Clinical updates: Assessment and management of suicidal ideation in adults bmj.com/content/393/bmj-2025…

Inviting Taliban officials to Brussels to discuss a migration deal sends a dangerous message that a regime can systematically oppress Afghan women and girls and still be welcomed as a diplomatic partner. This is the same regime that, last week, detained at least thirty women and girls in Herat for how they were dressed, opened fire on the people who protested their arrest, killed a child and injured others.  The Taliban’s system of gender apartheid has erased women’s and girls from public life — banning them from schools and work, severely restricting their freedom of movement and forcing them into marriage. Europe should not be considering deals with a regime responsible for one of the worst human rights crises in the world. rferl.org/a/eu-taliban-meeti…

🚨 Day 1,731 of Afghan women being isolated from the rest of society. When millions of girls are denied access to an education, inequality thrives. Education protects futures. You are not forgotten. #Afghanistan #LetAfghanGirlsLearn

I wouldn’t be where I am today without the love and support that @MichelleObama has poured into me over the years. Her story — from her South Side roots to the White House and beyond — is a central part of the Obama Presidential Center.

Afghan women gathered in front of the @UN office in Tehran, chanting: “Stop gender apartheid in Afghanistan” and “No to Taliban.”

RT @SkyYaldaHakim: Horrifying scenes in Afghanistan - the Taliban opened fire at a protest against the arrest of women for dress code viola…

If we want change to be systemic, we need to engage people across multiple levels, from influencing and involving many, to co-creating with some. The "Engagement Staircase" from Russ Gaskin (CoCreative) and Akash Bhalerao (Ashoka) is a really helpful, research-informed framework for thinking about who we need to engage and how. Their core premise is that engagement is not a single act. It exists on a spectrum of levels, from communicating to many, through consulting, involving, and collaborating, to co-creating with a smaller core. Each step represents a progressively deeper level of stakeholder participation, ownership and shared power. In health and care, that tends to mean a lot of communication and consultation, and not enough collaboration and co-creation. We often inform people about change. We ask for their views. We call it engagement. But informing is the bottom step of the staircase, and consulting, however well-designed, still positions the leader as the one who decides. Working at higher levels of engagement requires a different kind of change leadership capacity. Co-creation is likely to mean relinquishing control over outcomes. Collaboration requires an ongoing investment in relationships, not just in on-off tasks. Most change leadership development is better at building lower-level engagement skills than upper-level ones. In our sector, there is a big push towards “co-production” or “co-creation” which is a positive thing. However, It is also problematic to think that we need to co-create with a lot of people. The higher up the staircase, the fewer people are involved, and that's by design. We communicate to many; we co-create with some. We have to be intentional about this distribution. The risk is trying to get everyone to the top step, or, just as problematic, keeping everyone at the bottom. Both are strategic errors. We should seek to work across all five levels simultaneously. It’s about holding large-scale awareness and influence across a wide network while nurturing a smaller network of co-creators who are deeply invested in the work. This requires thinking about engagement like a portfolio, mapping who needs to be where on the staircase, and actively managing upward movement over time. There is also an equity dimension. Who gets invited to collaborate and co-create? In too many change initiatives, the higher levels of engagement get reserved for those who already hold formal power or existing relationships with the change leader. Creating the conditions for systemic change means actively seeking out people whose experience is closest to the problem, even when that requires bridging structural divides. We might treat the Engagement Staircase as a mirror - reflecting on which levels we are working at, with whom, and what it would take to move the right people to higher levels of ownership of the change. The article: lnkd.in/eaDX8z5p. It has links to some great resources.

David Shepherd describes how a gentle and thoughtful approach to dementia diagnosis helped him and his wife prepare for the future bmj.com/content/393/bmj.s808…

The idea vaccines cause autism was invented by Andrew Wakefield in 1998 and was so thoroughly debunked he lost his license for gross malpractice And here we are 27 years later RFK Jr dredging up the same nonsense Such a tiresome waste of time

“Dear migrants, before I say any other word to you, I want to bow before your dignity. “You are not numbers or case files. “You are people — with a family and a home left behind, with dreams that no one has the right to scorn.” — Pope Leo XIV

I am pleased to share the advanced edited version of my upcoming report to #HRC62 which I will present on 22nd of June 2026 on violence against mothers (A/HRC/62/49): ohchr.org/sites/default/file…

The fact she asked if her name was Angela was a clever move ❤️ Always hated when parents talk for their kids

Clinical updates: Assessment and management of suicidal ideation in adults bmj.com/content/393/bmj-2025…

Polio vaccine is safer than polio Diphtheria vaccine is safer than diphtheria Measles vaccine is safer than measles Tetanus vaccine is safer than Tetanus And yes Covid vaccine is safer than Covid That's The Whole Point Of Vaccines

I'm a cardiologist. A 42-year-old mother of two came to my office complaining of jaw pain and crushing fatigue. She ran half-marathons. Her EKG was normal. Another doctor had sent her home with anxiety medication. When I got her into the cath lab, I found severe microvascular disease — plaque choking the tiniest vessels of her heart, the ones standard angiograms routinely miss. Her heart had been starving in silence while everyone told her she was stressed. She is alive today. Too many women like her are not. Heart disease kills more women than every cancer combined. And medicine is still diagnosing it through a male lens. 84% of cardiologists report having patients in the past year whose heart disease was misdiagnosed by another physician. Women with a STEMI heart attack have a 59% greater chance of being misdiagnosed compared to men. Women with an NSTEMI — 41% greater chance. The reason is structural. For decades, we screened, tested, and treated women using a template built for men. Men's heart attacks announce themselves — the crushing chest pain, the clutched fist, the Hollywood collapse. Women's hearts whisper. Crushing fatigue that feels like wearing a lead vest. Jaw pain written off as TMJ. Nausea blamed on a stomach bug. An ache between the shoulder blades blamed on a long week. Shortness of breath blamed on being out of shape. For years, medicine called these "atypical" symptoms. They are not atypical. They are female-typical. Half of humanity is not a variant. And the biology runs deeper than symptoms. Women have smaller hearts and narrower coronary arteries. Plaque doesn't only clog the big highway vessels — it hides in the microvasculature, the tiny branches feeding the heart muscle itself. A woman can have a heart attack with a completely "clean" standard angiogram. SCAD — spontaneous coronary artery dissection — occurs 90% of the time in women. Often young, fit women with zero traditional risk factors. It's the leading cause of heart attack in women under 50, accounting for roughly one quarter of all cases in that age group. Most doctors have never diagnosed one. And some of the most dangerous cardiac risk factors are hidden in women's medical histories where no one thinks to look: Preeclampsia or gestational hypertension doubles to quadruples lifetime heart disease and stroke risk. Pregnancy is the body's first cardiac stress test — and these complications are early warning sirens, not closed chapters. Autoimmune disease — lupus, rheumatoid arthritis, psoriasis — far more common in women, turbocharges inflammation and plaque formation at any age. Cardiovascular disease in women aged 20-44 is projected to surge nearly 50% by 2050. The youngest patients in my practice keep getting younger. What every woman should ask her doctor — and what every doctor should be asking: "Given my pregnancy history, autoimmune status, and family history — what is my full cardiovascular risk?" If they don't ask about preeclampsia or gestational diabetes, volunteer it. "Should I have an Lp(a) test and a coronary calcium score?" Standard cholesterol panels miss too much. Lp(a) is genetic, one-time, and most women have never been tested. "My tests came back normal but my symptoms haven't stopped — what's next?" Normal stress tests and angiograms can miss microvascular disease, spasm, and SCAD. Persistent symptoms warrant coronary CT angiography or cardiac MRI. And if something feels wrong — say these exact words to your doctor: "I am concerned this could be my heart." That single sentence changes the workup. Do not soften it. Do not apologize for it. 80% of heart disease is preventable. But the playbook has to be built for female biology. Two decades ago, I wrote one of the first books warning that heart disease was the number one killer of women and that medicine was diagnosing it through a male lens. It was recognized by First Lady Laura Bush at the White House during the early years of the national conversation about women's heart health. I'm haunted by how much of that book I could republish today unchanged. The science has advanced. The awareness has grown. But the gap between what we know and what happens in the exam room is still costing women their lives. Share this with every woman you love — and every doctor who treats them. READ MORE: open.substack.com/pub/afshin…

It was great meeting with the talented folks who’ll be working at the Obama Presidential Center. We're excited to welcome everybody here soon!

#SexIndustryStats Childhood victimization and subsequent risk for promiscuity, prostitution, and teenage pregnancy: a prospective study. ajph.aphapublications.org/do… "This study examined the extent to which being abused and/or neglected in childhood increases a person's risk for promiscuity, prostitution, and teenage pregnancy. METHODS: A prospective cohorts design was used to match, on the basis of age, race, sex, and social class, cases of abused and/or neglected children from 1967 to 1971 with nonabused and nonneglected children; subjects were followed into young adulthood. From 1989 to 1995 1196 subjects (676 abused and/or neglected and 520 control subjects were located and interviewed. RESULTS: Early childhood abuse and/or neglect was a significant predictor of prostitution for females (odds ratio [OR] = 2.96). For females, sexual abuse (OR = 2.54) and neglect (OR = 2.58) were associated with prostitution, whereas physical abuse was only marginally associated. Childhood abuse and neglect were not associated with increased risk for promiscuity or teenage pregnancy. CONCLUSIONS: These findings strongly support a relationship between childhood victimization and subsequent prostitution. The presumed causal sequence between childhood victimization and teenage pregnancy may need to be reevaluated."

These incidents at Manchester are appalling. And we know that sexual violence is an issue in medical schools across the country. We are committed to working with national stakeholders to eliminate all forms of sexual violence towards medical students across the country. theguardian.com/education/20…

Human rights are for everyone, everywhere. No one should be treated unfairly because of who they are or whom they love. June’s #PrideMonth is an opportunity to stand up for the equal rights & fair treatment of LGBTIQ people everywhere. 📷: @free_equal