The pathway aligns regulatory review by the Medicines and Healthcare products Regulatory Agency (MHRA) with the National Institute for Health and Care Excellence (NICE) health technology appraisal process, so that decisions are reached simultaneously.

But Huseyin Naci at the London School of Economics and Political Science notes that these two bodies require different forms of evidence. The MHRA focuses on a product’s clinical effectiveness and safety, while NICE assesses its comparative effectiveness and long term value for money against current NHS treatments.

Rather than aligning evidentiary standards, the pathway runs two independent processes in parallel with the aim of synchronising their conclusions, he explains, offering companies earlier revenue and a longer rebate-free window, while benefits for patients and the NHS are less clear.

He acknowledges that earlier access to effective new drugs can matter for patients with significant unmet needs, but says, unlike the patient-focused Innovative Licensing and Access Pathway (ILAP), the new pathway expedites all new medicines regardless of added therapeutic benefit.

The pathway will also impose timelines to ensure that MHRA and NICE decisions are reached simultaneously. Yet Naci points out that fixed drug evaluation deadlines have historically been linked to higher rates of adverse events, and fast-tracked medicines are more prone to post-marketing safety issues than those approved through standard routes.

A further problem is that NICE committees may be asked to assess products on evidence not yet fully vetted by the MHRA, compounding the uncertainty under which they already operate, he writes.

Earlier adoption of expensive, potentially low-value medicines will also extend the period over which they divert NHS resources from more cost-effective interventions, a problem exacerbated by the 2025 US-UK trade agreement committing NICE to a 25% higher cost-effectiveness threshold, he adds.

Naci urges the government to ground medicines access policy in patient need and population health, calling for clarification on the assumptions underpinning the pathway and assessment of its anticipated benefits and harms for all stakeholders, not just industry.

NICE’s focus on synchronisation of decisions risks overlooking whether the NHS will be adequately protected from the earlier adoption of medicines that prove harmful, ineffective, or poor value, he concludes.

The study examined the facilitators and challenges of so-called tobacco endgame policies in Europe. These policies refer to goals and measures aimed at reducing the use of tobacco products in the population to such a low level that it no longer places a significant burden on public health. Tobacco causes more than seven million premature deaths worldwide each year.

The EU’s Tobacco-Free Generation target was launched in the 2021 Cancer Plan and was recently reinforced in the Safe Hearts Plan. The aim is to reduce the use of tobacco products among the European population to below five per cent by 2040.

EU support is decisive for achieving the targets

According to the study, achieving the targets is particularly supported by broad political commitment, effective and long-term cooperation between different actors, and an active civil society that keeps the issue visible and brings public opinion to light.

In contrast, tobacco industry influence on decision-making, the visible marketing of new nicotine products, and the slowness of regulation make progress towards the targets more difficult.

The interviewees saw the EU’s role as central in reducing the use of tobacco and nicotine products. Common EU regulation and examples from other countries can accelerate national measures and encourage countries to set more ambitious targets for reducing the use of tobacco and nicotine products.

“The ongoing revision of EU tobacco legislation provides an important opportunity to strengthen Member States’ actions and accelerate progress towards the Tobacco-Free Generation target,” says Senior Specialist Hanna Ollila from the Finnish Institute for Health and Welfare.

Finland has been a forerunner

In some countries, the target has been extended to cover nicotine products as well. Finland has been a forerunner in this respect. In Finland, the objective of the Tobacco Act is to end the use of tobacco and nicotine products. In practice, the aim is to achieve a prevalence below five per cent by 2030.

“It is important for Finland to continue its active role and ensure that national regulation remains up to date, particularly with regard to new nicotine products. The rapid increase in the use of nicotine pouches among young people requires swift additional measures, such as raising the age limit,” Ollila states.

The study is based on interviews with 23 experts in eight European countries. The interviewees included officials, researchers and representatives of non-governmental organisations. It was carried out as part of the Joint Action on Tobacco Control 2 -project, within a work package led by THL.

The warning label currently required on alcohol containers in the United States has not changed since its adoption in 1988, despite new evidence linking alcohol to several diseases. The label states the risks of drinking during pregnancy and while driving or operating machinery and warns generally that drinking alcohol “may cause health problems.” The label often goes unnoticed and unremembered by consumers.

“We wanted to test whether new warnings could better inform consumers about alcohol’s harms and better encourage people to consider cutting back on their drinking,” says lead author Anna H. Grummon, Ph.D., M.S.P.H., assistant professor at the Stanford University School of Medicine. The study was conducted as part of a larger project co-led with Marissa G. Hall, Ph.D., associate professor at the University of North Carolina.

Designed to compare the effects of differently worded and designed warning labels, the study recruited a nationally representative sample of 1,036 adults of legal drinking age (21 and older) who reported drinking at least once a week.

Participants viewed 10 messages — one control, eight new warning labels, and the current U.S. warning label — in random order. They then rated each message on how well it encouraged them to drink less alcohol, reminded them of alcohol’s harms, and informed them of something new.

“Each participant rated multiple warnings covering a range of health harms — such as cancer, liver disease, hypertension, and dementia, among others — so we could make direct, apples-to-apples comparisons between them,” says Grummon.

All the new alcohol warnings in the study outperformed the current U.S. warning label, but those highlighting cancer risk were particularly effective. This finding is notable as policymakers in the United States and abroad debate whether to adopt a cancer warning on alcohol products.

“Ireland, for example, is set to require cancer warnings on alcohol containers in the coming years, and Alaska already requires a cancer warning to be posted in bars, restaurants, and liquor stores where alcohol is sold,” says Grummon. “Our findings suggest these policies could help people understand the risks of drinking and potentially reduce consumption.”

Study participants also rated the effectiveness of warning icons and label design. Triangles and octagons were perceived as more effective and attention-grabbing than other icons, such as a magnifying glass.

More research is underway. Grummon and Hall are currently running a randomized trial to test whether new alcohol warnings effectively lead people to drink less. The study will also measure whether the warnings improve knowledge of alcohol-related harms over time.

“We know from tobacco control that well-designed warnings can inform consumers and encourage healthier choices,” says Grummon. “Given that alcohol-related deaths are increasing, we hope policymakers will consider whether updating alcohol warnings should be part of a broader strategy to address alcohol-related harms.”
—–
Grummon, A. H., Lee, C. J. Y., Campos, A. D., Lazard, A. J., Brewer, N. T., Whitesell, C., Ruggles, P. R., Greenfield, T. K., & Hall, M. G. (2026). New alcohol warnings outperform the current U.S. warning in a national survey experiment. Journal of Studies on Alcohol and Drugs, 87(3), 433-443. https://doi.org/10.15288/jsad.25-00226

By W.B. Kagan

image: “Government warning” alcohol label

View more Credit: Journal of Studies on Alcohol and Drugs

The purchasing and consumption of foods high in energy, saturated fat, free sugars, and salt, is associated with an increased risk of obesity and diet-related non-communicable diseases. In recent years, the UK Government has set a series of voluntary targets for manufacturers, retailers, and restaurants to reduce the sugar, salt, and calorie content of food. The sugar targets were intended to be met by 2020, the salt targets by 2024, and the calorie targets by 2025. Few studies have assessed the nutritional quality of foods in the restaurant sector, despite an increasing percentage of weekly food intake coming from takeaway or restaurant meals.

In the new study, researchers gathered nutritional information from the 21 highest-grossing restaurant chains in the UK in 2024, using PDF menus or nutritional information on restaurant websites. They calculated the proportion of menu items from each restaurant and food subcategory that met the nutritional targets. Nine of the 21 restaurants had more than half of their menu items meeting all applicable targets. Menu items from Papa John’s were the lowest adhering to the calorie (35%) and salt (8%) targets, while menu items from Burger King, KFC, Nando’s, and Vintage Inns had zero adherence to the sugar targets.

Food within the same subcategory varied in adherence to the targets, with salads and breakfast items having the highest overall adherence, and desserts and pizzas the lowest. However, there were examples of companies across all subcategories performing well, indicating that performance is not constrained by the type of cuisine being offered.

“Our findings demonstrate that there was low adherence to the UK Government’s sugar, salt, and calorie reduction targets in 2024,” the authors say. “This is consistent with other research that finds limited effectiveness of voluntary regulation on reformulation, suggesting that mandatory regulation may be a more effective approach to improving the nutritional quality of out-of-home food.”

Alice O’Hagan adds, “Our study shows that the UK Government’s voluntary sugar, salt, and calorie reduction targets were not being met consistently across the highest-grossing UK restaurant chains, in 2024. Only 43% of menu items met all of the targets they were eligible for, and adherence to the targets varied widely between restaurants and food categories, showing that healthier menus are achievable but are not yet the norm.”

“Interestingly, restaurants with similar menu styles performed quite differently in meeting the targets. This shows the nutritional quality of menus is not fixed by cuisine type, making the shift towards healthier menus a more attainable goal for food companies.”

Co-author Lauren Bandy adds, “Voluntary targets alone are not delivering consistent improvements in the salt, sugar or calorie content of food items on offer in UK restaurants. Our findings highlight the potential value of stricter regulation in the out-of-home sector, and show that improving transparency and accountability of individual food companies will be key in supporting healthier food provision for the UK population.”

Freely available paper in PLOS Medicine: https://plos.io/4bNeHl9

Citation: O’Hagan A, Pechey R, Forde H, Bandy L (2026) Adherence to voluntary UK sugar, salt, and calorie reduction targets in the highest-grossing restaurant chains: A cross-sectional study. PLoS Med 23(5): e1004681. https://doi.org/10.1371/journal.pmed.1004681

Author countries: United Kingdom

Funding: AOH and RP are supported by the NIHR Oxford Health Biomedical Research Centre (https://oxfordhealthbrc.nihr.ac.uk/). RP is also supported by the Royal Society and Wellcome Trust (Sir Henry Dale fellowship; 222566/Z/21/Z; https://www.royalsociety.org/grants/henry-dale/). HF is funded by the SHIFT: Sustainable and Healthy Interventions for Food Transitions project, which is funded by the Wellcome Trust (grant reference 227132/Z/23/Z; https://wellcome.org/research-funding/funding-portfolio/funded-grants/shift-sustainable-and-healthy-interventions-food), and by the COPPER project, which is funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (grant reference NIHR133887; https://fundingawards.nihr.ac.uk/award/NIHR133887). LB is supported by the NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley (https://www.arc-oxtv.nihr.ac.uk/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Image: Dan Gold, Unsplash (CC0, https://creativecommons.org/publicdomain/zero/1.0/)

In an expert commentary titled ‘AI can reason like a physician; what comes next? published in Science, Flinders researchers caution that while new AI systems show impressive capabilities, strong results in controlled studies do not mean they are ready for routine use in hospitals or clinics.

The authors say there is an urgent need to understand how emerging AI tools can be safely integrated into everyday clinical practice, with patient outcomes remaining the central focus.

Despite these warnings, the researchers acknowledge that recent advances in AI create genuine opportunities to support doctors, particularly in busy and high-pressure care settings.

The commentary reviews new research showing that advanced reasoning-based AI systems can work through diagnostic scenarios step by step and, in some cases, closely match or even exceed the diagnostic performance of experienced doctors.

Erik Cornelisse, a PhD candidate at Flinders University and co-author of the commentary, says this shift marks a move from simple question answering tools towards algorithms capable of seemingly human-like clinical reasoning on text-based tasks.

However, the Flinders team stresses that real world medical care involves far more than text-based reasoning or test performance.

They say clinical practice depends on physical examination, listening to patients, understanding medical and social context, and taking responsibility for outcomes, elements that current AI systems cannot safely provide on their own.

“Health care decisions are complex, high stakes, and deeply human, and accuracy alone, particularly on just text-based cases, does not make a system safe for patients,” says Mr Cornelisse from the College of Medicine and
Public Health.

Senior author Associate Professor Ash Hopkins, an NHMRC Investigator and leader of Flinders’ Clinical Cancer Epidemiology Lab, says modern healthcare relies on judgement, accountability, and ethical oversight.

“AI systems have demonstrated that they can reason through clinical problems with similar performance to doctors, notably on the same scenarios used to train clinicians themselves. This presents genuine opportunities to support clinicians in the future,” says Associate Professor Hopkins.

“Multiple stakeholders are currently working on the frameworks for AI in terms of legal, professional, or moral responsibility for its decisions, and presently there is a critical need for deliberate and controlled integration into clinical care.”

The commentary highlights known risks linked to poorly evaluated systems, including bias, inequitable care, and unintended patient harm.

“History shows that algorithms can worsen outcomes when deployed without sufficient safeguards and can amplify problems as easily as they solve them, particularly when systems are trained on incomplete or unrepresentative data,” says Mr Cornelisse.

Looking ahead, the Flinders researchers argue that enthusiasm for medical AI must be matched by strong governance and clearer standards for evaluation.

“We do not allow doctors to practise without supervision and evaluation, and AI should be held to comparable standards,” says Mr Cornelisse.

The researchers stress that improvement in real patient outcomes, not exam scores, benchmarks, or demonstrations, must be the true measure of success.

Associate Professor Hopkins says AI holds enormous promise but must be applied responsibly.

“Patients deserve technology that improves care in the real world, not systems that only look impressive in studies,” he says.

“With careful design, strong oversight, and rigorous evaluation, AI could become a powerful tool to deliver safer, fairer, and more effective care across health systems worldwide,” concludes Associate Professor Hopkins.

The paper, ‘AI can reason like a physician; what comes next?’, by Ashley M. Hopkins and Erik Cornelisse is published in SCIENCE.  DOI 10.1126/science.aeg8766 (link live after embargo lifts)

In 2024, the FDA updated the definition of the term “healthy” as it relates to how manufacturers can use the word on food packages. The new definition replaced one from 1992 and is consistent with current nutrition science and federal dietary guidance.

Also for the first time, the agency proposed an “FDA healthy” label icon for food packages, which is still undergoing approval.

The new study, led by researchers at Oregon State University and Tufts University, examined consumer purchasing preferences for snack products with and without healthy labels, focusing on the new FDA definition and healthy symbol to understand how endorsement from a regulator, such as the FDA, shapes consumer choices.

“Our main finding is that trust in government was an important part for people and that they were willing to pay more for that label,” said lead author Katherine Fuller, an assistant professor at Oregon State University who studies consumer behavior, particularly in the context of food and sustainability.

Fuller noted that the finding mirrors past research related to the USDA “organic” label, which has also been associated with a premium price.

For the new study, published in Food Quality and Preference, the researchers conducted an experiment in 2023 with 267 shoppers in person at six grocery stores in the Boston area. In the stores, participants were given tablets and shown pictures of 15 real-world products, nine of which were considered healthy and six that were not.

Participants first viewed products without any special healthy label and then viewed the same products, with those products meeting the new FDA “healthy” standards bearing either a generic healthy label or the FDA-healthy label. Participants received $5 in cash and a $10 gift card from the store. They were informed that the $5 could be applied toward the purchase of a product they selected in one of the scenarios they were presented. This procedure ensured the participants’ decisions had real economic consequences.

“Giving study participants purchasing power in a setting that mirrored a real shopping experience let us better observe how the labels might influence behavior,” said senior author Sean Cash, chair of the Division of Agriculture, Food and Environment at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University and an economist studying food policy and consumer behavior.

Each participant also completed a survey providing information about their demographics, knowledge of healthy food options and levels of generalized trust and trust in government.

Research findings from the study included:

• Consumers were more likely to choose the healthy snacks over unhealthy options.
• Consumers’ preference for healthy snacks increased when products were labeled with healthy icons. While the FDA and generic labels were associated with higher selection of healthy snacks, only the FDA label had a statistically significant effect.
• Prior findings that consumers are willing to pay more for labeled healthy foods were confirmed, and, additionally, the new results showed that adding a healthy label increases this premium further. For example, consumers were willing to pay 59 cents more on average for a healthy product with an FDA-endorsed label compared to a product with no label.
• The stronger effect of the FDA label reflects the role of perceived institutional credibility. These results are consistent with previous studies that demonstrate institutionally credible labels more effectively shape consumer decisions.
• The effectiveness of the FDA’s healthy label varied with the degree to which consumers indicated they trusted the government.

“Our findings demonstrate that labels act as signals for consumers, and policy can shape how well those signals work,” said Cash. “When labels are viewed as credible, such as when they have the endorsement of a government agency, they are more likely to influence eating patterns and purchasing habits.”

“Right now, there is a lot of misinformation about what is healthy and what isn’t healthy,” Fuller added. “Having a clear label, supported by scientific research, saying this is healthy because we checked, is important.”

Co-authors of the paper are Julia Reedy Sharib, Bingbing Fan and Dariush Mozaffarian, of the Friedman School at Tufts University, and Jennifer L. Pomeranz, of New York University.

Citation and Disclaimer: Research reported in this article was supported by the National Institutes of Health’s National Heart, Lung, and Blood Institute under award number R01HL115189. Complete information on authors, funders, limitations, methodology and conflicts of interest is available in the published paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Researchers surveyed 700 adults across the United States who had used e-cigarettes in the past 30 days. Study participants made hypothetical monthly purchases across seven product categories: disposable e-cigarettes, pod devices, pod starter kits, pod refill packs, tank devices, e-liquids, and cigarettes.

The study found that higher pre-tax base prices and higher taxes both reduced e-cigarette use, measured by product units purchased and the amount of nicotine consumed.

To reflect real-world conditions, the experiment used three pre-tax price levels, low, medium, and high, representing roughly the 25^th, 50^th, and 75^th percentiles observed in the marketplace. Compared with lower prices, mid-range prices were linked to roughly 30 to 33% fewer product units purchased, while the highest prices were linked to roughly 49% to 51% fewer products purchased. Higher taxes also reduced purchases.

The analysis found that different e-cigarette types often act as substitutes: when the price of one product rises, adults may switch to another. At the same time, certain products function as complements, such as tank devices and e-liquids, or pod devices and refill packs, because they are used together. Notably, the study did not find statistically significant evidence that raising e-cigarette prices led to greater cigarette consumption among the general adult e-cigarette-using sample.

“Our findings suggest that increasing e-cigarette prices can effectively reduce vaping without the unintended consequence of more smoking among adult vapers,” said Shaoying Ma, PhD, first author of the study and research scientist at the Center for Tobacco Research at the OSUCCC – James. “However, because adult vapers navigate a complex marketplace of disposables, pods, and tanks, a one-size-fits-all tax may not be sufficient to reduce nicotine consumption. Policymakers may consider tiered tax designs to achieve specific public health goals.”

The researchers emphasize that price remains a powerful tool for curbing nicotine use, as states continue to refine their tobacco control strategies.

Coauthors in the study include Sooa Ahn, Hojin Park, Qian Yang, John FP Bridges, and Ce Shang.

Every year, EMA issues EU recommendations for the composition of seasonal influenza vaccines on the basis of observations by the World Health Organization (WHO), which are informed by regular monitoring activities on the prevalence and characteristics of different influenza viruses worldwide.

Manufacturers of live-attenuated vaccines or egg-based vaccines should include these three virus strains for the 2026/2027 season:

• an A/Missouri/11/2025 (H1N1)pdm09-like virus;
• an A/Darwin/1454/2025 (H3N2)-like virus;
• a B/Tokyo/EIS13-175/2025 (B/Victoria lineage)-like virus.

Manufacturers of cell-based vaccines should include these three virus strains for the 2026/2027 season:

• an A/Missouri/11/2025 (H1N1)pdm09-like virus;
• an A/Darwin/1415/2025 (H3N2)-like virus;
• a B/Pennsylvania/14/2025 (B/Victoria lineage)-like virus.

Previously, most authorised influenza vaccines were formulated to protect against the four main strains of influenza responsible for seasonal flu, including the strain known as B/Yamagata.

However, since B/Yamagata has not been detected in circulation since March 2020, it is considered to no longer pose a threat to public health. As a result, there is no EU recommendation for a B/Yamagata strain in seasonal influenza vaccines for the 2026/2027 influenza season, which is in line with the respective WHO recommendation regarding the composition of vaccines for 2026/2027.
In case quadrivalent vaccines are still required (e.g. in regions where the transition to trivalent vaccines has not been finalised yet), vaccine manufacturers of inactivated vaccines can consider producing a quadrivalent vaccine containing two influenza B virus strains for the 2026/2027 season. For these vaccines it is proposed to follow WHO recommendations from previous years for the B/Yamagata strain, i.e. a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

Influenza viruses continuously change and evolve. The periodic replacement of the virus strains contained in influenza vaccines is therefore necessary to keep the vaccines effective.

The newly approved medicines are:

• Adstiladrin (nadofaragene firadenovec), for the treatment of adult patients with Bacillus Calmette-Guérin unresponsive non-muscle invasive bladder cancer with carcinoma in situ with or without papillary tumours.
• Imdylltra (tarlatamab), a new treatment for relapsed extensive-stage small cell lung cancer which addresses an unmet medical need in adults with poor prognosis and limited treatment options.
• Joenja (leniolisib) for the treatment of activated phosphoinositide 3-kinase delta syndrome (APDS) in adults and adolescents 12 years of age and older and weighing 45 kg or more. APDS is a rare, inherited progressive and potentially life-threatening condition of the immune system.
• Zepzelca (lurbinectedin) for the maintenance treatment in patients with extensive-stage small cell lung cancer whose disease has not progressed after first-line induction therapy.
• Bopediat (furosemide) for the treatment of oedema (swelling caused by excess fluid) of cardiac or renal origin, oedema of hepatic origin and hypertension in children from birth to under 18 years of age with chronic kidney disease.

The committee also recommended extensions of indication for 13 medicines that are already authorised in the EU: Besponsa, Capvaxive, Feraccru, Hetronifly, Hympavzi, Imcivree, Lojuxta, Mekinist, mResvia, Namuscla, Retsevmo, Sotyktu and Tafinlar.

Sugary drink taxes have been adopted in several U.S. jurisdictions as a public health strategy to curb sugar consumption and improve dietary behaviors. Research on the impact of these taxes on grocery stores purchases attribute sugary drink taxes to an estimated 15% decrease in sales. However, whether this translates to an impact in restaurant sales has not been well studied.

Researchers analyzed six years of sales data (2015–2020) from more than 7,300 Taco Bell locations nationwide, focusing on drive‑through purchases. The study compared beverage calories per transaction at 60 restaurants across five jurisdictions with sugary drink taxes—Albany, California; Cook County, Illinois; Oakland, California; Philadelphia, Pennsylvania; and Seattle, Washington—with a matched group of similar restaurants in areas without such taxes.

Overall, the analysis found no significant association between sugary drink taxes and beverage calories per transaction, suggesting that sugary drink taxes of this size or alone may not substantially reduce beverage calorie consumption in fast food restaurant settings.

The authors note that consumer behavior in restaurants—such as choosing combo meals or prioritizing convenience—may limit the effectiveness of these policies.

Elbel adds, “Using millions of transactions from six years of sales data, we found that sugary beverage taxes did not influence beverage calories when implemented in five cities in the U.S.”

Rummo notes, “These results suggest that sugary drink taxes may not be effective in reducing beverage calorie consumption in fast food restaurants, as compared to supermarkets. This could be because the sizes of sugary drink taxes in the U.S. are too small for consumers or that they just aren’t responsive to price changes in these settings, among other reasons.”

In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: https://plos.io/4sFufx5

Citation: Rummo PE, Echenique JA, Wu E, Mijanovich T, Desai SM, Bragg MA, et al. (2026) Impact of sugary drink taxes on beverage calories purchased in a national fast food restaurant chain: A quasi-experimental study. PLoS Med 23(4): e1004642. https://doi.org/10.1371/journal.pmed.1004642

Author countries: United States of America

Funding: This work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, grant number 5R01HL147474 (PER, JAE, EW, TM, SM, MAB, BCW, BE). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Taco Bell was aware of the research question before agreeing to data sharing but did not sponsor this study and had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Past scholarly research has found that most Americans say they support mental health policies. Jake Haselswerdt, an associate professor of political science in Mizzou’s College of Arts and Science, wanted to take the topic a step further by asking whether mental health policies actually matter when people choose to vote for a political candidate.

Drawing on a nationally representative sample of 1,000 adults from the 2024 Cooperative Election Study, Haselswerdt asked participants to choose between competing priorities. The results showed that even small differences could sway voters, and mental health was often the issue that tipped the scale in a candidate’s favor.

The results indicate mental health issues influence political decision making in substantive ways, Haselswerdt said.

“I assumed mental health would rank below topics that typically dominate public discussion, like border security,” he said. “But that’s not what I found. I found that people consider this to be as important as other issues that get a lot more news coverage.”

Mizzou’s study comes during a time when concerns about Americans’ mental well-being remain elevated across the country. Recent polling from the National Alliance on Mental Illness shows one in six adults reporting poor mental health, largely influenced by the cost of living, personal health concerns and the demands of daily life.

Haselswerdt said the findings point to a significant and often under-recognized opportunity for policymakers to take stronger action on mental health policies.

“If there’s one takeaway, it’s that political leaders should pay more attention to addressing the deepening mental health crisis in America,” he said.

The study, “Who cares about mental health? Benchmarking the issue importance of mental health for American voters” was published in PLOS One.

When a lack of proper medication reconciliation (MedRec) led to a sharp deterioration in her father’s health Dr Rita Shane (Vice President and Chief Pharmacy Officer at Cedars Sinai Medical Center, Los Angeles, California) promised herself that she would ‘fix’ the problem before she retired. Just 20 years later she succeeded – MedRec by pharmacy staff became a legal requirement in California.

In 1998 Dr Shane’s father underwent a craniotomy for a brain metastasis associated with lung cancer. He developed “intractable agitation” and was transferred to a geriatric-psychiatric unit where his condition became much worse. When Dr Shane asked about his medication it became apparent that the steroids that he had been prescribed after the craniotomy had been abruptly discontinued when he was transferred.  “I knew you can’t just ‘cold turkey’ discontinue a steroid in a patient. Ultimately, I had him transferred back to Cedars Sinai because he ended up febrile. He was getting a decubitus [ulcer] and I was concerned that he would die of sepsis in a gero-sych unit due to what I considered an iatrogenic issue”, she says.

Medication reconciliation is often viewed as a simple clerical task. In fact, making an accurate record of current medication is an important procedure because the list becomes the basis for future prescribing decisions. Dr Shane has spearheaded a decades-long campaign to transform this process, arguing that pharmacy staff – pharmacists and technicians – are the only professionals with the specific expertise required to ensure medication safety during transitions of care. This effort recently culminated in California law SB 1254 and subsequent regulatory changes that mandate pharmacy-led MedRec for high-risk patients at both admission and discharge.

The “poly problem” and iatrogenic risk

One important reason for specialised pharmacy intervention is what Dr. Shane calls the “poly problem”: poly-disease, poly-doctor, and poly-pharmacy. As patients over 65 tend to have multiple chronic conditions, they often receive prescriptions from multiple providers and pharmacies. This fragmentation can create a chaotic medication history. In many ambulatory settings, medication histories are entered into the electronic health record (EHR) by medical assistants who, while vital to practice support, may lack in-depth training in pharmacology. These entries then become the “source of truth” for hospital admissions. For example, “When we first implemented our electronic health record, we would see orders like “methotrexate daily” [instead of weekly] that the pharmacist would intercept – and that’s really just a lack of knowledge and skills on the part of people that are transcribing orders without the benefit of the clinical knowledge”, she notes. Dr. Shane compares a medication order to a complex sentence: it requires the correct drug, dose, dosage form, route, rate, and duration. The pharmacist serves as a guardian angel over this process, making sure that orders are complete and accurate in the context of the whole patient, she says.

The evidence: Why pharmacy ownership matters

The push for legislative change was based on rigorous research evidence. Dr. Shane and her team conducted a randomised controlled trial in the emergency department, comparing “usual care” (medication histories taken by busy physicians or nurses) with those taken by trained pharmacy staff. The results were stark: pharmacists and technicians were significantly more accurate, identifying up to eight errors per high-risk patient.

The business case for pharmacy-led MedRec

For healthcare administrators, the argument for pharmacy-led MedRec extends beyond clinical outcomes to financial sustainability. Adverse drug events (ADEs) are a primary driver of increased hospital costs and. Data indicates that an ADE can increase a patient’s length of stay (LOS) – and therefore hospital costs – by an average of 3.1 days. At the time of the evaluation, the cost of a single admission or readmission due to these errors was estimated at $12,000 to $14,000.

By leveraging pharmacy technicians to transcribe histories accurately into the EHR, hospitals can achieve significant savings while allowing nurses and physicians to practice at the highest level of their licenses. One organisation demonstrated savings of $830,000 by utilising technicians for this function. Furthermore, reducing the 40 minutes of nursing time typically spent per patient on medication histories provides a major relief to frontline clinical staff.

All of this information was brought together in an infographic that was used to educate the State Board of Pharmacy and the California legislature about the problem. “Timing is everything” says Dr Shane and it turned out that one of the California senators was a pharmacist and he enthusiastically supported Dr Shane’s initiative. After a number of hearings, the bill was signed into law in September 2018, just two years and four days after her father’s death. “It was an exciting journey and really an outstanding opportunity to educate legislators”, she recalls. Moreover, during her discussions with legislators, “Everyone seemed to have an example of a family member having a problem with an inaccurate medication list – and that brought it home”, she adds.

Following the passage of SB 1254 (the bill in question) in 2018, a larger study involving 11 California hospitals (ranging from university-based to community hospitals) further validated these findings. Over a six-week period, the study captured approximately 16,000 errors across 2,300 medication histories. Notably, 94% of medication lists contained at least one error, and 25% of those errors were classified as serious or life-threatening. These findings were verified by independent physician reviews, ensuring that the severity of the errors was not overstated. Reflecting on the findings, Dr Shane says, “We demonstrated that we prevented significant harm in the state of California for the hospitals that implemented this new law”.

Closing the loop: MedRec at discharge

While the 2018 legislation focused on admission, Dr. Shane realised that the “back end” of the hospital stay remained a point of extreme vulnerability. She uses the analogy of a totally wrecked car (the patient) that is painstakingly repaired in a body shop (the hospital), only to be driven off a cliff at discharge because the final medication list was inaccurate.

Studies showed that even with accurate admission medication lists, patients still experienced an average of two medication errors at discharge. Approximately 20% of hospital admissions are medication-related, and at least 40% of patients have an error on their discharge medication list, she says. These errors, such as the inadvertent omission of anticoagulants or antibiotics, are then perpetuated by community pharmacists who, lacking access to patient records, have no way of recognising the mistakes.

To address this, Dr. Shane successfully advocated for a regulatory change through the California State Board of Pharmacy’s “sunset review” process. As of January 1, 2026, the law was expanded to include medication reconciliation at discharge for high-risk patients.

A new paradigm: The “high-alert patient”

Perhaps the most transformative concept proposed by Dr. Shane is the shift from focusing solely on high-alert medications to identifying the “high-alert patient”. This designation would apply to the most vulnerable individuals – those with multiple diseases and complex regimens – who should be “tagged” for prioritised pharmacist attention across all providers.

Dr. Shane’s vision is to see these California-led successes become a national standard. Through collaboration with the National Association of Boards of Pharmacy (NABP) and the Joint Commission, she continues to advocate for model legislation that designates pharmacy staff as the clear “owners” of the medication list. For health professionals, the message is clear: ensuring an accurate medication list is not a secondary task; it is a foundational element of patient safety that requires the specialised clinical lens of the pharmacy profession.