The Inflation Reduction Act, enacted in 2022, included establishing a cap on out-of-pocket spending for those enrolled in Medicare Part D prescription drug plans.

Researchers from the University of Michigan’s Institute for Healthcare Policy and Innovation and Rogel Cancer Center used the online Medicare Part D Plan Finder tool to assess how much patients were paying for the most commonly prescribed oral chemotherapies. They compared data from 2023, when no out-of-pocket cap was in place, to 2024, when the policy first took effect.

For Medicare Part D beneficiaries, annual out-of-pocket costs for oral cancer medications averaged $11,284 in 2023. In 2024, the average annual cost for the same medications is estimated to be $3,927. The median cost saving from 2023 to 2024 is estimated to be $7,260, demonstrating the policy’s effect on decreasing costs for patients. The study is published in JAMA Network Open.

“People with cancer are already vulnerable to financial distress and medical debt. Our analysis suggests that legislative policy can have a big impact on the cost of cancer care. This is especially critical as lawmakers now consider extending an out-of-pocket cap to commercial insurance,” said lead study author Benjamin Pockros, M.D., M.B.A., a urology resident at Michigan Medicine.

In 2025, an out-of-pocket cap will be set at $2,000, which the researchers predict will result in even greater savings for patients.

Additional authors: Chad Ellimoottil, M.D.; Belal Sbei; Megan Caram, M.D.; Kristian Stensland, M.D., M.P.H., M.S.

Funding for this work is from the University of Michigan Institute for Healthcare Policy and Innovation.

Disclosure: None

Paper cited: “Changes in Out-of-Pocket Spending for Common Oral Cancer Medications After the Inflation Reduction Act,” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.32456

At least 11 of the 17 members of the Scientific Advisory Committee on Nutrition (SACN) have conflicts of interest with the likes of Nestle, sugar manufacturer Tate and Lyle, and the world’s largest ice cream producer, Unilever, reports freelance journalist Sophie Borland.

And at least six out of the 11 members of SACN’s Subgroup on Maternal and Child Nutrition have ties to food firms, including baby food manufacturers and formula milk brands.

SACN is a powerful group of people appointed as independent experts to advise the government, which in turn influences policy, explains Borland. Since being set up in 2000 it has produced high profile guidelines on daily salt and sugar intake, vitamin D supplements, and feeding babies.

But there is concern that both SACN – and the previous governments reviewing its recommendations – have not done enough to curb rising obesity levels and food-related ill health.

The BMJ looked at the interests declared by SACN members – in publicly available documents published on the government website – within the past three years.

Among them is David Mela, a retired senior scientist from Unilever, who has done consultancy work for Unilever, Tate and Lyle, Coca Cola’s Israel franchise CBC Israel, and Cargill, which produces cocoa and chocolate products among other things.

Another member, Julie Lovegrove, is chair of an expert group at the International Life Sciences Institute (ILSI) Europe, whose member companies include Pepsico, Cadbury’s US owner Mondelez, and General Mills, the American firm behind Cheerios and Haagen Dazs.

Members of SACN’s Maternal and Child Nutrition subgroup include Ann Prentice, a council member of the Nestle Foundation, and Marion Hetherington who has undertaken work for Danone and baby food brand Ella’s Kitchen, the latter on an unpaid basis. The group’s chair, Ken Ong, has also received research funding from Mead Johnston Nutrition, which makes formula milk.

The Department for Health and Social Care (DHSC) responded on behalf of SACN and all members named in this article, saying SACN members are required to declare any potential conflicts of interest annually – and new ones at the first appropriate committee meeting, which are included in the minutes and published on the SACN website.

It added: “No members of the committee are directly employed by the food and drink industry, and all have a duty to act in the public interest and to be independent and impartial.”

But Chris van Tulleken, associate professor at University College London and author of a best-selling book on ultra-processed food, says: “Even small financial conflicts affect behaviour and beliefs in subtle or unconscious ways,” while Rob Percival, head of policy at the Soil Association, says: “We’re concerned that the committee and its integrity might be undermined by those ties to the food industry.”

Experts tell The BMJ the make-up of SACN needs to be reviewed in light of members’ ties to the food industry. However, Kat Jenner, director of the Obesity Health Alliance, says these ties are partly a result of the lack of money in relevant research.

Alison Tedstone, former chief nutritionist for Public Health England, also suggests that refusing to allow experts with industry ties on SACN would “diminish” its expertise and could delay future legislation.

Yet Van Tulleken insists: “Despite two decades of work from a conflicted SACN there has been an explosion of suffering and death from diet-related disease in the UK so I don’t think it’s credible to claim that the committee has been very effective.

“There are some excellent independent experts but they are a minority and in my view their work has been hampered by conflicts of interest with the industry that has created this health crisis. SACN must become independent of the food industry.”

Even though health warnings need to be written on physical products sold in stores and included in traditional advertisements, a new research study led by Boston University found that the majority of ads posted on social media by synthetic nicotine brands left the warnings off.

Synthetic nicotine is a substance created in a laboratory that has the same, or very similar, chemical structure to the nicotine derived from tobacco leaves. Despite marketing that labels it as “tobacco-free nicotine,” it still has the same addictive properties and additives that can cause lung damage, cancer, and other health issues. Plus, since it’s commonly paired with appealing flavors—made from chemicals that are known to be unsafe to inhale—it can be even harder to quit.

“When synthetic nicotine started appearing in products, we really wanted to know how it was being received and how it was being promoted,” says Traci Hong, a BU College of Communication professor of media studies.

When she first started in her career as a health communication researcher, she says, it was a different era: social media was not widely used, cigarette use was declining, and electronic cigarettes and vapes were in their infancy. But when vapes containing synthetic nicotine started getting more and more popular, she turned her attention to social media to find out how the advertising of these products was being regulated—and what could be done to make them less appealing to kids and young adults.

In their new paper, Hong and her collaborators found that in over 2,000 Instagram posts from 25 different synthetic nicotine brands, the vast majority did not include warning labels informing users about the health risks. The findings have been published in JAMA Network Open.

“These are brands that I think have a legitimate responsibility to inform their potential consumers that there are health risks and you need to be aware of them,” Hong says. Especially considering that Instagram is one of the most popular social media platforms in the US for young adults.

The FDA passed a requirement in 2022 that says health warnings need to take up 20 percent of the advertising and appear in the upper portion of the advertisement for e-cigarettes that contain synthetic nicotine. Hong, who is a research fellow at BU’s Rafik B. Hariri Institute for Computing and Computational Science & Engineering, and her colleagues identified whether an image posted on Instagram included the required health warning and, if it did, whether it took up the right amount of space. The study involved interdisciplinary collaboration across the University, including experts from BU’s School of Public Health, Chobanian & Avedisian School of Medicine, and College of Arts & Sciences.

The Instagram posts were analyzed using a custom-built AI algorithm, called Warning Label Multi-Layer Image Identification (WaLi), which uses computer vision to detect if health warnings follow the FDA rules. The team found that only 13 percent of the analyzed posts complied with FDA health warning requirements. They also discovered that the posts with health warnings received fewer likes and comments than posts without the warnings. According to the paper, the larger the warning label, the less comments the posts received. This means that having health warning labels could reduce how many social media users, especially young adults, are seeing and engaging with this content.

“We need federal government policies to combat the appeal of e-cigarette advertising on social media and to prevent kids from using tobacco products,” says Jessica Fetterman, a Chobanian & Avedisian School of Medicine assistant professor of medicine and coauthor on the study. The FDA recently estimated that the number of middle and high school students using e-cigarettes in 2024 is about 1.63 million, down from 2.13 million in 2023, with the vast majority using flavored nicotine. Enforcing and requiring health warning labels on social media content is one way to make products less visible and appealing, Fetterman says.

“Our study indicates that e-cigarette brands are creating Instagram posts advertising their products with seemingly no enforcement by the social media platform or government,” Fetterman says. Instagram lists tobacco products, electronic cigarettes, “and any other products that simulate smoking” on their list of prohibited branded content. But, Fetterman says, synthetic nicotine products are flouting that rule.

“All our work is really trying to find evidence-based research to help people make informed decisions about their health,” Hong says. With synthetic nicotine and e-cigarette companies continuing to use flavors as a way to appeal to youth, she says, her team plans to monitor social media posts with WaLi to ensure brands are using the correct language to dissuade people from getting hooked.

This research was supported by the National Institutes of Health and the American Heart Association.

Original source

The EMA will award a grant to the African Medicines Regulatory Harmonisation (AMRH) initiative which was founded by the African Union Development Agency (AUDA-NEPAD). The move will help to fund a pilot to test procedures for the joint continental evaluation of medicines in Africa. AUDA-NEPAD has been working on harmonisation activities for a decade.

The launch of the African pilot aims to validate procedures and processes ahead of the establishment of the AMA. The pilot, which is co-funded with the Bill & Melinda Gates Foundation, will run for a year.

Under the new initiative, the AMRH Evaluation of Medicinal Products Technical Committee (EMP-TC) will evaluate the quality, safety and efficacy of priority medicinal products with the support of the continental Good Manufacturing Practices Technical Committee (GMP-TC). This will help to develop continental processes and procedures, facilitate national authorisations of recommended medicines and strengthen information sharing and reliance.

The two AMRH technical committees visited EMA in June 2024 to share knowledge and get insights into EMA’s regulatory procedures and processes, which could serve as a model for the African regulatory system.

This pilot is part of EMA’s regulatory support for medical devices, following the introduction of new legislation in the EU in 2022. The plan could bring new products to people with rare diseases and conditions with unmet need.

Orphan devices are medical devices which are intended to be used for diseases or conditions affecting only a small number of individuals each year (fewer than 12,000 individuals in the EU per year). Often they are used to treat or diagnose rare diseases or conditions for which no or insufficient alternative diagnostic or therapeutic options exist, thereby fulfilling an unmet medical need.

The programme will initially benefit selected manufacturers and notified bodies – the national authorities responsible for assessing devices and awarding the CE mark. While the first phase of the programme is currently scheduled to run until the end of 2025, the Agency said it aims to establish a long-term process for orphan device support.

Manufacturers can consult the expert panels at different stages of the development of the clinical strategy for their device, while notified bodies can request advice at specific moments of the ongoing conformity assessment of the device.

As part of the pilot programme, EMA will prioritise certain types of orphan medical devices, such as devices for treating a medical condition that is life-threatening or that could cause permanent impairment of a body function, devices intended for children, and novel devices with potential major clinical benefit.

In June 2024, the European Commission announced new guidance on the clinical evaluation of orphan medical devices issued by the Medical Device Coordination Group, which is composed of representatives of all EU Member States. This guidance sets out criteria to determine when a medical device should be regarded as an orphan device under the EU Medical Devices Regulation and aims to guide manufacturers and national authorities.

Newly-approved products:

• Anzupgo (delgocitinib), a medicine intended for the treatment of moderate to severe chronic hand eczema in adults for whom topical corticosteroids are inadequate or inappropriate.
• Iqirvo (elafibranor), for the treatment of primary biliary cholangitis, a chronic and progressive autoimmune disease that can cause liver damage.
• Kayfanda (odevixibat), for the treatment of cholestatic pruritus in patients with Alagille syndrome, a rare, life-threatening genetic disorder with a wide variety of clinical manifestations affecting the liver, heart, skeleton, eyes, skin, central nervous system, kidneys, and facial features.
• Loqtorzi (toripalimab), for the treatment of nasopharyngeal carcinoma and oesophageal squamous cell carcinoma.
• Vevizye (ciclosporin), for the treatment of adult patients with moderate to severe dry eye disease which has not improved despite treatment with tear substitutes.
• Vyloy (zolbetuximab), to treat gastric or gastro-oesophageal junction adenocarcinoma, a cancer of the stomach.
• Yuvanci (macitentan / tadalafil), for the treatment of pulmonary arterial hypertension, a chronic and progressive disease of the small pulmonary arteries that is characterised by vascular proliferation and remodelling.

The Committee adopted positive opinions for six biosimilar medicines:

• Eksunbi (ustekinumab) and Fymskina (ustekinumab), for the treatment of plaque psoriasis, paediatric plaque psoriasis, psoriatic arthritis, ulcerative colitis and Crohn’s disease.
• Ituxredi (rituximab), for the treatment of non-Hodgkin’s lymphoma, chronic lymphocytic leukaemia, rheumatoid arthritis, granulomatosis with polyangiitis and microscopic polyangiitis and pemphigus vulgaris.
• Otulfi (ustekinumab), for the treatment of plaque psoriasis, paediatric plaque psoriasis, psoriatic arthritis and Crohn’s disease.
• Ranibizumab Midas (ranibizumab), for the treatment of neovascular (wet) age-related macular degeneration, visual impairment due to diabetic macular oedema, proliferative diabetic retinopathy, visual impairment due to macular oedema secondary to retinal vein occlusion and visual impairment due to choroidal neovascularisation.
• Tuznue (trastuzumab), for the treatment of breast and gastric cancer.

Marketing authorisation was also approved for Axitinib Accord (axitinib), a generic medicine for the treatment of adult patients with advanced renal cell carcinoma.

Extensions of indication were recommended for eleven products that are already available in the EU for the treatment of other conditions: Arexvy, Braftovi, Edurant, Keytruda, Mektovi, Opsumit, Padcev, Rybrevant, Slenyto, Spevigo and Tecentriq.

In addition, the CHMP finalised its assessment of an application to extend the use of the weight loss medicine Wegovy (semaglutide) to include prevention of major cardiovascular problems in adults with established cardiovascular disease and a body mass index (BMI) of at least 27 kg/m2.

The CHMP considered that this use is already covered by the approved indication for weight management and therefore did not agree to add a separate indication for the prevention of cardiovascular disease. Instead, it recommended to include additional information from a study in the product information.

Only half (53%) of online advertisements for medicines are correctly categorised as legitimate or illicit by Italian and Spanish consumers, posing a significant risk of purchasing substandard and falsified medicines (SFMs).

The illicit market for medicines has grown since the COVID-19 pandemic, exploiting vulnerable consumers through misleading online advertisements and websites. Existing efforts to combat the spread of SFMs online focus mainly on targeting online supply. The CAPSULE project instead focused on the demand side of the market, assessing the exposure and behaviour of consumers.

In January 2024, a survey was conducted among a representative sample of Internet users in Italy and Spain who were aware of the possibility of buying medicines online and had been exposed to online advertising or had bought at least one medicine online. The survey exposed them to a mix of legitimate and illegitimate online advertisements for medicines.

The results showed that consumers correctly categorised legitimate advertisements 63% of the time, but struggled significantly with illicit ads, correctly identifying them only 43% of the time in Italy and 42% in Spain. The most important factors influencing the decisions of the respondents are the absence of a label certifying authorisation by the Ministry of Health, followed by the absence of a drug description or the presence of errors.

The results of the study highlight the need for awareness campaigns tailored to different demographics and types of consumers: while older participants showed less capacity to detect illicit advertisements, younger participants expressed less trust in healthcare professionals and a higher propensity to rely on the Internet for obtaining healthcare information.

Most respondents were aware that legitimate online medicine sales in Italy and Spain are restricted to non-prescription medicines (73% in Italy and 66% in Spain). Only one third distinguished dietary supplements from medicinal products, underscoring the difficulty in distinguishing between products subject to different regulations.

Italian participants exhibited a higher rate of online purchases (69%) of medicines compared to Spain (52%). A substantial majority of Italians (85%) and Spaniards (75%) reported having seen at least one form of online advertisement for medicines.

In Italy, flu treatments were the most popular online purchases, followed by chronic pain and cholesterol management medicines. Spanish consumers mainly bought performance-enhancing and weight-loss products.

‘Given the overall increase in online purchases of medicines, the results highlight the need for better crime-proofing of legitimate advertising and selling channels to reduce the diffusion of substandard or fake medicines,’ said Dr Marco Dugato, researcher at Transcrime,  ‘This also requires a constant support from research in this area to monitor evolving consumer behaviour and market dynamics”.

In the absence of US-specific nutrition or promotional guidelines for these foods, researchers at The George Institute for Global Health assessed data on 651 infant and toddler food products sold in the top ten US grocery chains held in the Institute’s FoodSwitch database against this international benchmark.²

Among all products, 70 percent failed to meet protein requirements and 44 percent exceeded total sugar requirements. A further one in four products did not meet calorie requirements and one in five exceeded recommended sodium limits.

Dr Elizabeth Dunford, Research Fellow at The George Institute, and Adjunct Assistant Professor, Department of Nutrition at the University of North Carolina said that the rising popularity of processed convenience foods for infants and young children was concerning.

“Early childhood is a crucial period of rapid growth and when taste preferences and dietary habits form, potentially paving the way for the development of chronic diseases such as obesity, diabetes and some cancers later in life,” she said.

“Time-poor parents are increasingly choosing convenience foods, unaware that many of these products lack key nutrients needed for their child’s development and tricked into believing they are healthier than they really are.”

Researchers found that baby food pouches are the fastest growing products in the sector, with a 900 percent increase in the proportion of sales deriving from pouches in the last 13 years. Concerningly, pouches ranked among the unhealthiest products assessed, with fewer than 7 percent meeting total sugar recommendations.*

The study also revealed the extent of misleading marketing practices, with almost all (99.4 percent) products featuring at least one prohibited claim on their packaging. On average, products displayed four prohibited claims, with some displaying as many as 11. Common claims included ‘non genetically modified (GM)’ (70 percent), ‘organic’ (59 percent), ‘no BPA’ (37 percent), and ‘no artificial colors/flavors’ (25 percent).

Dr Daisy Coyle, Research Fellow and Dietitian at The George Institute said that claims like these create a so-called ‘health halo’ around these products.

“The lack of regulation in this area leaves the door wide open for the food industry to deceive busy parents,” she said.

“We saw this not only in the use of misleading claims but also in the use of misleading names, where the product name did not reflect the main ingredients found on the ingredient list.”

“For example, snack and finger foods often referred to fruit or vegetables in the product name, despite primarily being made of flour or other starches,” Dr Coyle added.

Obesity in children aged two to five has more than doubled in the US since the 1970s, with approximately 13% of preschool children living with obesity.³ This has only worsened since the COVID-19 pandemic.⁴

“While reducing childhood obesity was a priority under the Obama administration, the issue appears to have fallen by the wayside in recent years,” added Dr Dunford.

“Our findings highlight the urgent need for better regulation and guidance in the infant and toddler foods market in the United States – the health of future generations depends on it.”

1. Coyle DH et al. An evaluation of the nutritional and promotional profile of commercial foods for infants and toddlers in the United States. Nutrients 2024. 16,0
2. World Health Organization. Nutrient and Promotion Profile Model: Supporting appropriate promotion of food products for infants and young children 6–36 months in the WHO European Region. 2022
   https://www.who.int/europe/publications/i/item/WHO-EURO-2022-6681-46447-67287
3. Fryar CD, et al. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. NCHS Health E-Stats. 2020. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf
4. Lange SJ et al. Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2021;70:1278–1283
   https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm7037a3_w

*This represents 7 percent of all pouches, but fruit-based pouches (which contain the most sugar) aren’t included in the WHO criteria. This figure becomes 69% if fruit-base pouches are excluded.

They found that 1 in 8 caregivers had difficulty accessing mental health services for their children between 2016 and 2019. But those who lived in states with the most comprehensive mental and behavioral health coverage laws were about 20% less likely to report trouble accessing care than those who lived in states with the least comprehensive laws.

Caregivers of Black and Asian children were more likely to report poor access to mental and behavioral health care, as were caregivers of children who experienced more adverse childhood events (ACEs).

“Unfortunately, in my own practice, I regularly see children who are unable to access needed mental health care, and their symptoms continue to worsen until they reach a crisis point,” said first author Ashley Foster, MD, a pediatric emergency care physician at UCSF Benioff Children’s Hospital San Francisco. “That inspired me to study whether more comprehensive laws about mental health insurance coverage can influence whether kids can get the care they need, and that is exactly what we found.”

The study appears Aug. 12 in JAMA Network Open.

While legislation appears to influence access, it also matters how well states enforce their laws.

“Even when families have insurance, mental and behavioral health providers may refuse to accept certain insurance types – or insurance altogether,” Foster said. “For those who do access care, there may be high co-pays or deductibles, which can affect perceptions of access.”

To counter this, the authors wrote, states should invest in community-based mental health services, develop a workforce that better reflects the state’s cultural diversity and support reimbursement for tele-mental health care. States also should define the disorders that must be covered by insurance, such as autism and attention-deficit hyperactivity disorder.

Authors: Additional co-authors include Jennifer A. Hoffmann, MD, MS, of Ann & Robert H. Lurie Children’s Hospital of Chicago; Megan Douglas, JD, of Morehouse School of Medicine; Michael C. Monuteaux, ScD, Kathrine E. Douglas, MD, and Joel D. Hudgins, MD, MPH, of Boston Children’s Hospital; Teal W. Benevides, PhD, MS, OTR/L, of Augusta University; and Amanda M. Stewart, MD, MPH, of Children’s National Hospital.

Funding: None.
Disclosures: None.

A paper released today titled “Modeling impact of Inflation Reduction Act price negotiations on new drug pipeline considering differential contributions of large and small biopharmaceutical companies,” published in the journal Clinical Trials, showed that for large pharmaceutical producers, which account for the large majority of product sales, revenue, and profit, the level of R&D spending was strongly related to revenue from 2000-2018. In contrast, for smaller biotechnology companies, which typically have few products and little revenue but sponsor the majority of all clinical trials, there was no relationship between R&D spending and revenue. These companies typically acquire capital for R&D substantially through new investment in equity offerings.

This research also assessed the impact of reducing drug pricing on the number of new drug approvals using a drug development pipeline model that considers the differential contributions of large and small companies and likely changes in R&D spending in response to changes in revenue. This analysis suggests the current level of drug approvals could be maintained in the face of global revenue reductions of up to 10% through strategic distribution of cost reductions in large companies between early and late phases of clinical development, coupled with continued acquisition of candidate products in early phases of development by biotechnology companies.

A related working paper titled “Implications of the Inflation Reduction Act for the biotechnology industry; sensitivity of investment and valuation to drug price indices and market conditions,” published by the Institute for New Economic Thinking, showed that there was no relationship between investment in biotechnology and indices of drug prices 2000-2020. This suggests that investment in biotechnology companies is unlikely to be affected by decreases in drug prices and will continue to provide the capital necessary for early-stage innovation and development in biotechnology companies.

These studies describe a dynamic innovation process in which small, emerging biotechnology companies originate the majority of new products and sponsor the majority of all clinical trials with innovation capital arising from private or public investment. These products may then be developed by the biotechnology companies themselves or acquired by large pharmaceutical companies for late-stage development and commercialization. The analysis suggests that the industry can sustain current levels of product approval and commercialization without compromising corporate earnings or investor returns.

These studies do not support industry arguments that drug price reductions anticipated by the IRA represent a threat to corporate profits, investor returns, or new product approvals.

“Pharmaceutical innovation is not adequately described by conventional economic theories that fail to account for the distinct business models of small, science-based biotechnology companies” said Fred Ledley, Director of the Center for Integration of Science and Industry, and the senior author on these studies. “Our work suggests that established management and investment practices could preserve both the industry’s profits and current levels of drug approvals in face of the reductions in drug price anticipated by the Inflation Reduction Act.”

Dr. Gregory Vaughan, Associate Professor of Mathematical Sciences at Bentley University, was the lead author of the publication in Clinical Trials along with Roger Du and Dr. Ledley. Dr. Cody Hyman, Assistant Professor of Accounting at Bentley University, was the lead author of the working paper published by INET along with Henry Dao, Dr. Vaughan, and Dr. Ledley. Roger Du and Henry Dao worked as undergraduate researchers at Bentley University.

This work was funded by the West Health Policy Center and National Biomedical Research Foundation through grants to Bentley University.

Trusted names including Hilary Jones, Michael Mosley and Rangan Chatterjee are being used to promote products claiming to fix high blood pressure and diabetes, and to sell hemp gummies, explains journalist Chris Stokel-Walker.

Deepfaking is the use of artificial intelligence (AI) to map a digital likeness of a real-life human being onto a video of a body that isn’t theirs. Reliable evidence on how convincing it is can be hard to come by, but one recent study suggests that up to half of all people shown deepfakes talking about scientific subjects cannot distinguish them from authentic videos.

John Cormack, a retired doctor based in Essex, worked with The BMJ to try and capture a sense of the scale of so-called deepfaked doctors across social media.

“The bottom line is, it’s much cheaper to spend your cash on making videos than it is on doing research and coming up with new products and getting them to market in the conventional way,” he says.

The slew of questionable content on social media co-opting the likenesses of popular doctors and celebrities is an inevitable consequence of the AI revolution we’re currently living through, says Henry Ajder, an expert on deepfake technology. “The rapid democratisation of accessible AI tools for voice cloning and avatar generation has transformed the fraud and impersonation landscape.”

“There’s been a significant increase in this kind of activity,” says Jones, who employs a social media specialist to trawl the web for deepfake videos that misrepresent his views and tries to take them down. “Even if you do, they just pop up the next day under a different name.”

A spokesperson for Meta, the company that owns both Facebook and Instagram, on which many of the videos found by Cormack were hosted, told The BMJ: “We will be investigating the examples highlighted by the British Medical Journal. We don’t permit content that intentionally deceives or seeks to defraud others, and we’re constantly working to improve detection and enforcement. We encourage anyone who sees content that might violate our policies to report it so we can investigate and take action.”

Deepfakes work by preying on people’s emotions, writes Stokel-Walker, and when it comes to medical products, that emotional connection with the individual telling you about the wonder drug or magnificent medical product matters all the more.

Someone you don’t know trying to sell you on the virtues of a particular treatment may raise suspicions. But if they’re someone you’ve seen before on social media, television or radio, you’re more likely to believe what they’re saying.

Spotting deepfakes can be tricky too, says Ajder, as the technology has improved. “It’s difficult to quantify how effective this new form of deepfake fraud is, but the growing volume of videos now circulating would suggest bad actors are having some success.”

For those whose likenesses are being co-opted, there’s seemingly very little they can do about it, but Stokel-Walker offers some tips on what to do if you find a deepfake. For instance, take a careful look at the content to make sure your suspicions are well-founded then leave a comment, questioning its veracity. Use the platform’s built-in reporting tools to voice your concerns, and finally report the person who or account that shared the post.

The sugar from soft drinks alone made up over half this total, the estimates suggest. But overall daily energy intake from free sugars levels are still higher than the updated recommendation from the World Health Organisation (WHO) of 5%—equivalent to 30 g/day for adults, 24 g for 7–10 year olds, and 19 g for 4–6 year olds—point out the researchers.

Mounting evidence implicates consumption of sugar sweetened drinks, which are a major source of dietary free sugars, particularly among children, in a heightened risk of weight gain, type 2 diabetes, coronary heart disease and premature death.

To date, more than 50 countries have introduced a sugar tax on soft drinks in a bid to persuade manufacturers to reformulate their products. The UK did so in 2018.

While the evidence suggests that sugar intake derived from these drinks fell in the year following its introduction, it’s not clear whether other sources of dietary sugar were substituted instead.

To assess the impact of the levy on total sugar intake, the researchers drew on 11 years of responses (2008–19) to the annual nationally representative UK National Diet and Nutrition Survey. This captures information on food consumption, nutrition, and nutrient intake in and outside of the home from 500 adults and 500 children over a 4-day period.

The researchers looked particularly at absolute and relative changes in total intake of dietary free sugars from all food and soft drinks combined and from soft drinks alone, to include full and low calorie soft drinks; semi-skimmed, whole and skimmed milk; fruit juice; and other milk drinks and cream.

Protein intake was used as a comparator because although not subject to a levy, it could still be affected by influential factors such as increases in food prices, say the researchers.

The results draw on information for 7999 adults and 7656 children, and estimated changes in free sugar consumption are based on the period January to March 2019 and compared with what would be expected had no sugar tax been announced and implemented.

In the period after the sugar tax was announced in 2016, free sugars consumed from all soft drinks more or less halved in children and fell by a third in adults compared with the period before the announcement.

Taking into consideration previous trends in free sugar consumption, the survey responses indicated that 1 year after the UK sugar tax had come into force children further reduced their free sugar intake from food and drink combined by around 5 g/day (relative reduction of 10%) and adults by around 11 g/day (relative reduction of 20%).

Over half of this total was from soft drinks alone, accounting for around 3 g/day (relative reduction of 23.5%) in children and around 5 g/ day (relative reduction of just under 40.5%) in adults. Protein intake remained stable throughout in children and adults.

“In children, a daily reduction of 4.8 g sugar equates to approximately 19.2 kilocalories out of an approximate daily intake of  2000 kilocalories which is equivalent to approximately 1% reduction in energy intake,” point out the researchers.

Energy intake from free sugars as a proportion of total energy consumed didn’t change significantly following the the introduction of the levy, indicating energy intake from free sugar was reducing at the same time as overall total energy intake, and suggesting that people didn’t change their diets substantially by substituting more sugary foods and drinks, say the researchers.

It wasn’t possible to study different age groups due to the limited number of participants, but falls in the levels of sugar in food and drink may have affected different age groups differently, say the researchers.

For example, the largest single contributor to free sugars in 4–10 year olds is cereal and cereal products, followed by soft drinks and fruit juice. By the age of 11–18, soft drinks provide the largest single source (29%). For adults the largest source of free sugars is sugar, preserves, and confectionery, followed by non-alcoholic drinks, they explain.

The fall in consumption of free sugars observed in the whole diet rather than just from soft drinks suggests that consumption of free sugar from food was also falling from as early as 2008, they add. This might be because of the public health signalling following the announcement, they suggest.