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Young children with attention deficit/hyperactivity disorder often receive medication just after being diagnosed, which contravenes treatment guidelines endorsed by the American Academy of Pediatrics, a Stanford Medicine-led study has found.
The finding, published on Aug. 29 in JAMA Network Open, highlights a gap in medical care for 4- and 5-year-olds with ADHD. Treatment guidelines recommend that these young children and their families try six months of behavior therapy before starting ADHD medication.
But pediatricians often prescribe medication immediately upon diagnosis, according to an analysis of medical records from nearly 10,000 young children with ADHD who received care in eight pediatric health networks in the United States.
“We found that many young children are being prescribed medications very soon after their diagnosis of ADHD is documented,” said the study’s lead author, Yair Bannett, MD, assistant professor of pediatrics. “That’s concerning, because we know starting ADHD treatment with a behavioral approach is beneficial; it has a big positive effect on the child as well as on the family.”
In addition, stimulant medications prescribed for the condition cause more side effects in young patients than they do in older children, Bannett said. Before age 6, children’s bodies don’t fully metabolize the drugs.
“We don’t have concerns about the toxicity of the medications for 4- and 5-year-olds, but we do know that there is a high likelihood of treatment failure, because many families decide the side effects outweigh the benefits,” he said. Stimulant medication can make young children more irritable, emotional and aggressive.
ADHD is a developmental disorder characterized by hyperactivity, difficulty paying attention and impulsive behavior.

“It’s important to catch it early because we know these kids are at higher risk for having academic problems and not completing school,” Bannett said. Early identification and effective treatment for ADHD improve children’s academic performance. Research has shown that good treatment also helps prepare individuals with ADHD for many aspects of adulthood, such as maintaining employment, having successful relationships and avoiding trouble with the law.
Complementary treatments
Behavioral therapy and medication, the two mainstays of ADHD treatment, have different purposes.
“Behavioral treatment works on the child’s surroundings: the parents’ actions and the routine the child has,” Bannett said. The therapy helps parents and kids build skills and establish habits compatible with how the child’s brain works.
The evidence-based behavioral treatment recommended by the American Academy of Pediatrics is called parent training in behavior management. The training helps parents build strong, positive relationships with their children; offers guidance in rewarding a child’s good behaviors and ignoring negative behaviors; and recommends tools that help kids with ADHD, such as making visual schedules to help them stay organized.
In contrast, medication relieves ADHD symptoms such as hyperactivity and inattentiveness, with effects that wear off as the body breaks down each dose of the drug.

Both approaches are needed for most kids with ADHD to do well. But previous studies of preschoolers diagnosed at age 4 or 5 show that it’s best to start with six months of behavioral treatment before prescribing any medication.
Rapid prescriptions
The researchers analyzed data from electronic health records for children seen at primary care practices affiliated with eight U.S. academic medical centers. They began with 712,478 records from children who were 3, 4 or 5 years old and were seen by their primary care physician at least twice, over a period of at least six months, between 2016 and 2023.
From these records, the scientists identified 9,708 children who received an ADHD diagnosis, representing 1.4% of the children in the initial sample. They found that 42.2% of these children — more than 4,000 kids — were prescribed medication within a month of their ADHD diagnosis. Only 14.1% of children with ADHD first received medication more than six months after diagnosis. The researchers did not have access to data on referrals to behavioral therapy, but since young children are supposed to try the therapy alone for six months before receiving medication, any who were prescribed medication sooner were likely not being treated according to academy guidelines. A smaller study of recommendations for behavior therapy, published in 2021, found only 11% of families got the therapy in line with guidelines.
Children who were initially given a formal diagnosis of ADHD were more likely to get medication within the first 30 days than those whose medical charts initially noted some ADHD symptoms, with a diagnosis at a later time. But even among preschoolers who did not initially meet full criteria for the condition, 22.9% received medication within 30 days.
Barriers to behavioral treatment?
Because the study was based on an analysis of electronic medical records, the researchers could not ask why physicians made the treatment decisions they did. However, Bannett’s team had informal conversations with physicians, outside the scope of the study, in which they asked why they prescribed medication.
“One important point that always comes up is access to behavioral treatment,” Bannett said. Some locales have few or no therapists who offer the treatment, or patients’ insurance may not cover it. “Doctors tell us, ‘We don’t have anywhere to send these families for behavioral management training, so, weighing the benefits and risks, we think it’s better to give medication than not to offer any treatment at all.'”
Bannett said he hopes to educate primary care pediatricians on how to bridge this gap. For example, free or low-cost online resources are available for parents who want to learn principles of the behavioral approach.
And while the study focused on the youngest ADHD patients, behavioral management therapy also helps older children with the diagnosis.
“For kids 6 and above, the recommendation is both treatments, because behavioral therapy teaches the child and family long-term skills that will help them in life,” Bannett said. “Medication will not do that, so we never think of medication as the only solution for ADHD.”
Researchers contributed to the study from the Children’s Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Texas Children’s Hospital, Baylor College of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Children’s Hospital of Philadelphia, the University of Colorado, and Nemours Children’s Hospital. `
This work was supported by the Stanford Medicine Maternal and Child Health Research Institute; the National Institute of Mental Health (grant K23MH128455); and the National Heart, Lung, and Blood Institute (grant K23HL157615). The study was conducted using PEDSnet, A Pediatric Clinical Research Network. PEDSnet was developed with funding from the Patient-Centered Outcomes Research Institute.

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Researchers at University of California San Diego School of Medicine have identified a new investigational drug that shows promise in treating metabolic dysfunction-associated steatohepatitis (MASH), a serious form of fatty liver disease linked to obesity and type 2 diabetes that can lead to cirrhosis, liver failure, and even liver cancer.
The study, published in the August 23, 2025 online edition of The Lancet, found that the medication, ION224, targets a liver enzyme called DGAT2, which plays a key role in how the liver produces and stores fat. By blocking this enzyme, the drug helps reduce fat buildup and inflammation, two major drivers of liver damage in MASH.
“This study marks a pivotal advance in the fight against MASH,” said Rohit Loomba, MD, principal investigator of the study and chief of the Division of Gastroenterology and Hepatology at UC San Diego School of Medicine. “By blocking DGAT2, we’re interrupting the disease process at its root cause, stopping fat accumulation and inflammation right in the liver.”
The multicenter, Phase IIb clinical trial involved 160 adults with MASH and early to moderate fibrosis across the United States. Participants received monthly injections of the drug at different doses or a placebo over the course of one year. At the highest dose, 60% showed notable improvements in their liver health compared to the placebo group. These benefits occurred regardless of weight change, suggesting the drug could be used alongside other therapies. The medicine showed no serious side effects linked to the treatment.
MASH, formally known as nonalcoholic steatohepatitis (NASH), affects people with metabolic conditions like obesity and type 2 diabetes. It is often called a “silent” disease because it can progress for years without symptoms.
More than 100 million people have some form of fatty liver disease in the U.S. and as many as 1 in 4 adults worldwide may be affected, according to the Centers for Disease Control and Prevention. If left untreated, MASH can progress to liver failure and often may require a transplant.
“This is the first drug of its kind to show real biological impact in MASH,” Loomba said. “If these findings are confirmed in Phase III trials, we may finally be able to offer patients a targeted therapy that halts and potentially reverses liver damage before it progresses to life-threatening stages.”
Loomba, who is also director of the metabolic-dysfunction associated steatotic liver disease (MASLD) research center at UC San Diego School of Medicine, and a gastroenterologist and hepatologist at UC San Diego Health, adds that for patients and families affected by this serious condition, these results bring new hope for better care and outcomes. He emphasizes that early intervention and targeted therapies may also help reduce the burden on health care systems by preventing costly and complex liver disease down the line.

Next steps include a larger clinical trial to move closer to making this treatment widely available.
Co-authors of the study include Erin Morgan, Keyvan Yousefi, Dan Li, Richard Geary, Sanjay Bhanot, all from Ionis Pharmaceuticals, and Naim Alkhouri, Arizona Liver Health.
Funding for this research came from Ionis Pharmaceuticals (ION224-CS2).

Long-term stress levels, measured through hair samples, may provide important clues about mental health risks in children with chronic physical illnesses (CPI), according to new research from the University of Waterloo.
The study highlights how high hair cortisol, a type of steroid hormone, acts as a powerful early warning sign that could help identify children who live with CPI and who could be most at risk of mental health challenges, helping guide prevention and treatment strategies to better support their health and well-being.
An estimated 40 percent of children in Canada live with a CPI — a number that has been rising steadily for decades. These children face a much higher risk of developing mental health problems than their healthy peers, putting them at greater risk for poor quality of life, suicidal thoughts and increased reliance on health-care services.
“Living with a chronic illness means facing daily challenges such as taking medications, missing school and adjusting activities, all of which can take a serious emotional toll,” said Emma Littler, a Waterloo PhD candidate in Public Health Sciences and lead author of the study.
“Our findings suggest that chronically high stress, measured through hair samples, could help identify children with CPI at the highest risk for developing mental health problems. This opens the door to earlier and more targeted support.”
The study followed 244 Canadian children with chronic physical illnesses over four years, measuring stress using hair cortisol — a biological marker that reflects stress levels over time. Researchers found that more than two-thirds of these children had persistently high cortisol levels. Those children were also more likely to show symptoms of depression, anxiety, or other mental health concerns compared to peers whose cortisol levels decreased over time.
When the researchers compared these patterns to reports of emotional and behavioral difficulties, they found that children whose cortisol levels declined over time showed fewer symptoms of anxiety, depression and behavior problems than those whose cortisol levels stayed high.

“Identifying these risk factors early could help doctors and families intervene before emotional and behavioral difficulties take hold,” said Dr. Mark Ferro, a professor in Waterloo’s School of Public Health Sciences and co-author of the study.
“Hair cortisol offers a non-invasive, easy-to-collect biomarker that could one day be used to screen children and track whether treatments or support programs are helping to reduce stress.”
The study, “Association between hair cortisol and psychopathology in children with a chronic physical illness,” was recently published in Stress and Health.
Ferro and colleagues from Waterloo and McMaster University also published new research showing that biomarkers found in the blood of children with CPI may help predict future mental health challenges. The study, Inflammatory biomarkers predictive of psychopathology in children with physical illness, found that some blood signals were linked to children with CPI experiencing worsening mental health over time, while others were associated with improvements. The findings suggest that routine blood tests, combined with mental health check-ups, could help doctors identify children who may need extra support earlier.

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3 hours agoShareSaveKumail JafferLocal Democracy Reporting ServiceShareSavePA MediaSenior doctors have warned there is severe inequality within London for weight loss drugs so patients are facing a postcode lottery trying to access them.Weight loss drugs are administered via a weekly injection and make patients feel fuller for a longer time, reducing their appetite and overall food intake.Dorottya Norton, an NHS weight management specialist, told a London Assembly committee: “The lack of fairness is apparent to patients – some are able to get started and others are not.”According to the Local Democracy Reporting Service, inequality is growing as patients are buying products online, which are either fake or designed for medical research.EPATirzepatide – also known by its brand name Mounjaro – has been prescribed for severely obese patients in the UK since June, with around 220,000 people with the “greatest need” set to receive it over the next three years.It is seen by the NHS as an additional tool to tackle the country’s growing obesity rate and reduce the overall workload on the health service.However, senior doctors and pharmacists have warned that there is severe inequality within London when it comes to accessing weight loss drugs.Ms Norton also told the health committee: “There is a lack of consistency across London, England and the UK – there is a postcode lottery with weight management services.”She added that there had been “a huge increase” in referrals.”We need some degree of consistency across London so patients can get away from the postcode lottery.”It’s becoming a difficult clinical environment because there is such a gap between what patients understand, what they want and what is available. “Many patients are also self-funding, so inequality is growing.”ReutersAn imbalance between supply and demand has prompted those who are able to afford it to secure unregulated supplies on the black market, the committee was told.Sokratis Papafloratos, founder of Numan, an online provider of weight loss drugs, said: “In terms of illicit access, I think we really underestimate the problem and misunderstand it.”You can buy the active ingredients as somebody that does research. “However, people are finding these companies and buying and importing ingredients that are designed for clinical research and are injecting them into their bodies, which I find mind blowing.”Sukhi Basra, National Pharmacy Association vice chair, told London Assembly members that her patients had shown her photos of boxes “full of fake medicines”.”They’re being sold as generic medications, and that petrifies me.”