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.

Rates of depression and anxiety have increased worldwide since the COVID-19 pandemic, and more people are pursuing mental health treatment as a result. However, there is limited up-to-date data describing how these individuals seek out and receive care. Detailed, population-level information can help healthcare systems meet this growing population’s needs.

To make a start on gathering this data, Kruk and her colleagues surveyed 32,419 adults in 18 high-, low-, and medium-income countries. More than 1,000 people from each country responded. Participants self-reported data via the People’s Voice Survey in 2022 and 2023.

First, survey respondents self-assessed their physical and mental health (the latter including “poor,” “fair,” “good,” “very good,” and “excellent”). Then, they quantified their overall confidence in the healthcare system, their own use of healthcare services, the typical quality of care received, and their ability to manage their own mental health (a metric called patient activation).

Across all countries, respondents reporting poor mental health were more likely to report chronic illness, poorer overall health, lower patient activation, worse care quality and lower confidence in the healthcare system. Between 0.9% (Lao PDR) and 52.4% (UK) of these respondents reported receiving mental health care in the last year. Respondents in Nigeria reported the best overall mental health (4.7% people reported the lowest proportion of “poor” or “fair” mental health (4.7%), while respondents in China had the highest proportion (39.6%).

The researchers hope these results can help the countries in question — and individual healthcare systems — better serve the needs of those with poor mental health. While this is a descriptive study, the researchers posit patient activation as a potential target for elevating overall health and wellness.

The authors acknowledge that big-picture data doesn’t describe individuals’ specific experiences within the healthcare system. They suggest comparison across similar health systems and tracking system performance over time to continuously improve health services.

The authors add, “What stands out from this study is that poor mental health doesn’t exist in isolation. People reporting poor mental health were nearly twice as likely to have a chronic illness and far less likely to feel empowered to manage their own health. Health systems need to stop treating mental health in a silo and recognize that these patients are showing up across all areas of care — and often with more complex needs.”

Kruk adds, “As a research consortium working across very different health systems, we expected to find variation, and we did, in treatment access. But the experience gap was remarkably consistent: people with poor mental health had worse care, more unmet needs, and less trust in the system, regardless of where they lived. Health systems globally need to rethink how they serve this growing group, not just whether they can reach them.”

Freely available paper in PLOS Medicine: https://plos.io/3O045Xd

Citation: Kruk ME, Kapoor NR, Arsenault C, Carai S, Daray FM, Doubova SV, et al. (2026) Health system use and experience among people with poor mental health: A cross-sectional analysis of the People’s Voice Survey in 18 countries. PLoS Med 23(5): e1004745. https://doi.org/10.1371/journal.pmed.1004745

Author countries: United States of America, Greece, Argentina, Mexico, Peru, Ethiopia, India, South Africa, Republic of Korea, United Kingdom, Nigeria, Italy, China

Funding: This work was supported by the Bill & Melinda Gates Foundation (https://www.gatesfoundation.org/ INV-005254) to MEK; the Swiss Agency for Development and Cooperation (https://www.eda.admin.ch/deza/en/home.html; 81067262) to MEK; Merck Sharp & Dohme LLC (https://www.merck.com) to MEK; the Inter-American Development Bank (https://www.iadb.org/en; Project No. RG-T3768) to EGE; and the Taejae Research Foundation (https://taejaefoundation.or.kr/en) to JO. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The team analyzed data from the 2024 National Survey on Drug Use and Health (NSDUH). This was the first year the large‑scale, nationally representative survey asked psilocybin‑specific questions, enabling the researchers to gain a more accurate picture of past‑year use among the 58,633 respondents. Previous national surveys have grouped psilocybin with other hallucinogens and have focused on lifetime use rather than its use during the past 12 months.

“Prior surveys only captured lifetime use, which tells us little about current use patterns; someone who tried psilocybin once in college a decade ago and someone using it regularly today look identical in that data. Past-year gives us a much more clinically relevant picture of who is using psilocybin right now and what factors are associated with their use,” said first author Kevin Yang, MD, resident physician in the Department of Psychiatry at UC San Diego School of Medicine.

The research found:

• 18–25 year-olds had 1.4x the odds of psilocybin use compared to those ages 35–49, while those over 50 had about one-third lower odds
• Males had 1.7x the odds compared to females and white respondents had 2.5x the odds of Black respondents and 1.4x the odds of Hispanic respondents
• The use of cannabis and hallucinogens like LSD, MDMA and ketamine was strongly associated with past-year psilocybin use.
• Alcohol use disorder and prescription stimulant misuse were also correlated with psilocybin use.
• Individuals with a major depressive episode in the past year had higher odds of psilocybin use.

The findings have implications for clinical practice. Over the past decade, clinical trials have revealed that psilocybin has promising therapeutic effects for depression and treatment‑resistant depression, but the safety profile of unsupervised, naturalistic use remains unclear. Unlike controlled clinical settings where participants are carefully screened, doses are standardized, and psychological support is provided, naturalistic use lacks these safeguards.

“When psilocybin is used outside of a clinical setting, the risks look very different. We’ve seen reports of anxiety, paranoia and prolonged psychological distress, and there are also potential interactions with antidepressants that clinicians need to look out for,” said Yang.

He says the findings highlight the need for clinicians to be aware of psilocybin use among their patients, particularly those with depression.

“With 8 million Americans using psilocybin in the past year, this is something that psychiatrists and other clinicians should be asking about, including why patients are using it and what benefits they perceive, as well as being prepared to counsel them on harm reduction and potential risks,” said Yang.

Looking forward, Yang says longitudinal studies that track the mental health of people over time as they use psilocybin are needed, as well as increased public health surveillance as de‑criminalization and potential FDA approval of the substance progress.

Additional co-authors on the study include: Avery Eun, UC San Diego School of Medicine; Joseph J. Palamar, NYU Grossman School of Medicine.

Read the full study here.

These services are frequently hosted on digital platforms which can be inaccessible to disabled people, the consequences of which can be life-altering.

Blind people, for example, have reported being unable to book vaccinations during the pandemic due to websites that block screen readers. Wheelchair users report having to give their secure card details to strangers when they cannot reach a payment kiosk.

Disabled voters may face challenges accessing online voter registration systems or digital voting platforms that are not designed with accessibility in mind, effectively excluding them from participating in democratic processes.

The new book Digital Accessibility Ethics: Disability Inclusion in all Things Tech, with contributions from a global coalition of experts and advocates, calls for urgent action.

“Digital accessibility is not a luxury, it’s a civil and human right,” the editors Lainey Feingold, Reginé Gilbert and Chancey Fleet argue. “Without it, disabled people are excluded from participating in society, and the digital world cannot be ethical.”

Inequity in the digital age

The team of 39 expert authors demonstrate how the digital accessibility gap, a component of the digital divide, harms disabled people, who make up over 1 billion of the global population according to the World Health Organisation.

The experts argue that inaccessibility is pervasive and a daily challenge. As more services move online and technology continues to advance, without digital accessibility the digital divide will continue to widen.

“Increasingly, everything is digital,” the editors explain. “Our devices help us find our next job, our next love, our community gathering places. Learning and teaching happen online – in and out of the classroom, the workplace, the library. We depend on computers for work, entertainment, shopping, civic participation, and connection. Digital tools allow us to withdraw our own money, listen to music, play games, follow our favourite teams, and participate in local government.

“Legal problems are increasingly handled online. Daily, we look to our phones to find our way. In an emergency, the digital devices in our pockets offer critical safety information and unite us with loved ones.

“None of this is possible for people with disabilities when digital tools and content are not accessible.”

Inaccessibility has economic and social consequences for disabled people, who are more likely to live in poverty, face higher unemployment rates and lack access to critical services due to systemic barriers. Employers also miss out on the skills and creativity of a large section of society when disabled people are blocked from leadership potential by inaccessible workplace tools.

Systemic exclusion

One example where the stakes could not be higher is in emergencies and crises. According to the United Nations, only 20% of disabled individuals can evacuate without support, but less than 40% of emergency plans mention disability at all.

“These statistics are not coincidences,” explains Erin E. Brown, a Bahamian Disability Inclusion Consultant. “They are symptoms of structural ableism, where emergency preparedness frameworks fail to incorporate basic accessibility, digital or otherwise. And in a world increasingly reliant on technology to issue warnings, give directions, and provide services, the absence of digital accessibility is more than a design flaw. It’s an ethical breach.”

Emergency alerts and news updates often fail to include captions, sign language interpretation or screen-reader-friendly formats, leaving deaf, blind and neurodivergent individuals without critical emergency information.

A roadmap for change

The authors introduce a Digital Accessibility Ethics Framework, a tool designed to guide governments, corporations and people in creating inclusive digital environments.

The authors call for immediate action in several key areas, including introducing the Ethics Framework into organisational decision-making before exclusion happens, calling for more government accountability and enforcing compliance with the growing number of digital accessibility legal requirements across the globe.

The authors also suggest organisations should focus on creating digital tools and content that disabled people can use just as easily and independently as everyone else. This means adopting policies to ensure all technologies, whether purchased, licensed, or free, provide equal access to everyone.

They also suggest organisations should provide accurate and current accessibility information about their products and services, including a clear roadmap for addressing accessibility gaps. A robust feedback loop should be established to capture, remediate, and report on issues identified by disabled individuals, ensuring their voices are heard and acted upon, they advise.

“While technology and law are rapidly changing, one thing remains constant: the continued growth of the digital world. In the coming years, more decisions will be made about digital tools and content that impact ever-increasing aspects of our lives. Digital accessibility ethics must be part of that decision‑making,” the editors conclude.

DOI: 10.1201/9781003616702 

Researchers found that initially DAA treatment was concentrated among older adults and those with Medicare or commercial insurance, but over time, treatment has shifted toward younger patients and Medicaid beneficiaries. Specialist prescribing peaked in 2015 and then declined through 2025.

“Treatment levels being too low may help explain why hepatitis C prevalence hasn’t fallen (and may have even increased) in recent years,” said senior author Benjamin Rome, MD, MPH, a faculty member in the Division of Pharmacoepidemiology and Pharmacoeconomics in the Mass General Brigham Department of Medicine. “Elimination will require system-level changes, not just better screening.”

“Hepatitis C is a curable disease, but current treatment levels are substantially below what’s needed to achieve national elimination targets,” said lead author Sanjay Kishore, MD, a faculty member at the University of Viriginia School of Medicine and a former resident at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system.

Authorship: In addition to Kishore and Rome, co-authors include Margaret Hayden, Micah Johnson, and Aaron S. Kesselheim.

Disclosures: Kishore and Hayden reported consulting for the Equal Justice Initiative. Kishore, Hayden, and Johnson reported being unpaid cofounders of EqualCure. Kesselheim reported serving as an expert witness in cases against Gilead, Johnson & Johnson, generic manufacturers, and pharmacy benefits managers and serving as a consultant for Alosa Health. Rome reported receiving grants from Humana, Elevance Health Public Policy Institute, and PCMA Foundation and personal fees from Alosa Health.

Funding: Kesselheim and Rome were supported by a grant from Arnold Venture.

Paper cited: Kishore S et al. “National Prescribing Trends of Direct-Acting Antivirals for Hepatitis C” JAMA DOI: 10.1001/jama.2026.3328

As the global health landscape undergoes rapid transformation, the role of the pharmacy profession has never been more critical to the stability and efficacy of health systems. In this interview Dr Catherine Duggan, the Chief Executive Officer of the International Pharmaceutical Federation (FIP), describes how FIP is working to meet these challenges. FIP is a non-governmental, not-for-profit organisation that was established in 1912; Dr Duggan emphasizes that the “absolute nugget of FIP is to advance pharmacy worldwide”. FIP represents a global footprint of 160 member organisations comprising pharmacists, pharmaceutical scientists, and educators across all six World Health Organization (WHO) regions, she adds.

Strategic alliances and global health governance

FIP maintains a unique and long-standing position within global health governance, having been in official relations with the WHO since 1948 and UNESCO since 2010. As a “non-state actor,” FIP works directly with the WHO through triennial work plans to ensure pharmacy plays its full role in global health. These plans address wide-ranging issues, including the global workforce, academic capacity, migration, and the maintenance of essential medicines lists.

Dr Duggan emphasises that FIP’s advocacy is more urgent than ever due to recent staffing cuts within the United Nations and WHO. She says that “pharmacy needs to step up and step into the space” created by these resource gaps to ensure global health goals are met. Through an alliance with medics, nurses, physiotherapists, and dentists, FIP presents pharmacy-related policy statements at the World Health Assembly.  As a signatory to the 2018 Astana Declaration, FIP gained a higher profile within WHO. This high-level engagement has led the WHO Director-General, Dr. Tedros, to acknowledge that “no health system could create community pharmacy or hospital pharmacy services from scratch now” and that the profession is an “imperative for global health”.

The 2025–2030 Strategic Plan: A vision for access

FIP’s current strategic trajectory is defined by its 2025 – 2030 plan, which is closely aligned with the United Nations Sustainable Development Goals (SDGs). The core of this vision is a world where everyone has access to safe, affordable and effective medicines – a goal that Dr Duggan notes was severely challenged by the COVID-19 pandemic. To achieve this, the federation has identified six strategic objectives:

1. Universal access: Advocating for access to medicines and health services for all, as a right rather than a privilege.
2. Person-centred pharmaceutical care: Supporting pharmacists, educators, scientists, and technicians in providing well-being-focused pharmaceutical care.
3. Innovation: Placing pharmaceutical sciences at the centre of healthcare progress through innovation in pharmaceutical science. An example of this is the rapid development of covid vaccines – building on 60 years of mRNA research – in which pharmacy played a central role, notes Dr Duggan.
4. Workforce development: Equipping the workforce through leadership development and robust regulatory frameworks.
5. Combating antimicrobial resistance (AMR): Leading the global fight against antimicrobial resistance through responsible medicine use.
6. Leadership, governance and global engagement: Strengthening the capacity of nations that currently lack regulators or leadership bodies.

Equity, education and health literacy

Recognising that 70% to 75% of the global pharmacy workforce is female, FIP launched the FIPwise (Women in Science and Education) program to address the lack of women in top leadership positions. Dr Duggan, is the first female CEO in FIP’s history and she views her role as an opportunity to “champion women” and support mentorship networks.

FIP’s focus on equity extends to health literacy, which Dr Duggan identifies as a prerequisite for a world where medicines are safe and effective. She explains that health literacy is a “much more complex initiative than we first thought when it was about access to good information. This is about really meeting the patients’ needs head-on”. FIP provides tools and online learning to help pharmacists manage everyday encounters, ensuring patients and carers – whose literacy needs may be affected by cognitive impairment or language barriers – understand their medicines and treatment pathways.

Clinical priorities: non-communicable diseases (NCDs) and antimicrobial stewardship

One of the most pressing challenges addressed by FIP is the rise of non-communicable diseases (NCDs), which now account for 74% of deaths worldwide. Five conditions make up the bulk of this – cardiovascular disease, chronic obstructive pulmonary disease (COPD), cancer, diabetes and mental health. Pharmacists are naturally positioned to lead in this area; Dr Duggan notes that “pharmacists manage those NCDs in their sleep almost. It’s our bread and butter”. FIP has expanded its focus to a “five times five” approach, targeting the five major groups alongside tobacco use, diet, physical activity, alcohol consumption and air pollution.

In the realm of communicable diseases, FIP’s work on antimicrobial resistance (AMR) is significant. During the 83rd World Congress of Pharmacy, 82 member organisations signed the FIP Copenhagen Declaration on AMR. This declaration sets out global priorities, including international partnerships, promoting vaccination and responsible use of antimicrobials, safeguarding medical supply chains and advancing research on antimicrobial stewardship and health outcomes. FIP supports these efforts with data from its Global Pharmaceutical Observatory and regional roadmaps tailored to the specific needs of different WHO regions.

Responsiveness in crisis: Humanity Rx and pandemic learnings

The frequency of global crises has increased significantly; Dr Duggan notes that “we have 10 times more crises now in a year than we did in 2018”. In response, FIP developed Humanity Rx, a designated program and collaborative competency framework for pharmacists working in humanitarian environments—whether as experts or frontline responders to wars, floods, and earthquakes.

The COVID-19 pandemic further underscored the profession’s resilience. Through the “COVID 1000 Days” report, FIP analysed how pharmacy rose to the challenges imposed by the pandemic. Dr Duggan notes that community pharmacies remained operational while “everyone else closed their doors”. The pandemic highlighted the stark association between health outcomes and social determinants of health, prompting FIP to issue statements of principle on protecting both vulnerable patients and the profession itself.

FIP membership benefits

FIP offers the individual a global network of colleagues with whom to share knowledge, experiences and expertise. The benefits include not only sharing best practices but also “listening, learning, being part of our communication structure and sharing your stresses and troubles around developing services, getting them funded, getting them recognised. This is this is part of the tangible benefits and the intangible or the innate is the friendships that you make….. having friends across the world really pulls you together in a new way”, says Dr Duggan.

Conclusion: Recognising professional worth

For frontline healthcare professionals, Dr Duggan’s closing message is one of confidence and self-worth. Pharmacy offers a unique breadth of expertise, allowing professionals to cross sectors – from drug discovery to patient-facing care – carrying highly-valued transferable skills.

One key takeaway for the profession is Duggan’s advice: “Do not wait for perfection to stand in the way of good”. Whether through service development or policy discussion, pharmacists must be vocal about their value – “where we have evidence of impact, to be confident about that”, she says. Dr Duggan concludes with a powerful reminder of the profession’s role in the global health ecosystem: “Without pharmacy, we don’t have healthcare. And that’s the mantra I think we should all be really proud to deliver”.

About Catherine Duggan

Catherine Duggan is currently the Chief Executive Officer of the International Pharmaceutical Federation (FIP), a role that she has held since 2018.

Before joining FIP, Dr Duggan held several senior roles at the Royal Pharmaceutical Society, including Director of Professional Development and Support and interim Country Director for England.

Earlier in her career she served as Chair of UKCPA and as a member of the RPSGB Council. She also had a portfolio of roles across academia, hospital, primary care and community sectors.

Recently, she was the recipient of the 2025 RPS Charter Award, in recognition for her outstanding leadership, global impact and unwavering commitment to advancing the pharmacy profession worldwide.

The findings were published on March 9, 2026 in the CMAJ/Canadian Medical Association Journal.

“Our findings may reflect improved recognition and treatment of ADHD in adulthood; however, the speed and scale of this growth also raises important questions about how diagnoses are being made, and if this prescribing is always appropriate,” said Dr. Tara Gomes, program director of the Ontario Drug Policy Research Network at St. Michael’s Hospital, Unity Health Toronto and an ICES scientist, Toronto, Ontario.

As background, the researchers noted that, historically, stimulants have been prescribed mainly for pediatric cases of ADHD and some other conditions. But in the past 20 years, ADHD diagnoses and stimulant prescriptions have increased among adults, and data shows that this change accelerated after the start of the pandemic.

“We sought to examine patterns of stimulants dispensed to adults in Ontario and characterize adults who initiated such therapy before and during the pandemic,” the authors said.

The investigators used a regional database to identify monthly rates of new stimulant dispensations among adults in Ontario between January 2016 and June 2024

They found that among 327,053 adults who initiated stimulant therapy, the median age was 31 years and 55.4% were female.

When compared with stimulant prescribing before the COVID-19 pandemic, new adult users during the pandemic were more likely to be aged 25 to 34 years (26.5% v. 32.8%) and female (48.0% v. 59.0%). And the drugs were less likely to be prescribed by psychiatrists (25.5% v. 18.0%).

The rate of new stimulant dispensations rose from 0.16 to 0.44 new monthly dispensations per 1000 people between January 2016 and June 2024.

“Many of these findings are consistent with trends in stimulant prescribing observed globally in the post-pandemic era and are likely influenced by greater awareness of adult ADHD and improved access to care following a historical pattern of underdiagnosis of ADHD in adulthood — particularly among women,” said coauthor Dr. Mina Tadrous, associate professor, Leslie Dan Faculty of Pharmacy, University of Toronto. “However, the rising impact of social media influencers on ADHD awareness in young adults, as well as the rapid evolution of virtual health services that support online assessments and treatment, may also be contributing to misdiagnoses and potential harm.”

The authors concluded, “In Ontario, rates of new prescriptions for stimulants dispensed to adults accelerated rapidly during the COVID-19 pandemic. Monitoring and evaluation are needed to ensure appropriateness of use and safeguard against potential harms.”

The emergence of online healthcare via mobile apps has brought about changes in the availability of and demand for health care. The current study, published in The Economic Journal, analyzes the consumption patterns of 19- and 20-year-olds.

The study is based on data from young people in the regions of Stockholm and Västra Götaland. During the study period, 1 9-year-olds were not charged a co-pay for online consultations, while 20-year-olds had to pay a fee..

Price sensitivity among patients was evident. Those who had turned 20 had on average half the number of online consultations compared to 19-year-olds. Women generally had higher consultation rates than men, and experienced a sharper decline once they turned 20.

The value of easing worries

“People often seek online healthcare for simple ailments, a type of care for which price generally matters more,” says Gustav Kjellsson, a researcher in health economics at the University of Gothenburg. “This doesn’t necessarily mean that it is unwarranted care. It’s important to bear in mind that without access to medical expertise, it is difficult to determine which healthcare needs you actually have. Easing people’s worries also has a value.”

The researchers estimate that 45% of the online consultations by 19-year-olds substituted a physical visit, while the remaining 55% represented care that would not have taken place without easy access to online care.

“These often relate to respiratory infections, skin conditions, and healthcare related to sexual and reproductive health, such as contraceptive management, which would typically be handled by a midwife,” he continues. “What we are seeing is a shift toward more care provided by doctors.”

Cost-neutral increase in volume

The researchers found no measurable negative medical effects from the shift toward more online and fewer in-person consultations, either on follow-up care or complication rates. A secondary finding is that young men, who are generally less inclined to seek healthcare, increased their visits to youth clinics.

“This may be an effect of an initial online doctor consultation,” says Gustav Kjellsson. “Accessibility may make it easier to seek help for conditions that are sensitive in nature, such as sexually transmitted diseases.”

The Swedish debate on online doctors involves quality of healthcare, resource allocation, the extent to which the burden on primary care is relieved, and not least how the regions reimburse private online doctor consultations. Against this background, there is another finding in the study that the researchers say stands out: The increased consumption of healthcare among 19- and 20-year-olds did not result in higher total production costs.“Interestingly, our estimates indicate that the increased volume of healthcare is more or less cost neutral. The regions’ costs for digital healthcare are not primarily due to production costs, but to the reimbursement models of private online consultation.”

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.

Defined as the collective ability of a team to generate novel and useful ideas, team creativity has long been studied in business and organizational psychology. However, until now, it had not been explicitly examined or validated in primary health care.

“Primary care teams are under growing strain. Despite being central to delivering high-quality, patient-centered care, these teams face rising burnout and declining job satisfaction,” said Yuna Lee, PhD, assistant professor of Health Policy and Management at Columbia Mailman School, and first author. “Over the past two decades, many interventions have attempted to improve clinician well-being, but most have focused on individual resilience or workload. Our findings suggest that strengthening team-level conditions—specifically creativity—may simultaneously reduce burnout, enhance satisfaction, and improve care.”

The study was conducted within a large New York State health system serving approximately 12 million people, with 85,000 employees, 21 hospitals, and 890 outpatient care centers. The sample included approximately 400 primary care providers and team members.

Among survey respondents, 32 percent had worked in their practice for more than five years; 16 percent were physicians, and 24 percent were registered nurses. Eighty-two percent identified as female, and 56 percent identified as White.

The study makes three key contributions to health services research:

1. Establishes team creativity as a meaningful concept in primary care. This is the first study to show the importance of team creativity to well-being outcomes in a setting that requires optimal teamwork for high-quality, patient-centered care.
2. Introduces and validates a practical measurement tool for measuring team creativity in primary care teams.
3. Advances understanding of how the work life of health care professionals impacts their well-being and, subsequently, patient care.

“Our study highlights the pivotal role of creativity in primary care teams,” said Lee. “Drawing on decades of research in management, organizational behavior, and social psychology, we show that creativity is not just about innovation—it is closely tied to how clinicians experience their work. This has significant implications for how health systems approach burnout.”

Lee continues, “With state policymakers and health system leaders under pressure to improve outcomes while addressing workforce shortages, our findings suggest that fostering team creativity should be viewed as a strategic asset.

Co-authors are Nancy LaVine, Northwell Health and Department of Medicine, Lenox Hill Hospital; Cheryl Rathert, College for Public Health and Social Justice, Saint Louis University; Yulia Kogan, Population Health Analytics, Northwell Health; and Lusine Poghosyan, Stone Foundation and Elise D. Fish Columbia University Professor of Nursing and Professor of Health Policy and Management.

The study was supported by the Agency for Healthcare Research and Quality (Grant 5R03HS027502-02).

The British Medical Association (BMA) says that, by 2040, England should have one  full time equivalent (FTE) GP for every 1,000 patients, to ensure manageable workloads and patient safety.

But new data released last month shows that every one of England’s 42 ICBs is falling far short of meeting this safe threshold, explains Stephanie Santos Paulo.

Nationally, there is one FTE GP for every 2,220 patients, but ICB level data show some regions are facing a far more severe doctor drought than others. The highest reported patient to doctor ratios are in London, Bedfordshire, Luton and Milton Keynes, where there are more than 2,700 patients for every GP.

“No matter where a patient lives in England, the safe limit for patients is being exceeded, with patient demand far outstripping GP capacity,” said Katie Bramall, chair of the BMA’s GP Committee.

Victoria Tzortziou Brown, chair of the Royal College of GPs, added that the findings demonstrated the “troubling picture” of general practice under growing strain. “The pressures on general practice are clearly far beyond what is safe or sustainable,” she said.

But a Department of Health and Social Care (DHSC) spokesperson defended the government’s record on GP numbers, saying, “We currently have the highest number of fully qualified GPs since at least 2015 thanks to actions taken by this government.”

While it is true that England now has 648 more FTE GPs than six years ago, since then around 3.7 million more patients have been registered at GP practices. This represents a 6% rise in patient numbers, against a 2% increase in GPs, leaving practices more thinly spread.

What’s more, since 2019 the gap between the most and least stretched ICBs has hardly changed, suggesting that these workforce shortages are chronic.

Tzortziou Brown said the “stark disparities” between ICBs were worrying. “We know that areas facing higher deprivation often have the highest ratios of patients to GPs, as well as the most difficulty recruiting and retaining GPs,” she said.

A spokesperson for Bedfordshire, Luton and Milton Keynes ICB said, “We presently have over 140 GPs in training roles, many of whom we expect to contribute to improving our GP to patient ratio when they qualify.” But they acknowledged that a low number of GP vacancies could make it difficult for trainees to secure posts once they qualified.

The data underline what GP leaders describe as a paradox in the workforce crisis, with qualified GPs unable to find work while their employed counterparts struggle to keep pace with growing patient lists, writes Santos Paulo.

The DHSC says it has recruited more than 2,000 extra GPs in the past year, and health and social care secretary Wes Streeting has also pledged to expand training numbers further.

But expansion of GP training places would need to be considerable to keep up with growing demand, argues Santos Paulo. In 2025, there were 20,995 applications for 4,726 GP specialty training posts, a ratio of almost five applicants per post. This competition ratio has more than tripled since 2019, when there were just 1.34 applications per post.

She also points out that despite workforce pressures, the monthly number of GP appointments rose by more than 10 million between December 2018 and December 2025, reaching a record high last year.

The DHSC spokesperson said that GPs are “at the heart” of the government’s “historic shift” from hospital to community and will benefit from a growing share of NHS funding.

But Tzortziou Brown said the health secretary’s promises to support general practice and deliver “thousands more GPs” must be backed by a clear and robust 10 year workforce plan.

“General practice is the bedrock of the NHS,” she says. “With the right investment and meaningful initiatives to recruit and retain GPs we can turn this ar

For years, drug companies and industry allies have argued that the U.S. gets faster and wider access because its government moves quicker than foreign regulators, but the new analysis suggests the U.S. advantage in drug access is driven less by faster government review and more by when companies apply for review and the type of drugs they submit.

The study, published in Health Affairs, looked at every new prescription drug approved between 2014 and 2018 in the U.S., and Europe, and then tracked submission delays and review times for these products across regulators in Canada, Japan and Australia through the end of 2022. The analysis assessed the speed of the review process and the timing of submissions for approval, with results broken down by drug characteristics, including therapeutic value of the drugs.

Specifically, the researchers explored whether different patterns in submission and review times emerged for drugs that offered little added medical benefit over drugs that were already on the market.

“Some commentators have argued that foreign regulators take too long to review drugs and should do more to ensure timely access to new therapies, often pointing to limited availability of new cancer therapies in Europe and other rich markets relative to what’s on the market in the United States, as evidence that regulatory red tape is getting in the way of timely patient access,” said lead author Irene Papanicolas, a professor of health services, policy and practice at the Brown University School of Public Health. “Where we’re coming at this from is saying that broader availability of new medicines is generally a great thing — we want patients to get access to new meds — but not all new medications are equally important from a medical standpoint.”

In fact, what stood out most was how companies handled drugs that provide little therapeutic advantage over existing treatments, which the authors referred to as “low-value” drugs in their analysis. The researchers found these drugs were typically submitted to U.S. regulators months or even years before companies sought approval in other high-income countries, giving Americans earlier and wider access to expensive drugs that may not significantly improve patient outcomes.

The findings likely reflect a mix of business incentives and policy choices, according to the research team which along with Papanicolas and other Brown co-authors Olivier Wouters and Tania Sawaya also includes health policy experts from Vanderbilt University and the London School of Economics and Political Science.

The U.S. is the world’s largest drug market, and manufacturers can generally set prices freely when a drug launches. In contrast, many other countries evaluate how much a new drug improves health compared with existing treatments and use that information to negotiate prices or limit coverage, said Wouters, an associate professor in the Department of Health Services, Policy, and Practice.

“There are many drugs that enter the U.S. market that frankly aren’t much better than what’s already available,” Wouters said. “Companies generally seem to submit these lower-value products for approval  earlier in the United States than in other markets. This may reflect the fact that governments in other countries tend to drive a tougher bargain than U.S. payers, which could influence companies’ decisions about where and when to seek approval.”

The study also showed that drugs offering clear medical benefits over existing treatments tended to reach most high-income countries at roughly the same time. This is because drugmakers typically submit those products for approval simultaneously across the high-income countries the researchers looked at. The Food and Drug Administration was only slightly faster than its counterparts abroad in approving the drugs by a few weeks or a month on average, the researchers said.

“Historically, yes, the U.S. gets more new drugs and gets them faster than other countries but a lot of what is driving this pattern aren’t the drugs that have this meaningful therapeutic gain for patients,” Papanicolas said. “Everybody’s getting those important new drugs quickly.”

Overall, the study helps add nuance to the question of why the U.S. spends far more on prescription drugs than other high-income countries without consistently better health outcomes. It also paints a more complicated picture as policymakers debate proposals such as the “most favored nation” approach, to bring down drug spending, which proposes linking U.S. drug prices to those paid in peer countries.

“It’s not clear how this is going to work,” Papanicolas said. “How will the US authorities handle products that haven’t yet been marketed abroad? Will the policy affect where and when companies decide to submit drugs abroad? No one really knows yet.”