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Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.

From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.

The word limit for letters selected from posted responses remains 300 words.

Re: NHS England: divorced, beheaded, died
Re: NHS England: divorced, beheaded, died Kamran Abbasi. 388:doi 10.1136/bmj.r555

Dear Editor,

Congratulations on being one of the few commentators to correctly state that NHS Commissioning Board was formed by the Lansley reforms. The organisation was unhappy with being only first amongst equals with clinical commissioning groups at a local level.

Simon Stevens' well connected endeavours rapidly promoted NHSCB with the alias NHS England. And the major point of the reforms was conceded. This name only became official in 2022 at the same time as ICBs came in to being, see the first section of the 2022 NHS act. During the brief 3 year history of NHS England, it has not been as effective as its predecessor organisation. Whilst promoting the 2022 Act I asked the CEO if structural reform of CCGs was needed and she said that the structures were less important than the functions. However the structural reforms do damage the functioning of the organisation taking from four to 10 years to recover. During this time it is likely that large hospital trusts will successfully consolidate their control of local systems and their power will reconstruct the carefully constructed integration between multiple organisations developing along the lines laid out in 2016.

Without an alternative and compelling narrative as to future function, control is most likely to be determined by financial flows rather than population need, public health design or clinical requirements.

Competing interests: No competing interests

23 March 2025
David O'Hagan
GP
Liverpool
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Inclusive clinical trials: an oxymoron?
Re: Inclusive research: a path to equity and better outcomes Sonia S Anand, Laura Arbour, Gina S Ogilvie, Alan T N Tita. 388:doi 10.1136/bmj-2024-082486

Dear Editor

The call for “proportional representation of all ethnic groups in clinical trials” is, at best, naïve (1,2).

Clinical trials aim to establish causal relationships through strict selection criteria. Inclusion and exclusion criteria are designed to optimize study success and minimize bias. Mandating representation based on cultural traits—such as language, religion, or diet—complicates recruitment, increases type II error risk, and introduces poorly defined variables.

Calls for “inclusive” research prioritize ideology over scientific rigour. Pivotal trials already face major challenges, including reproducibility issues. Adding arbitrary barriers undermines their primary goal: experimentation, not real-life representation. These trials serve as prerequisites for drug approval, not reflections of population diversity. Regulatory agencies should focus on translational medicine—bridging experimental settings with real-world applications—rather than enforcing artificial inclusivity. Of note, subgroup analyses from clinical trials are often unreliable and should remain hypothesis-generating.”(3) In contrast, observational studies, using comprehensive national healthcare databases like those in Nordic countries or France, are better suited for assessing real-world benefits and harms. Pre-registering hypotheses, study designs, and analytical plans—through platforms like Open Science Framework— should be the mandatory norm in observational research to ensure scientific integrity.(4,5)

References
1. Anand SS, Arbour L, Ogilvie GS, Tita ATN. Inclusive research: a path to equity and better outcomes. BMJ. 2025;388:e082486. Published 2025 Mar 11. doi:10.1136/bmj-2024-082486
2. Anand SS, Bosch J, Mehran R, Mehta SR, Patel MR. Designing inclusive clinical trials: how researchers can drive change to improve diversity. BMJ. 2025;388:e082485. Published 2025 Mar 11. doi:10.1136/bmj-2024-082485
3. Wallach JD, Sullivan PG, Trepanowski JF, Sainani KL, Steyerberg EW, Ioannidis JP. Evaluation of evidence of statistical support and corroboration of subgroup claims in randomized clinical trials. JAMA Intern Med. 2017;177(4):554-560. doi:10.1001/jamainternmed.2016.9125
4. Braillon A, Naudet F. STROBE and pre-registration of observational studies. BMJ. 2023;380:90. Published 2023 Jan 18. doi:10.1136/bmj.p90
5. Naudet F, Patel CJ, DeVito NJ, et al. Improving the transparency and reliability of observational studies through registration. BMJ. 2024;384:e076123. Published 2024 Jan 9. doi:10.1136/bmj-2023-076123

Competing interests: I'm an old geezer from Northern France with variable practices.

23 March 2025
alain braillon
retired senior consultant
80000 Amiens. France
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Re: Offer me hope to overcome gambling harm
Re: Offer me hope to overcome gambling harm Sue Acton. 388:doi 10.1136/bmj.r331

Dear Editor

Hats off to Sue Acton for her painfully honest depicted journey from gambling addiction to gambling sobriety. I've known individuals whose families were irreversibly damaged by the mode of gambling very similar to hers. Whether it concerns gambling addiction, or addiction to drugs, alcohol, clothes, chocolate, sex, etc, addictive behaviour is still not fully understood, owing to somewhat low awareness perhaps. Channel 5 drama "Compulsion" (2022), available on iPlayer is a good starting point for everyone willing to reflect on how a single bet could lead to a disaster.

Competing interests: No competing interests

23 March 2025
Ann Mason
Occupational Medicine Physician
Milton Keynes
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Is it public health or policy makers failing?

Re: Trends in UK mortality reflect a public health failure Lucinda Hiam, David Walsh, Gerry McCartney. 388:doi 10.1136/bmj.r525

Dear Editor

It's not just mortality but morbidity that’s affected by austerity. People living in the most deprived communities spend more years in ill health - since they get multiple long-term health conditions 10 to 15 years earlier than those living in richer neighbourhoods.(1)

But even more importantly, the headline here surely doesn’t help?

There’s a call for a ‘reversal of austerity policies’ and, hidden deep in the article, a mention on policy makers being held accountable.
But the headline says its public health that has failed.

Lets please ‘avoid [an] incomplete narrative’ and instead hold the different governments since 2010 - the policymakers - accountable?
Including the current government.

A few weeks ago Rachel Reeves changed her mind on non-doms tax “after one of the world’s most powerful financiers asked her personally not to increase the tax burden on the super rich.”(2)
Could someone please ask her why she is not doing something about the shameful increase in the number of people living in destitution: 3.8 million in 2022 - 60% of them disabled? (3) Being destitute means you struggle to afford to meet the most basic physical needs to stay warm, dry, clean and fed. Which of course makes disability worse.

1) Multiple long-term conditions (multimorbidity) and inequality- addressing the challenge: insights from research
HEALTH AND SOCIAL CARE SERVICES RESEARCH
20.09.23 // 10.3310/nihrevidence_59977
2) Shone E. Rachel Reeves softened non-dom plans after Blackstone CEO ‘raised concerns’. Open Democracy 6 March 2025.
3) Suzanne Fitzpatrick, Glen Bramley, Morag Treanor, Janice Blenkinsopp, Jill McIntyre, Sarah Johnsen, and Lynne McMordie. Destitution in the UK 2023. 24 October 2023. JRF.

Competing interests: I've got multiple long term conditions

22 March 2025
caroline mawer
Person with multiple long term conditions / ill health retired doctor
London
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Re: Abolishing NHS England: risks and opportunities
Re: Abolishing NHS England: risks and opportunities Nigel Crisp. 388:doi 10.1136/bmj.r553

Dear Editor,

Your poll on the abolition of NHS England seems to run neck to neck. I pondered over how I might respond and then felt compelled to agree with the abolition, even if I believe it could all have been done more compassionately and with consideration for the large number of employees of the organisation. I have heard Wes Streeting say variously that there are 18,000 or around 11,000, though it doesn't really matter if is ten employees or ten thousand.

What matters at this time, as Lord Crisp with his vast experience has articulated, is that there are cool heads at the top. The impression many of us get from recent politics, is that the Starmer government are in competition with the Trump government, almost as if they want to outdo the Trump-Musk shooting from the hip tactics.

The NHS, as many will admit, has been in better health in the past, and despite its many challenges (I would hate to think these as failings because it is policies and funding that are the main culprits here and not those who work in it), it soldiers on, providing a service that remains as comprehensive as possible and free at the point of delivery.

There are many wise suggestions in Lord Crisp's piece. Life is all about relationships, and there is much repair work required by the government who will at some point have to stop blaming others for current problems with the NHS and the economy.

Ultimately it is us on the ground, the doctors, nurses, pharmacists, therapists, porters, and admin staff, who can deliver on their ambitions.

Harnessing our goodwill requires maturity and kindness. That would be my prescription for better handling of the NHS.

Competing interests: Fellow BMJ Commissioner for the Future of the NHS project

22 March 2025
JS Bamrah
NHS Consultant Psychiatrist
NHS
Park View, North Manchester General Hospital, Crumpsall, Manchester M8 5RB
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Re: Medical journals should use the term “public health and social measures”
Re: Medical journals should use the term “public health and social measures” Azeem Majeed, Kamran Abbasi. 388:doi 10.1136/bmj.r409

Dear Editor

Professor Majeed and colleagues recently proposed replacing the traditional term "non-pharmaceutical interventions" (NPIs) with the more constructive phrase "public health and social measures" (PHSMs) in medical literature. Using PHSMs can facilitate consensus on the importance of such measures and minimise communication barriers caused by terminological ambiguities.

Given that the World Health Organization (WHO) initially promoted the PHSM initiative during the COVID-19 pandemic, it is crucial to reflect on the lessons learned from this global crisis and how they may inform future practices (1).

China's response to COVID-19 provides a particularly salient example, developing a comprehensive approach termed the "dynamic zero-COVID" strategy. This approach not only included conventional measures such as mask-wearing, disinfection, isolation of infected individuals but also incorporated innovative measures, such as rapid contact tracing (within 24 hours), extensive use of big data (for precise identification of contacts and at-risk populations), and active community participation (2). Clearly, categorising these multifaceted strategies merely as NPIs does not adequately capture their scope or significance.

These integrated measures remained highly effective even after vaccines were introduced. However, when many countries lifted these measures prematurely in early 2022, the emergence of the Omicron variant caused global daily cases to spike from 15 million to about 45 million, highlighting the significant risks of undervaluing PHSMs (3).

Persisting with the term NPIs risks undervaluing their positive contributions and overlooking potential negative consequences of excessively strict or prolonged measures (4). Such overly restrictive policies can lead to severe repercussions, including resource wastage, increased unemployment, and disproportionate impacts on disadvantaged groups with limited resilience to economic shocks.

Although NPIs have long been widely accepted, academic progress demands that terminology evolves alongside societal change. Precision in definitions is fundamental, and thus we support this progressive shift in terminology, reflecting the evolving understanding and response to public health challenges.

References
1. World Health Organization. Public health and social measures during health emergencies. https://www.who.int/initiatives/who-public-health-and-social-measures-in....
2. Chen H, Shi L, Zhang Y, et al. Comparison of Public Health Containment Measures of COVID-19 in China and India. Risk Manag Healthc Policy 2021:14:3323-3332. doi: 10.2147/RMHP.S326775.
3. Sachs JD, Karim SSA, Aknin L, et al. The Lancet Commission on lessons for the future from the COVID-19 pandemic. Lancet 2022;400:1224-1280. doi: 10.1016/S0140-6736(22)01585-9.
4. Tang JL, Abbasi K. What can the world learn from China’s response to covid-19? BMJ 2021:375:n2806. doi: 10.1136/bmj.n2806.

Competing interests: No competing interests

22 March 2025
Yong Wu
associate professor
Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
56 Yulv road, Shenzhen 518102, China
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Re: Response to Dr. Sudfeld regarding errors in trial inclusion in meta-analysis of the effect of vitamin A supplementation on the incidence of measles
Re: Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis Zulfiqar A Bhutta, et al. 343:doi 10.1136/bmj.d5094

Dear Editor

We acknowledge the comments from Dr. Sudfeld and have revisited the included studies in the analysis on the effect of vitamin A supplementation on incidence of Measles. We agree that case definition in studies by Semba 1995 et al. and Bahl 1999 et al. was not clear. We however notice that in the study by Semba 1995 et al.[1] the reported cases of measles-like rash in both vitamin A and placebo group were higher than 5% which is the typical occurrence of rash post measle vaccination [2]. So, it was not clear if there were actual cases of measles or just the measle-like rash. We however agree that data from both Semba 1995 and Bahl 1999 could be excluded because of lack of clear definition of measles cases. In studies by Herrera 1992 and Barreto 1994, the data were reported for subset of population and not the whole populations allocated to vitamin A and placebo group and those studies could be excluded as well [3,4].

We have revised the analysis and the revised summary estimate of RR 0.45; 95 % CI 0.30, 0.69 is not meaningfully different from the published estimate (RR 0.50, 95 % CI 0.37, 0.67). The certainty assessment based on GRADE criteria will be downgraded from high to low due to risk of bias in Chowdhury 2002 [5] study and indirectness of the pooled data. We have requested BMJ editors for an erratum to the published manuscript to show the revised analysis.

Evan Mayo-Wilson
Aamer Imdad
Zulfiqar Ahmed Bhutta

References
1. Semba RD, Munasir Z, Beeler J, et al. Reduced seroconversion to measles in infants given vitamin A with measles vaccination. Lancet. May 27 1995;345(8961):1330-2. doi:10.1016/s0140-6736(95)92536-8
2. CDC. Pink Book: Chapter 13: Measles: Available at https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-13-measles.html. Last accessed March 19th, 2025. . 2021;
3. Barreto ML, Santos LM, Assis AM, et al. Effect of vitamin A supplementation on diarrhoea and acute lower-respiratory-tract infections in young children in Brazil. Lancet. Jul 23 1994;344(8917):228-31. doi:10.1016/s0140-6736(94)92998-x
4. Fawzi WW, Herrera MG, Willett WC, Nestel P, el Amin A, Mohamed KA. Dietary vitamin A intake and the incidence of diarrhea and respiratory infection among Sudanese children. J Nutr. May 1995;125(5):1211-21. doi:10.1093/jn/125.5.1211
5. Chowdhury S, Kumar R, Ganguly NK, Kumar L, Walia BN. Effect of vitamin A supplementation on childhood morbidity and mortality. Indian J Med Sci. Jun 2002;56(6):259-64.

Competing interests: No competing interests

21 March 2025
Zulfiqar Ahmed Bhutta
Physician
Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan, Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
Stadium Road, ​P. O. Box 350​0 Karachi 7480​0, Pakistan
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Re: NHS England: divorced, beheaded, died
Re: NHS England: divorced, beheaded, died Kamran Abbasi. 388:doi 10.1136/bmj.r555

Dear Editor

In your editorial on the demise of NHS England (20 March 2025) you assert that 'public health is a shadow of the force it once was'. The unstated assumption is that somehow public health having returned to local government in 2013 under the Lansley health system reforms is in the wrong place. If this is what is being implied then it's both misleading and not backed up by the evidence. Few Directors of Public Health would wish to see a return of public health to the NHS where it remained a Cinderella sector and had little impact. It's far from clear when public health was last the force referred to and certainly not under successive 'redisorganisations' of the NHS. What is a problem are the swingeing cuts to the public health budget during the years of austerity. But had public health remained located in the NHS during this period it's almost certain its budget would have been raided as it frequently was to protect the budgets for hospital care and beds. Local authorities are public health organisations and public health belongs there.

Competing interests: No competing interests

21 March 2025
David J Hunter
Emeritus Professor of Health Policy and Management
Newcastle University
Level 3, Sir James Spence Institute, Royal Victoria Hospital, Newcastle
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Re: The US withdrawal from the WHO: a global health crisis in the making
Re: The US withdrawal from the WHO: a global health crisis in the making Kent Buse, Larry Gostin, Adeeba Kamarulzaman, Martin McKee. 388:doi 10.1136/bmj.r116

Dear Editor,

The Trump administration's decision to withdraw the U.S. from WHO(1) and freeze funding from USAI(2) threatens the progress of rehabilitation within health systems. As a major financial and technical contributor to the WHO, the U.S. has played a significant role in advancing rehabilitation as an essential health service for universal health coverage (UHC). Its withdrawal undermines this progress, endangering millions—particularly in low- and middle-income countries (LMICs)—who risk losing access to rehabilitation services and Assistive Technology (AT). The authors of this response are leaders of the International Society of Physical and Rehabilitation Medicine (ISPRM). For 25 years, ISPRM has served as a non-state actor in official relations with the WHO. ISPRM members work daily to strengthen rehabilitation within health systems across countries of all income levels. We have witnessed firsthand and supported the transformative work of the WHO in rehabilitation, shifting its perception from a highly specialized service required by a select few to its recognition as an essential health service needed by one in three people worldwide.

The global demand for rehabilitation is substantial but remains largely unmet. In 2021, 2.6 billion people could benefit from rehabilitation; however, in LMICs, up to 50% lack access(3, 4). The insufficient integration of rehabilitation into global health systems contributes to these significant unmet needs. The World Health Assembly (WHA) resolution on strengthening rehabilitation in health systems represents a historic milestone in acknowledging rehabilitation as an essential health service(5). This resolution emphasizes, for the first time, rehabilitation’s role in addressing pressing global health challenges. The WHO has provided necessary conceptual clarity, technical guidance, and stakeholder cohesion to enable health policymakers to recognize the increasing unmet rehabilitation needs and the necessity to strengthen rehabilitation within health systems(6).

The WHO’s work has focused on ensuring that rehabilitation is not an afterthought, but rather an essential component of health systems. The WHO's Rehabilitation 2030 Initiative laid the groundwork for strengthening rehabilitation services worldwide. Under this initiative, the WHO has developed technical products to assist countries in building their health systems for rehabilitation, training the rehabilitation workforce, financing evidence-based rehabilitation interventions, and strengthening primary care(7). WHO, in collaboration with partner rehabilitation stakeholders, has supported more than 70 countries to strengthen their national health systems for rehabilitation, 50 of which are currently actively implementing rehabilitation systems reforms. In addition, WHO leads the World Rehabilitation Alliance, a global network of rehabilitation stakeholders(8). The U.S. withdrawal jeopardizes these initiatives, especially in countries that depend on WHO expertise and funding to develop their national rehabilitation systems.

The U.S. withdrawal is more than just a funding issue; it is fundamentally about global health equity, human rights, and sustainable development. Rehabilitation and AT are essential for many individuals to live independently and contribute to society. By withdrawing from WHO-led initiatives, the U.S. not only diminishes its influence in international health governance but also neglects millions who depend on WHO-led rehabilitation and AT programs.

The global health community must take action to mitigate the consequences of the U.S. withdrawal. The WHA resolution on rehabilitation must be upheld, and its implementation should continue with full political and financial support. Governments and non-governmental organizations need to mobilize alternative funding sources to close the gap left by the U.S. Research must continue so that data-driven policies and innovative solutions can be implemented to expand access to rehabilitation services for everyone.

Health policymakers and rehabilitation stakeholders need to unite to sustain the momentum the WHO has helped establish and safeguard the fragile advances made in rehabilitation. The future of rehabilitation in health systems depends on our collective commitment to ensuring that no one who needs rehabilitation is left behind.

References
1. The White House. Executive order: Withdrawing the United States from the World Health Organization 2025 [Available from: https://www.whitehouse.gov/presidential-actions/2025/01/withdrawing-the-....
2. The White House. Executive order: Reevaluating and realigning United States foreign aid 2025 [Available from: https://www.whitehouse.gov/presidential-actions/2025/01/reevaluating-and....
3. World Health Organisation, Institute for Health Metrics and Evaluation. WHO Rehabilitation Need Estimator 2021 [Available from: https://vizhub.healthdata.org/rehabilitation/.
4. Kamenov K, Mills J-A, Chatterji S, Cieza A. Needs and unmet needs for rehabilitation services: a scoping review. Disability and rehabilitation. 2019;41(10):1227-37.
5. Resolution: Strengthening rehabilitation in health systems [Internet]. 2023 [cited 26/03/2023]. Available from: https://apps.who.int/gb/ebwha/pdf_files/EB152/B152(10)-en.pdf.
6. Seijas V, Kiekens C, Gimigliano F. Advancing the World Health Assembly's landmark Resolution on Strengthening Rehabilitation in Health Systems: unlocking the Future of Rehabilitation. Eur J Phys Rehabil Med. 2023;59(4):447-51.
7. Rehabilitation: Key facts [Internet]. 2024 [cited 18.02.2025]. Available from: https://www.who.int/news-room/fact-sheets/detail/rehabilitation.
8. World Rehabilitation Alliance [Internet]. 2025 [cited 10/02/2025]. Available from: https://www.who.int/initiatives/world-rehabilitation-alliance.

Competing interests: No competing interests

21 March 2025
Vanessa Seijas
Physical Medicine and Rehabilitation doctor and researcher
Mercè Avellanet, MD Rehabilitation Department, Hospital N Sra de Meritxell, Andorra; Research Group on Health Sciences, University of Andorra, Saint Julia de Loria, Andorra/Carlotte Kiekens, MD IRCCS Istituto Ortopedico Galeazzi, Milan, Italy/ Gerard E. Francisco, MD/President, International Society of Physical and Rehabilitation Medicine (ISPRM); Department of Physical Medicine and Rehabilitation, The University of Texas; Health Science Center at Houston, McGovern Medical School, Houston, Texas USA/ Raju Dhakal, MD Spinal Injury Rehabilitation Center, Banepa, Kavre, Nepal. Patan Academy of Health Sciences, Lalitpur, Nepal. Walter Frontera, MD, PhD University of Puerto Rico School of Medicine, San Juan, Puerto Rico/Abderrazak Hajjioui, MD, MPM, PhD Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy, Abdelmalek Essaâdi University, Tangier, Morocco; Department of Physical Medicine and Rehabilitation, Mohammed VI Teaching University Hospital, Tangier, Morocco/Sinforian Kambou, MD Center for Promotion of Rehabilitation Medicine and Disability Research, Yaoundé Cameroon; Institute of Applied Neurosciences and Functional Rehabilitation, Yaoundé, Cameroon/Luz Helena Lugo Agudelo, MD, MSc Health Rehabilitation Research Group, University of Antioquia, Medellín, Colombia/ Francesca Gimigliano, MD, PhD Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland; University of Antioquia, Medellín, Colombia
Swiss Paraplegic Research, Nottwil, Switzerland
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Prevention and control of medical violence: ethical dilemmas and systemic blind spots beyond technological empowerment
Re: Body cameras and panic alarms for doctors could help deter violence and harassment Caroline Kamau-Mitchell. 388:doi 10.1136/bmj.r529

Dear Editor

Prevention and control of medical violence: ethical dilemmas and systemic blind spots beyond technological empowerment

Recently, an opinion article in the British Medical Journal (BMJ) highlighted the use of body cameras and emergency alerts to curb medical violence [1]. With the background of many malignant medical injury incidents around the world, the author proposes to deter abusers, retain evidence, and enhance the sense of security of care through technological means, and discusses the privacy protection and implementation path. This perspective addresses the urgent needs of medical security, but under the surface solution of technology empowerment, there are still ethical dilemmas and systemic loopholes that have not been fully discussed, which deserve further consideration.

The double-edged sword of technological deterrence: The authors argue that cameras can deter violence immediately, but ignore the particularity of medical scenes. The doctor-patient trust relationship may become a "surveillance relationship" due to the alienation of monitoring, which intensifies the defensive psychology of patients. For example, requiring patients who refuse to be photographed to switch to online consultations [2] actually turns trust issues into technical screening, which may deprive some groups of medical rights. Technology only shifts risk, leaving the root causes of violence untouched—such as conflicts over long waiting times—and cameras cannot resolve systemic contradictions.

Power game of privacy protection: Although encryption storage is proposed in this paper, the hidden danger of data control is not touched. Employers may overstep their authority by accessing videos for "performance reviews," and third-party providers may misuse medical data to train algorithms [3]. Privacy protection requires laws to clarify data sovereignty, rather than relying on technical design [4].

Deep soil for systematic violence: The authors call for "addressing the root causes of violence," but the measures stop at adding lounges, leaving structural problems such as overstretched health systems and gender power imbalances untouched. For example, women's health care accounts for 70 percent of sexual harassment victims [5], yet no gender-sensitive policies are proposed. Technology tools, without organizational cultural change, will eventually become superficial solutions.

The urgency of multidimensional governance: Medical violence is a microcosm of social contradictions, which needs to be combined with technology and system reform. For example, training health care providers to identify patient trauma, establishing interdepartmental databases to predict risk, and promoting legislation to increase penalties for medical violence. Only by embedding technology in social reform can we move from defense to elimination of violence.

The complexity of technological empowerment is that it is both a shield and a prism that refracts the flaws in the system. The real medical security is not in the lens of the camera, but in the eyes of the appeals and dignity that are heard.

References
1. Kitchen B. UK aid cuts will undermine global health and pose a risk to children’s lives BMJ 2025; 388 :r541 doi:10.1136/bmj.r541
2. Bakhai M, Atherton H. How to conduct written online consultations with patients in primary care BMJ 2021; 372 :n264 doi:10.1136/bmj.n264
3. Qin, Peiwu, et al., "Diagnosing Pathologic Myopia by Identifying Posterior Staphyloma and Myopic Maculopathy Using Ultra-Widefield Images with Deep Learning." (2024).
4. Tangari G, Ikram M, Ijaz K, Kaafar M A, Berkovsky S. Mobile health and privacy: cross sectional study BMJ 2021; 373 :n1248 doi:10.1136/bmj.n1248
5. Papantoniou P. Sexual harassment and organizational silencing in nursing: a cross-sectional study in Greece. BMJ Open 2021;11:e050850. doi: 10.1136/bmjopen-2021-050850

Competing interests: No competing interests

20 March 2025
Du Zhicheng
PhD candidate
Changyue Liu (Guangzhou International Economics College, Guangzhou, China)
Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China.
Shenzhen
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