals NHS Foundation Trust, are not routinely submitting variants to ClinVar. The laboratories point to good intentions and say they lack the necessary staff and technology to meet the requirement, adding that they intend to implement it as soon as possible. Even among the four hubs that are routinely submitting, the investigation found significant backlogs of variants that remain unsubmitted, along with inconsistencies and gaps in what has been shared.

For families affected by rare genetic conditions, the consequences of this fragmented data landscape are not abstract. Sophie Muir, whose son’s variant in the CACNA1C gene, associated with a severe multisystem disorder, was not picked up through NHS testing, describes the effect of inconsistent submission practices on the diagnostic pathway. ClinVar, she explains, functions as the shared clinical evidence base on which variant interpretation depends, and uneven participation creates blind spots that selectively limit the evidence available for rare disease diagnosis, variant reclassification, and research. Muir, who chairs the rare disease charity the Timothy Syndrome Alliance, argues that the failure amounts to a betrayal of the public investment in genomic medicine.

Other clinicians and researchers echo that concern. Jack Underwood, a forensic psychiatry registrar, observes that there is a loop that is broken when variants are not submitted to ClinVar, a reference to the feedback cycle through which each diagnosed patient’s data helps interpret the next. Professor John Sayer, an expert in rare inherited kidney diseases, is more direct, warning that patients ultimately are missing out because this is not happening. In a field where a single confirmed molecular diagnosis can end a diagnostic odyssey lasting years or even decades, and where treatment decisions, surveillance regimes, and family planning all hinge on accurate variant interpretation, the absence of shared evidence translates directly into prolonged uncertainty and delayed care.

The laboratories themselves cite practical constraints as the principal reason for the delay. Staffing was the issue most frequently mentioned in the freedom of information responses, reflecting the chronic workforce pressures that have affected NHS laboratory services across the board. Some hubs also blamed the time taken to develop the policies needed to govern submission, alongside technology and infrastructure issues that complicate the extraction and formatting of variant data for external databases. Those hubs that have not yet implemented routine ClinVar submissions say they plan to do so this year, suggesting that the gap, while significant, may be transitional rather than permanent.

Yet the explanations have done little to reassure critics who see the problem as symptomatic of something larger. Clare Turnbull, Professor of Cancer Genetics at the Institute of Cancer Research in London, frames the delay in variant sharing as part of a wider issue of lagging NHS information technology systems hobbling progress and innovation in genomic medicine. The United Kingdom invested heavily in the 100,000 Genomes Project and built the NHS Genomic Medicine Service on the promise that publicly funded sequencing would generate a continuously improving knowledge base. When the laboratories at the sharp end of that service cannot feed their clinically interpreted findings back into shared databases, the value of that national investment is diminished for every patient who follows.

The question of stewardship is central to the criticism. Muir points out that the GLHs are generating clinically interpreted data within a publicly funded system, and that public funds are going in to pay for genetic testing that is then not being shared. Sayer agrees that variant sharing maximises the value of the public investment in genetic testing and adds a further ethical dimension: knowing someone’s genetics is privileged information, and if a patient has consented to their data being used for the greater good, then failing to allow that information to be shared betrays the patient’s trust. Consent, in other words, is being given on the understanding that participation in genomic medicine is collective, an understanding that the current submission failures undermine.

For Muir and families like hers, the stakes are measured in time that rare disease patients do not have. The diagnostic odyssey for a rare genetic condition frequently involves years of inconclusive tests, and every variant that sits unsubmitted in a laboratory backlog is evidence that could have shortened that journey for another child. We do not have time on our side, she says, noting that families, children, researchers, clinicians, patient advocacy organisations, and the life sciences sector all need this data. The BMJ investigation makes clear that the technical requirement to share variant data exists, that the professional guidance is unambiguous, and that the remaining obstacles are organisational rather than scientific. Whether the three non-compliant hubs deliver on their stated intention to implement routine submissions this year will determine whether England’s genomic medicine service can close a gap that, until now, has been quietly limiting the power of one of the most ambitious publicly funded healthcare data systems in the world.

Subject of Research: NHS genomic laboratories' inconsistent sharing of genetic variant data in public databases for rare disease diagnosis

Article Title: NHS labs fails to share data vital for diagnosis and care of rare diseases

Article References: NHS labs fails to share data vital for diagnosis and care of rare diseases. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: NHS, genomics, rare diseases, ClinVar, genetic variants, variant interpretation, Genomics Laboratory Hubs, The BMJ, data sharing, molecular diagnosis, patient advocacy, genetic testing

The scale of destruction documented in the editorial is stark. According to figures cited from the United Nations, Israeli airstrikes over the past three years have severely damaged or destroyed more than 90 percent of school buildings in Gaza, disrupting education for all 658,000 children in the territory. The British Society for Middle Eastern Studies, as referenced by the authors, reports that every university in Gaza has been destroyed and that more than 200 academics have been killed. These numbers, the editorial argues, represent something qualitatively different from the incidental collateral damage that accompanies most warfare. They describe a pattern in which the institutions that produce knowledge, train physicians and engineers, and transmit collective memory from one generation to the next are themselves targeted.

The authors are careful to define why scholasticide deserves its own category of concern. Beyond the immediate harm to individuals, the damage to buildings, and the interruption of lessons, they identify a systemic degradation with direct consequences for health and healthcare. Universities are not simply places of learning; they are the training grounds for the medical workforce, the research infrastructure for public health, and the institutional memory of a society. When universities and hospitals are destroyed, the editorial notes, it can take decades after fighting ceases to restore both the physical infrastructure and the trained staff who once populated it. A destroyed teaching hospital cannot produce the surgeons, nurses, and epidemiologists a recovering society needs, and a destroyed laboratory cannot monitor disease outbreaks or rebuild agricultural systems.

The consequences for children are equally profound and long-lasting. Interrupted education exposes young people to long-term learning loss, diminishes their future opportunities, and undermines the economic rebuilding that must follow any cessation of hostilities. A generation that misses years of schooling carries that deficit into adulthood, reducing earning potential, weakening civic institutions, and slowing the transfer of technical knowledge. The authors frame this as a form of harm that compounds over time: the longer education systems remain disrupted, the more difficult and expensive reconstruction becomes, and the deeper the scars on a society’s human capital.

At the heart of the editorial is a legal argument. International humanitarian law strictly prohibits attacks on civilian infrastructure for essential services, including schools and hospitals, the authors explain. These protections are not aspirational statements but binding obligations on parties to any conflict, codified in the Geneva Conventions and their additional protocols, which classify civilian objects as immune from attack and deliberate targeting of them as a violation amounting to a war crime. Yet the authors observe that such attacks have rarely been formally investigated or sanctioned. This gap between the letter of the law and its enforcement, they argue, weakens confidence in the universal rule of law and signals to belligerents that the destruction of educational institutions carries no meaningful cost.

The impunity problem, as the authors frame it, is therefore structural rather than incidental. When violations of international humanitarian law go uninvestigated, the deterrent effect of the law erodes. Perpetrators learn that condemnation is rhetorical and accountability is optional. The editorial insists that restoring the credibility of a law-based global order demands that perpetrators of scholasticide be held to account, and that this accountability must be visible, public, and consequential. Without it, the protections that nominally shield schools and hospitals in wartime become words on paper rather than constraints on conduct.

To close that gap, the authors advance a concrete set of demands directed at the international community. They call for the application of economic and trade sanctions against perpetrators of scholasticide, a measure designed to impose real material costs on states and armed groups that target education systems. They further call for the prosecution of the sale of arms that are likely to be used for violations of international humanitarian law, placing responsibility not only on those who fire the weapons but on the states and companies that supply them when the foreseeable use is unlawful. Arms transfer regimes under international law already require exporting states to assess the risk that weapons will be used in serious violations, and the authors argue that this obligation should be enforced with respect to attacks on schools and universities.

Beyond governments, the editorial addresses universities, professional bodies, and civil society worldwide. The authors urge these institutions to consider adopting boycott and divestment policies until compliance with international law is assured. This appeal situates academic and professional communities as actors with leverage of their own: research partnerships, institutional investments, and professional collaborations can be conditioned on respect for the legal protections that education systems enjoy in wartime. The authors themselves embody this engagement; the declared interests accompanying the editorial note that Dr Dajani co-runs the Palestine Scholars project to commemorate killed academics in Gaza, while the other co-authors declare no competing interests, and The BMJ judged that there were no disqualifying financial ties to commercial companies.

The editorial’s central claim is distilled in the authors’ own words: Education sustains a society’s knowledge production and its collective identity and memory. It is essential to health and healthcare. Scholasticide is a war crime that must end. Restoring human capital, scientific capacity, and institutional continuity are vital. And law based global order demands that perpetrators be held to account. The statement links the fate of education to the fate of medicine and science directly. Medical research and training depend on universities, laboratories, and teaching hospitals; when those institutions are destroyed, the pipeline of clinicians and researchers dries up for a generation, and the health consequences of war are extended decades beyond the ceasefire.

Published as a commentary in The BMJ on 9 September 2026, the editorial arrives at a moment when the documented destruction of educational infrastructure in multiple conflicts has made the question of enforcement impossible to ignore. Its authors do not claim that condemnation alone will stop the attacks; rather, they argue that the combination of public condemnation, sanctions, arms trade accountability, and institutional pressure from the academic and professional world can begin to restore the deterrence that international humanitarian law is meant to provide. The message to the international community is unambiguous: the protection of schools and universities in war is not a humanitarian luxury but a legal obligation, and the era of impunity for those who violate it should come to an end.

Subject of Research: Deliberate attacks on education systems in armed conflict and accountability under international humanitarian law

Article Title: End impunity for targeted attacks on schools and universities, urge experts

Article References: End impunity for targeted attacks on schools and universities, urge experts. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: scholasticide, The BMJ, international humanitarian law, war crimes, Gaza, education in conflict, academic freedom, accountability, arms trade, university destruction, children's education, Rana Dajani

HPV is one of the most common sexually transmitted infections worldwide, and most sexually active people will acquire at least one genital HPV infection at some point in their lives. While many infections clear spontaneously without consequence, persistent infection with high-risk types can drive the development of cervical lesions and, ultimately, cervical cancer. The quadrivalent vaccine used in the Swedish study targets four HPV types, including types 16 and 18, which are together responsible for roughly seventy percent of all cervical cancer cases. Since vaccination programmes began rolling out in the mid-2000s, countries with high coverage have documented steep declines in vaccine-type infections, genital warts, and precancerous cervical lesions, providing the epidemiological foundation for the vaccine’s cancer-prevention credentials.

What has become increasingly clear in recent years, however, is that HPV infection may matter for pregnancy as well as for cancer. A growing body of evidence indicates that HPV infection itself, and the clinical procedures used to treat cervical lesions caused by the virus, are linked to an increased risk of pregnancy complications. Treatments such as excisional procedures on the cervix can compromise its structural integrity, a recognised contributor to preterm birth and preterm prelabor rupture of membranes. Direct viral effects on placental and fetal tissues have also been proposed as possible mechanisms. Preventing HPV infection in the first place, the reasoning goes, could therefore reduce the downstream cascade of treatments and complications that jeopardise pregnancy.

To test this hypothesis at scale, researchers in Sweden turned to the country’s nationwide health registers, which link individual-level records across vaccination programmes, antenatal care, and birth outcomes. Their study took the form of a population-based case-control analysis nested within a cohort of 624,713 singleton, first-time births among women aged 16 to 35 years in Sweden between 2006 and 2023. Of these women, 92,620, or about fifteen percent, had received the quadrivalent HPV vaccine before pregnancy. Cases were defined as women who experienced at least one adverse pregnancy outcome, spanning preterm birth before 37 weeks, very preterm birth between 28 and 31 weeks, preterm or prelabor rupture of membranes, delivery of a small or severely small baby, stillbirth, or newborn death.

Each case was matched with up to ten control women of the same age and year of conception, a design that helps control for calendar-time effects such as changing vaccination coverage and evolving clinical practice. The researchers then adjusted for a wide range of potentially confounding factors, including self-reported cigarette smoking and body mass index at the first antenatal visit, maternal diagnoses and use of assisted reproduction, the mother’s country of birth, and family income and education level. These socioeconomic and behavioural variables are critical in this field, because vaccination uptake and pregnancy outcomes are both patterned by social factors, and failure to account for them can generate spurious associations in either direction.

After these adjustments, quadrivalent HPV vaccination before pregnancy was associated with lower odds of all the adverse pregnancy outcomes included in the analysis compared with no vaccination. Statistically significant associations were observed specifically for preterm and very preterm birth, spontaneous preterm birth, preterm prelabor rupture of membranes, and delivery of a severely small baby. Notably, the risk reduction was generally more pronounced among women who had been vaccinated before the age of seventeen, a pattern consistent with the idea that vaccination is most protective when it prevents infection before first exposure to the virus. The same age gradient has been observed in cancer-prevention studies, where younger vaccination correlates with higher seroconversion rates and greater reductions in cervical lesions.

The biological plausibility of these findings rests on several mechanisms. By preventing persistent cervical HPV infection, vaccination may reduce the incidence of high-grade cervical lesions and, with them, the need for excisional treatments that weaken the cervix during pregnancy. There is also emerging interest in whether HPV infection can affect the intrauterine environment more directly, with viral particles or the inflammatory responses they provoke potentially influencing placental function and fetal growth. While the Swedish study did not dissect these clinical pathways in detail, its authors acknowledge that the underlying mechanisms warrant further investigation. What the study establishes is a robust population-level association that is consistent with these mechanistic hypotheses.

As with any observational study, no firm conclusions about cause and effect can be drawn, and the researchers are careful to note the limitations. Information on spontaneous abortions was incomplete, and the underlying clinical pathways linking vaccination to better outcomes were not extensively examined. The authors also cannot rule out the possibility that other unmeasured factors may have influenced the results, a persistent challenge in studies comparing vaccinated and unvaccinated populations. Nevertheless, they argue that the study’s scale, its foundation in high-quality national register data, its long follow-up period in a real-world setting, and its case-control design minimised bias and misclassification, enabling assessment of both common and rare adverse pregnancy outcomes. Results remained similar across further sensitivity analyses, suggesting the findings are robust.

The researchers place their results in the context of the accumulating safety literature on HPV vaccination in pregnancy. Although vaccination is not routinely recommended during pregnancy, inadvertent exposure has occurred in large numbers of women through vaccination programmes and surveillance studies, and this body of evidence has found no signal of harm to pregnancy outcomes. Against that backdrop, the new findings shift the framing: rather than merely being safe with respect to pregnancy, HPV vaccination may actively confer additional benefits by reducing the risk of adverse events. The authors state that, together with previous research showing the safety of HPV vaccination during pregnancy, their results suggest the vaccine is not only safe but may also protect against adverse pregnancy outcomes.

Taken together, the evidence strengthens the case for the global strategy of HPV vaccination and its continued implementation in routine immunisation programmes, the researchers conclude. For public health policymakers, the study adds a pregnancy-outcomes dimension to a benefit calculus already dominated by cancer prevention, potentially strengthening the economic and clinical argument for vaccinating children and adolescents at the youngest recommended ages. For clinicians counselling patients, the message is that timely HPV vaccination may offer protection that reaches into reproductive health years later. As national immunisation schedules continue to expand and newer vaccines extend coverage to additional HPV types, studies of this kind will be essential for quantifying the full spectrum of benefits that population-level HPV control can deliver, from the cervix to the delivery room.

Subject of Research: Association between pre-pregnancy quadrivalent HPV vaccination and adverse pregnancy outcomes

Article Title: HPV vaccination before pregnancy linked to lower risk of preterm birth and other major complications

Article References: HPV vaccination before pregnancy linked to lower risk of preterm birth and other major complications. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: HPV vaccination, preterm birth, pregnancy complications, quadrivalent vaccine, cervical cancer, The BMJ, Swedish registers, case-control study, prelabor rupture of membranes, fetal growth restriction, immunisation programmes, observational study

The scale of the investment at stake is considerable. Robotic surgery systems for joint replacement typically cost around one million pounds in upfront capital expenditure, with an additional estimated one thousand to two thousand five hundred pounds per patient in procedural costs. For a health service performing hundreds of thousands of hip and knee replacements each year, the difference between adopting robotics widely and continuing with conventional techniques represents a financial commitment running into billions of pounds. Against that backdrop, the researchers behind the new studies argue that their results highlight the importance of careful evaluation of robotic technology in publicly funded healthcare systems, given the substantially higher capital and procedural costs involved compared with established surgical methods.

Robotic-assisted joint replacement involves surgeons using computer-controlled robotic arms and high-definition camera systems to assist them during complex procedures. The technology is designed to help plan and execute bone cuts and implant positioning with a precision that exceeds what can be achieved freehand, and earlier studies have consistently shown that robotic assistance does improve the accuracy of implant placement. Better alignment and positioning have long been considered plausible routes to longer-lasting implants, since malpositioned components can wear unevenly, loosen, or destabilise a joint over time. If more precise surgery translated into fewer failed implants, the economics of robotics could eventually prove favourable even at a high initial price. What has remained unclear, however, is whether that theoretical chain of benefit actually holds in clinical practice.

That uncertainty prompted the National Institute for Health and Care Excellence, the body that advises the NHS on which technologies represent value for money, to call for urgent research into the effect of robotic surgery on revision risk after joint replacement. Revision surgery, in which a failed or problematic implant is replaced with a new one, is more complex, more costly, and generally associated with worse outcomes for patients than the original operation. Any technology that reliably reduced revision rates would therefore carry substantial clinical and economic value. The new studies were designed to answer precisely this question using the most comprehensive source of joint replacement data available in the United Kingdom.

The research team analysed National Joint Registry records covering 666,283 total hip replacements, of which 656,080 were performed conventionally and 10,203 robotically, and 697,145 total or partial knee replacements, of which 675,034 were conventional and 22,111 robotic. All procedures took place between 2018 and 2024 in both public and private hospitals across the UK, making this the first big data study of robotic joint replacement conducted in the country. Because patients are not randomly assigned to robotic or conventional surgery, the researchers used a statistical technique known as propensity score matching to balance out underlying differences between the two groups, allowing more reliable comparisons to be drawn from observational data.

Propensity score matching works by pairing patients who underwent robotic surgery with statistically comparable patients who had conventional operations, matching on characteristics that could independently influence outcomes. In this analysis, the factors taken into account included age, sex, body mass index, underlying diagnosis, physical fitness, implant type, and surgeon volume. By constructing balanced comparison groups in this way, the method seeks to mimic the conditions of a randomised controlled trial, an approach known as target trial emulation. The researchers note that this is one of the most robust methods available for analysing observational data, providing vital insights to help commissioners plan care when randomised evidence is not yet available.

Having constructed their matched cohorts, the researchers compared a broad range of outcomes between the robotic and conventional groups, including implant survival, patient survival, the specific reasons for revision surgery, and complications occurring during the operations themselves. Patients were followed for an average of two and a half years after surgery. The results were striking in their uniformity: there were no differences in implant survival, no differences in overall or cause-specific revision risk, and no differences in intraoperative complications between the robotic and conventional hip replacement groups, and the same pattern held for knee replacements. Nor was there any difference in patient survival between the conventional and robotic hip replacement cohorts.

There was one notable exception to the otherwise null findings. Robotic surgery was associated with a lower risk of hip revisions that may be related to implant malpositioning than conventional surgery. This result is consistent with the established finding that robotic systems improve the accuracy of component placement, and it suggests that the technology may indeed reduce the specific subset of failures attributable to imperfect positioning. However, because malpositioning accounts for only a fraction of all revision procedures, this advantage was not large enough to produce a detectable difference in overall revision rates or implant survival across the matched groups during the follow-up period.

The authors are careful to spell out the limitations of their work. These are observational studies, so no firm conclusions can be drawn about cause and effect, and other unmeasured factors could have influenced the findings despite the rigor of the matching process. The average follow-up of two and a half years is also relatively short in the context of joint implants, which are expected to last fifteen to twenty years or more in many patients, and the researchers acknowledge that this limited follow-up period may mask longer-term outcomes that could yet diverge between the two surgical approaches. Questions about patient functional outcomes, such as pain, mobility, and quality of life after surgery, also remain open, and these will be addressed in due course by the ongoing RACER clinical trials.

Even so, the immediate implications for health policy are difficult to ignore. With the NHS planning a sevenfold expansion of robotic surgery by 2035, the new evidence provides the first large-scale national test of whether that investment is justified by improved outcomes, and the answer so far is that it is not, at least for the endpoints of implant survival, revision risk, and surgical complications. The researchers conclude that the results underscore the importance of careful evaluation of robotic technology in publicly funded healthcare systems, given the substantially higher capital and procedural costs involved. Until longer-term data or the RACER trials demonstrate benefits that conventional surgery cannot match, the case for widespread adoption of robotics in hip and knee replacement remains, on this evidence, unproven.

Subject of Research: Comparison of robotic-assisted versus conventional hip and knee replacement surgery using UK National Joint Registry data

Article Title: Robotic surgery offers no clear benefit over conventional joint replacement surgery

Article References: Robotic surgery offers no clear benefit over conventional joint replacement surgery. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: robotic surgery, hip replacement, knee replacement, joint replacement, National Joint Registry, The BMJ, NHS, revision surgery, implant survival, propensity score matching, health technology assessment, surgical outcomes

The core of the argument is deceptively simple: the scientific case for the central claims made by these products has not been made. Menstrual tracking apps promise to scientifically analyse personal data to improve health, wellbeing, and performance based on where a user is in her menstrual cycle. A companion practice, known as “cycle syncing,” encourages users to adjust their diet and exercise routines according to menstrual cycle phases. Yet Lee and colleagues argue that neither menstrual tracking nor cycle syncing has been convincingly shown to improve health or other performance measures. In other words, the foundational premise of a multibillion-dollar product category rests on evidence that the authors describe as lacking.

The sports science literature is central to their critique. Cycle syncing content frequently draws on the idea that athletic training should be matched to hormonal fluctuations, with harder sessions scheduled in certain phases and recovery prioritised in others. But decades of sports science research, the authors note, show no overall effect of menstrual cycle phase on performance, injury risk, or health. Where effects have been found, they have been trivial in magnitude and highly individualised, meaning they do not generalise into the phase-based training prescriptions that circulate widely online. Research on phase-based dietary interventions intended to reduce menstrual cycle symptoms or improve performance is similarly inconclusive, highly individualised, or speculative. The physiological variation between individuals, and even within the same individual across cycles, overwhelms the average differences that can be attributed to cycle phase.

There is also a deeper technical problem with the products themselves. Even if menstrual phase did correspond with meaningful fluctuations in health, performance, or vulnerability to injury in individuals, Lee and colleagues explain that simple digital tracking technologies cannot reliably predict such variation. Consumer apps typically rely on self-reported data, such as the start and end dates of bleeding, and infer cycle phases from calendar arithmetic rather than direct hormonal measurement. Unlike clinical tools that measure luteinising hormone, progesterone metabolites, or basal body temperature with validated protocols, most apps produce phase estimates with substantial uncertainty. Presenting those estimates to users as actionable scientific insight, the authors argue, misrepresents what the underlying data can actually support.

Beyond the weak evidence base, the commentary catalogues a set of serious risks that the authors say accompany digital cycle tracking technologies. These include wasted time and labour, as users invest effort in logging data and adjusting their lives around predictions of uncertain validity. They include unwanted surveillance, since menstrual data can reveal intimate information about fertility, pregnancy, and health status. They include risks to health data privacy, an area where consumer health apps in many jurisdictions face weaker regulatory protections than medical devices. And they include a subtler harm: these products may distract from, or even threaten, broader efforts to advance women’s health by redirecting attention and resources toward commercial tools of unproven value.

The authors are unusually direct about the stakes. “These apps have the potential for widespread impact on the wellbeing of women and girls,” they warn, yet the evidence that these digital tools can actually help in the management of menstrual conditions, boost health, and provide insights into exercise and nutritional needs is lacking. That combination, wide reach paired with thin evidence, is what elevates the issue from a niche debate about app design to a public health concern. Menstrual tracking is among the most common health-related uses of smartphone technology, and the audience for cycle syncing content on platforms such as social media skews young, meaning many users encounter these claims before they have the background to evaluate them.

The commentary does not stop at diagnosis; it offers a set of suggestions for addressing the risks. The authors call for strengthening protections for consumer and employee data, a pointed reference to the ways menstrual information collected by apps could be used by employers, insurers, or data brokers. They call for improving user awareness of how data are used, so that people who download a tracking app understand what happens to the intimate information they enter. And they advise clinicians to recommend apps to patients only when those apps meet stringent standards, effectively asking the medical profession to act as a gatekeeper against products that have not demonstrated clinical utility. Taken together, these measures would shift the burden of proof from users and regulators onto the companies making health claims.

Other voices in the field, the authors note, have emphasised the need to regulate misleading marketing and to resist the commercial co-option of feminist activist rhetoric. This critique addresses the way femtech products often frame themselves as empowerment, using the language of bodily autonomy and self-knowledge to sell subscription services. The authors also point to an opportunity in the communication landscape itself: tailoring health communication approaches to the social media environments where users actually encounter cycle syncing content. Meeting misleading narratives about hormones and health on the platforms where they spread, rather than in journals or clinics alone, may help build public trust in more credible sources and counteract inaccurate claims before they harden into beliefs.

The authors conclude that health practitioners, regulators, and the general public must be aware of, and work to address, the risks that these consumer technologies pose to women’s health. The commentary appears in The BMJ, with the article titled “Digital menstrual tracking risks creating more harm than benefit,” and is classified as a commentary or editorial drawing on the authors’ expertise across sports science, women’s health, and research on technology and the body. Its publication reflects a growing willingness among researchers to challenge the evidence base of consumer health products that have scaled faster than the science behind them.

For users, the practical message is one of calibrated scepticism rather than outright prohibition. Tracking one’s cycle for personal awareness is not inherently harmful, and menstrual health remains an under-researched field where better tools could genuinely help. The problem, as Lee and colleagues frame it, is the gap between what the technology can deliver and what its marketing promises: apps that cannot reliably predict hormonal variation are being sold as instruments of optimised performance and health insight. Until the evidence catches up, and until data protections and marketing standards are strengthened, the authors argue that the slick presentation of digital menstrual cycle tracking and the scientifically suspect practice of cycle syncing deserve not enthusiasm but scrutiny, and in some cases resistance.

Subject of Research: Evidence and risks of digital menstrual cycle tracking apps and cycle syncing practices

Article Title: Digital menstrual tracking risks creating more harm than benefit, argue experts

Article References: Digital menstrual tracking risks creating more harm than benefit, argue experts. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: menstrual tracking, femtech, cycle syncing, health apps, data privacy, women's health, sports science, The BMJ, digital health, surveillance, misleading marketing, consumer health technology

The mechanics of a prescribing cascade are deceptively simple, which is precisely what makes them so difficult to catch in busy clinical practice. Consider one of the clearest examples highlighted in the study: non-steroidal anti-inflammatory drugs, or NSAIDs, which are among the most widely used medications for pain relief in older populations. NSAIDs are known to raise blood pressure in many patients. When that rise occurs, it can easily be read as the emergence of hypertension, a genuine and serious condition in its own right, leading to a new prescription for antihypertensive medication. What gets lost in that transaction is the causal thread connecting the two drugs. The patient now takes two medications instead of one, carries the side-effect burden of both, and the underlying trigger, the NSAID itself, remains untouched. The cascade, once established, can continue to grow.

Older adults are especially vulnerable to this pattern for reasons that are both biological and structural. Advanced age typically brings multiple chronic conditions, and multiple conditions mean multiple prescribing physicians, multiple pharmacies and, frequently, a long list of concurrent medications. When a new symptom appears in a patient taking ten or twelve drugs, tracing it back to a specific medication started months earlier is a formidable task for even the most diligent clinician. The symptom is more likely to be attributed to aging, to one of the existing diagnoses, or to a genuinely new disease. Dr. Rochon, who holds the Barry J. Goldlist Chair in Aging and Health at Sinai Health and is a professor of medicine at the University of Toronto, emphasized that these sequences of events are common but often missed in clinical practice. Knowing what medications a patient is taking, when each one was started, and for what indication, she noted, is essential for identifying problematic cascades before they compound.

To move the problem from anecdote to evidence, the research team assembled an interdisciplinary, international group of collaborators and leaders in drug prescribing and geriatric medicine research spanning the United States, Belgium, Italy, Israel and Ireland. The Canadian side of the effort included Sinai Health researchers Drs. Vasily Giannakeas, Nathan Stall and Christina Reppas-Rindlisbacher, along with research staff Wei Wu and Joyce Li. Working with Lavina Matai and Zhiyin Li at ICES, Ontario’s health data institute, the team gained access to population-level prescription data covering the province, an unusually powerful foundation for studying how prescribing patterns unfold across millions of patients over time rather than within the confines of a single clinic or hospital.

The analytical framework rested on work the team had completed previously: with the expertise of twelve international panelists specializing in internal medicine, geriatric medicine and clinical pharmacology, the researchers had compiled a list of sixty-five potentially inappropriate prescribing cascades drawn from the medical literature and expert consensus. Each cascade on that list describes a first drug, a second drug prescribed in response to the first drug’s adverse effect, and a plausible biological mechanism linking the two. The Ontario study then subjected all sixty-five candidates to a rigorous population-level test built on three criteria. First, how common was the initial drug in the population? Second, how often was it actually followed by the second drug in real-world prescribing data? Third, how strong was the observed link between the two prescriptions?

That three-part analysis allowed the researchers to distill the field down to the twenty-four potentially inappropriate prescribing cascades that are both most commonly seen in the Ontario population and most likely to cause harm. The list spans a striking range of everyday therapeutics. Beyond the NSAID-to-blood-pressure-medication pathway, the study points to cascades involving statins, iron supplements and other widely dispensed drugs, illustrating that the risk is not confined to exotic or high-alert medications. It is embedded in the routine, well-intentioned prescribing that happens thousands of times a day across the province. Because the analysis was conducted at the level of an entire population rather than a selected cohort, the findings offer some of the strongest evidence yet that prescribing cascades are a systemic issue rather than a collection of individual clinical errors.

For Dr. Rochon, the findings illuminate a gap that opens quietly, one prescription at a time. Her concern, she explained, is that the conversations between prescribers and patients that would reveal these connections are so often missed, leaving both parties unaware that a sequence of events is unfolding and that the events are connected to one another. Closing that gap, the team argues, requires physicians to treat medication history as a living document that deserves attention at every visit, not merely a static list of current drugs. Clinicians need to ask why each medication was started in the first place, when it was initiated, and whether the newest prescription on the list is genuinely treating a new disease or simply patching over the side effect of an older one. That reflective pause, applied consistently, could interrupt a cascade before a second or third drug is ever added.

The findings carry particular weight for mature women, a population that sits at the center of Dr. Rochon’s research program. Women tend to live with more chronic conditions than men over their lifetimes, are prescribed more drug therapies, and experience more adverse drug events. Each additional medication increases the surface area for harm, and each additional condition complicates the diagnostic picture when a new symptom emerges. A woman managing osteoporosis, arthritis, cardiovascular risk factors and other conditions simultaneously faces a heightened probability that a drug’s side effect will be mistaken for a new diagnosis rather than traced back to its source. The study’s population-level lens makes clear that this is not a marginal concern but a structural feature of how care is delivered to older women, and one that deserves targeted attention in prescribing guidelines and clinical education alike.

The research team’s conclusions point toward concrete, technologically feasible next steps. The first involves automated clinical decision support tools embedded directly in electronic prescribing systems. Such tools could flag a potential prescribing cascade in real time, alerting the prescriber at the exact moment a new prescription is about to be added that the patient is already taking a drug known to produce the symptom now being treated. Delivered at the point of care, this kind of automated awareness could transform prescribing cascades from an invisible population-level phenomenon into a visible, actionable warning. The technology required is not speculative; the underlying data linkages and rule-based logic mirror systems already used to flag drug allergies and dangerous interactions.

The second proposed step is organizational rather than technical: optimizing the role of pharmacists as full members of the care team and integrating them more directly into the prescribing process alongside physicians. Pharmacists possess precisely the expertise needed to spot the signature of a prescribing cascade, a new drug whose start date closely follows an older drug with a known adverse-effect profile, and to initiate a medication review before the cascade deepens. Together, the two strategies address the problem from complementary angles, embedding vigilance in both the software that supports prescribing decisions and the professional relationships that surround them. As populations age and polypharmacy becomes the norm rather than the exception, the Ontario study suggests that the question is no longer whether prescribing cascades cause widespread harm, but how quickly health systems can build the safeguards needed to stop them.

Subject of Research: Potentially inappropriate prescribing cascades in older adults identified through population-level analysis of Ontario prescription data

Article Title: Ontario study identifies potentially harmful drug combinations prescribed to older adults

Article References: Ontario study identifies potentially harmful drug combinations prescribed to older adults. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: prescribing cascades, older adults, polypharmacy, medication safety, geriatric medicine, NSAIDs, blood pressure, statins, clinical decision support, pharmacists, mature women's health, The BMJ