A man in his early fifties, diagnosed three weeks ago. Sugars up, carrying weight, creatinine normal, never had chest pain, feet intact. You already know what happens next, because it is what happens to every one of them: metformin, a word about diet, review in three months. That sequence has been the default for roughly thirty years. On Friday the two largest diabetes bodies in the world stopped recommending it as the automatic opening move.

The 2022 edition was titled Management of hyperglycaemia in type 2 diabetes. The one launched at the EASD congress in Milan is titled Management of type 2 diabetes, and the forty-five pages underneath explain the deletion. The sentence doing most of the work sits in the cardio-kidney section: SGLT2 inhibitors and GLP-1 based therapies deliver cardiovascular benefit independent of metformin, and belong among first-line considerations. Most people with type 2 diabetes, the panel writes, would benefit from one of them early — potentially from diagnosis. Not after metformin fails. Not after the first abnormal albumin. On the day you give them the news.

A man flew in from England, paid ₹64,000 for a bridge sitting on two implants, and watched it break three times across the next few years. Every replacement was done free, every one of them timed to his next trip home. By the time the matter reached the state commission in Chandigarh the dentist had the better clinical argument: the screws had held for years, only the bridge on top kept failing, so charge him for the bridge alone. The bench never examined his dentistry. It asked what the bridge had cost — and his own file carried a single number.

Read →

Reactin Plus is a Schedule H drug, sold against a prescription. Its carton carried the word analgesic, a list of everyday aches and a drawing of someone getting relief from muscular pain, and Maharashtra's FDA decided that printing broke the law by itself. Inspectors moved on the Wadki warehouse in late August and seized stock worth ₹11.19 lakh. Then the Bombay High Court stepped in, the regulator withdrew its own case and ran the whole process a second time from a blank page. The order signed on 1 October cancels the warehouse's sale and distribution licences. The box was only the first of the findings.

Read →

Every four years health workers there walk door to door with measles vaccine, collecting the children a clinic never sees: families who move, children in slums, parents who cannot make a Tuesday morning session. The 2024 round was postponed during political upheaval and then stayed postponed. The year after, a change in how vaccines were purchased emptied the shelves nationwide. National coverage read above 90% through all of it — in some places above 100%, which is arithmetically impossible and should have been read as an alarm. By mid-March 2026 every one of the country's 64 districts had measles, and the age of the children filling those wards is the part that should worry anyone running an immunisation programme.

Read →

Know a colleague who should be reading this? Forward this email to them.

Forwarded this issue? Subscribe free →