Grant M A Wyper and colleagues highlight a discrepancy between the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 life expectancy estimates for the microstate of Monaco and locally published figures. We welcome engagement on small-population estimation and offer several clarifications.
Science Journals
I congratulate Steven J Frank and colleagues1 on the successful completion of their multi-institutional study comparing photons with protons for oropharyngeal squamous cell carcinoma, but many questions remain. One of the main differences between intensity-modulated (photon) radiation therapy (IMRT) and intensity-modulated proton therapy (IMPT) was the risk of grade 3 xerostomia, which is defined by Common Toxicity Criteria for Adverse Events (CTCAE) as dry mouth leading to the inability to adequately aliment orally, tube feeding or total parenteral nutrition indicated, or unstimulated salivary flow rate of less than 0·1 mL/min.
Trials of local therapies where progression-free survival is equivalent but overall survival is improved raise the spectre of confounding. The overall survival improvement seen in the phase 3 trial by Steven J Frank and colleagues1 of proton therapy for oropharyngeal cancer is likely an example of this issue. First, if proton therapy truly increased survival—given the crossover from photon to proton and barring extreme bias in the crossover population—the overall survival difference should be attenuated in the intention-to-treat versus per-protocol comparison, which is not demonstrated.
We thank David J Sher for the compliments on our phase 3 trial of intensity-modulated (photon) radiation therapy (IMRT) versus intensity-modulated proton therapy (IMPT) for oropharyngeal cancer.1 A key finding from the trial was that proton therapy de-intensified chemoradiation therapy, reducing the rates of high-grade toxicities and gastrostomy tube dependency to 40·2% in the IMRT group and 26·8% in the IMPT group. Sher expressed concern that the reported rate of severe xerostomia (45% IMPT and 33% IMRT) was higher than that in the RTOG 1016 trial,2 where 243 (61·5%) of 395 patients given IMRT and cisplatin required a gastrotomy tube.
Cefepime–nacubactam and aztreonam–nacubactam are potential treatment options for Gram-negative cUTI and acute uncomplicated pyelonephritis, including infections caused by antimicrobial-resistant strains.
Decisions around which vaccines to use are increasingly important in the context of Gavi's country vaccine budgets. Robust metrics that allow comparison between vaccines are thus essential to inform discussions. The vaccine impact ratios presented in this study can be used to complement other evidence to support effective planning and prioritisation in national immunisation programmes.
After a prolonged follow-up of 55 months, both ibrutinib-containing groups showed relevant improvements not only in failure-free survival—a modified form of progression-free survival—but also in overall survival. In contrast, the addition of ASCT to an ibrutinib-containing regimen had no supplementary benefit but increased toxicity. Induction treatment with ibrutinib and R-CHOP plus R-DHAP (or R-DHAOx), followed by 2 years of maintenance treatment with ibrutinib, should be considered as a new standard of care for younger patients with mantle cell lymphoma.
Brain inflammation secondary to encephalitis is an urgent global emergency and presents multiple opportunities to reduce current substantial morbidity and mortality. Aetiologies can be divided into infectious and autoimmune causes. In this Seminar, we highlight pragmatic clinical approaches to recognise and distinguish the most common pathogenic viruses and emerging range of autoantibodies encountered in routine practice. These pre-test impressions are judiciously shaped by valuable, simple investigations—particularly serum and cerebrospinal fluid nucleic acid and autoantibody testing—to identify the precise causative agent.
Polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS), is one of the commonest endocrine disorders in women of reproductive age, with a global prevalence of 7-12%,1 including gender diverse people with female sexual organs. However, up to 70% of those affected are undiagnosed,2 reflecting persistent gaps in awareness, recognition, and care.3 Given the diagnostic challenges and broader spectrum of symptoms associated with the condition, its name was recently changed from PCOS to PMOS after a 14 year consultation process.4Against the backdrop of systemic failures in the diagnosis and management of PMOS and longstanding concerns raised by stakeholders, the recent report from the all party parliamentary group inquiry into the diagnosis, management, and care of PMOS in the UK provides timely attention to these shortcomings.5 Published with endorsement from Verity, the UK’s national PMOS charity, the report arrives ahead of the National Institute for Health and Care Excellence (NICE)...
An acknowledgement to Elize Massard da Fonseca was omitted in this editorial by Y Tony Yang and colleagues (BMJ 2026;393:s814; doi:10.1136/bmj.s814). The online version has been corrected.
Guidelines should help clinicians and patients make better decisions, but too often they do the opposite. Providing recommendations that are vague, outdated, or inactionable can harm patients by causing confusion and misunderstanding, delaying care, and eroding trust in evidence based medicine.1 Guideline developers must confront this. If recommendations fail to guide actionable decisions at the point of care, they are not just useless-they are harmful.Across specialties, guideline panels produce documents that seem authoritative but lack the precision needed for real world application.23 These recommendations often default to broad, non-committal language: “consider” multicomponent interventions, “offer” behavioural support, or “individualise” treatment without specifying priorities, sequences, or stopping rules. This vagueness leaves clinicians guessing, resulting in patients being underserved and inefficiency in healthcare systems.Recommendations should clearly define eligibility criteria, initial steps, monitoring protocols, escalation pathways, and exit strategies. Without this, guidelines lack utility, and key insights are buried or lost, undermining credibility.Timeliness exacerbates...
Polycystic ovary syndrome (PCOS) has been renamed polyendocrine metabolic ovarian syndrome (PMOS), an article published in the Lancet has advised.1However, experts warn that care must be taken to introduce the name gradually so as not to confuse patients or detract from efforts to raise awareness about the condition.PCOS is a complex endocrine disorder.2 What exactly triggers the condition is unknown, but it is known to be related to abnormal hormone levels in the body, including high levels of insulin. Symptoms include irregular periods or no periods at all, difficulty getting pregnant, excessive hair growth, and weight gain.3PCOS is very common, affecting one in eight women, although this can vary between countries. Despite PCOS’s prevalence, patients have often reported delays in diagnosis and limited access to treatment. A parliamentary report published last year found that more than a third of women with PCOS had to wait over four years for a...
A documentary detailing Israeli military attacks on hospitals and ambulances in Gaza and the deaths and injuries of Palestinian healthcare workers has won a British Academy of Film and Television Arts award for current affairs.The gong came despite the film’s initial commissioners, the BBC, controversially dropping it before it could be broadcast. Channel 4 eventually picked up the documentary and broadcast it on 2 July 2025.In his acceptance speech, Ben De Pear, executive producer of Gaza: Doctors Under Attack, took aim at the national broadcaster.“Given you dropped our film, will you drop us from the Bafta screening later tonight?” he asked. The 10 May award ceremony in London was broadcast in the UK by the BBC with a two hour delay. An edited version of the speeches appeared in the broadcast.The BBC commissioned Gaza: Doctors Under Attack in 2024 from the independent television production company Basement Films, with a broadcast...
Advertisements for meat products and fossil fuel based industries such as airline and cruise ship travel will be banned in Amsterdam, in a move welcomed by public health experts and environmentalists.The measure, the first for any capital city, came into force on 1 May and applies to advertisements for companies such as KFC and Royal Caribbean appearing in public spaces such as billboards, buses, bus shelters, metro stations, trains, and trams.Anke Bakker, a city councillor with the political party the Party for the Animals, told The BMJ of the difficulties in passing the ban, even in a country committed to reaching net zero by 2050 and reducing meat consumption.“The meat industry sent a lobby letter to all the city councillors with unsubstantiated claims about how healthy meat actually is,” she said. “For us, it had long felt quite hypocritical to have all these environmental policies while still allowing public space...
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01558-wEight of the top ten officials at the US National Institute of Allergy and Infectious Diseases have now been pushed out since President Donald Trump took office.
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01391-1Brandon Brown sees parallels between life as an academic and tending a citrus grove following his move to the country.
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01559-9Could spinach extracts be the next treatment for dry-eye disease?
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01083-wForging connections.
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01575-9Nature staff discuss some of the week's top science news.
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01503-xThe personalized treatment encourages the immune system to attack the tumours called glioblastomas.
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01590-wThe Trump administration has spent months investigating the lab after a Chinese postdoc was charged with smuggling biological material into the country.
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01534-4A survey of more than 300 mouse strains has found widespread discrepancies between how mutant mice are reported and their actual genetic make-up.
Nature, Published online: 15 May 2026; doi:10.1038/d41586-026-01504-wSome bacterial species became less abundant in the guts of American football players as the season progressed.
Extremely preterm birth (at <28 postconceptional weeks) leads to brain injury and represents the leading cause of childhood-onset neuropsychiatric diseases. No effective therapeutics exist to reduce the incidence and severity of brain injury of prematurity. Hypoxic events are the most important environmental factor, along with inflammation. Among other developmental processes, the second half of in utero fetal development coincides with the migration of cortical interneurons from the ganglionic eminences into the cortex; this process is thus prone to disruptions following extremely preterm birth. To date, no studies have directly investigated the migration of human cortical inhibitory neurons under hypoxic conditions. Using multi-day confocal live imaging in human forebrain assembloids (hFA) derived from human-induced pluripotent stem cells (hiPSCs) and ex vivo developing human brain tissue, we found a substantial reduction in the migration of hypoxic interneurons. Using transcriptomics, we identified adrenomedullin (<i>ADM</i>) as the gene with the highest fold change increase in expression. Based on previous literature about the protective role of supplemental ADM for other injuries, here, we demonstrated that addition of exogenous ADM to the hypoxic media restores the migration defects of interneurons. Lastly, we showed that one of the mechanisms of protection by ADM is through the activation of the cAMP/PKA pathway and subsequent pCREB-dependent rescued expression of a subset of GABA receptors, which are known to promote migration. Overall, in this manuscript, we provide the first direct evidence for hypoxia-induced deficits in the migration of human cortical interneurons and identify ADM as a possible target for therapeutic development.
Although it is well established that stem cells maintain tissue homeostasis while tumors disrupt it, the mechanisms by which tumors influence the development of nearby stem cells remain poorly understood. Using <i>Drosophila</i> ovaries as a model system, here we discovered that <i>bam</i> or <i>bgcn</i> mutant germline tumors inhibit the differentiation of neighboring wild-type germline stem cells (GSCs). Mechanistically, these tumor cells mimic the stem cell niche by secreting the bone morphogenetic protein (BMP) ligands Dpp and Gbb, but at reduced levels, resulting in moderate BMP signaling activation in adjacent GSCs. Such BMP signaling activation is sufficient to repress <i>bam</i> transcription, thereby blocking GSC differentiation. To our knowledge, this is the first example that tumors can functionally mimic a stem cell niche to inhibit the differentiation of neighboring wild-type stem cells. Similar regulatory paradigms may operate in mammalian tissues, including humans, during tumorigenesis.