Published January 24, 2026
Welcome to the Best of 2025 from our Morning Report newsletter. We've curated the most compelling and clinically relevant medical news that shaped practice this past year. Below you'll find ten articles that generated the most discussion, changed clinical approaches, or offered breakthrough insights across multiple specialties. Whether you missed them the first time or want to revisit the year's biggest stories, these summaries capture the medical developments that defined 2025.
Rethinking Bacterial Vaginosis Management
INFECTIOUS FINDINGS
Nearly a third of women of reproductive age grapple with bacterial vaginosis (BV), with most stuck in a relentless Groundhog Day of relapse. Despite antibiotic treatment, the infection roars back. Scientists have long sparred over the root of this stubborn resurgence, and a new study in The New England Journal of Medicine may finally deliver the smoking gun.
It takes two
What if clinicians treated women with BV and their sexual partners in tandem? That was the premise of an Australian randomized controlled trial involving 164 monogamous male-female couples. The Aussie researchers split the couples into two camps: one where women received standard care while their partners got oral and topical antibiotics, and a control group where only the women were treated.
“Crikey!” cried the Aussies, slamming the study’s emergency brake before completion. Women in the partner treatment group saw BV recurrence plummet to 35%, whereas the control crept to 63%. The verdict? BV is likely a sexually transmitted infection (STI).
What changed?
Despite years of whisperings about BV’s STI status, past studies flopped at showing efficacy with partner treatment. Why? Investigators had overlooked a crucial battleground—the penis. This study course-corrected by prescribing men not just oral antibiotics but also a topical cream for the penile skin.
Key takeaways
This study recasts BV as an STI, suggesting that cure rates hinge on clearing the infection in both partners—with oral and topical antibiotics. And while the trial focused on heterosexual couples, the findings likely extend to women in same-sex relationships. The Melbourne Sexual Health Centre wasted no time revamping its BV treatment protocols. Meanwhile, the research team—aware that global guidelines adapt at a glacial pace—launched a website to steer male partner treatment and mitigate the BV boomerang effect. Your move, CDC.
Skip the Slow Start in LDL-C Lowering
CARDIO CORNER
“Start low and go slow”—the rallying cry of cautious pharmacology works well—until it doesn’t. A new study questions whether this measured approach holds up in LDL-C reduction, especially for those at very high risk. Should combination lipid-lowering therapy be the opening move, instead of statin monotherapy followed by a long, anxious wait to see if the numbers behave?
When patience isn’t a virtue
A new meta-analysis, published in Mayo Clinic Proceedings, makes a compelling case for rethinking the monotherapy default. Drawing on data from >100,000 high-risk patients across 14 studies, the research found that initiating treatment with a combination of statin plus ezetimibe led to significantly greater reductions in LDL-C levels than monotherapy alone. On average, LDL-C dropped an additional 13 mg/dL, and 85% of patients reached target levels below 70 mg/dL. Crucially, combination therapy also delivered an 18% relative risk reduction in major adverse cardiovascular events and up to a 49% drop in all-cause mortality in network analyses.
As with any meta-analysis, the included studies are a mixed bag of size, design, and rigor. But the consistency across these diverse cohorts lends credibility.
Key takeaways
Cardiology leans on adages harder than a BBQ dad with a buzz, slinging life advice with grill tongs. While this study contradicts “start low and go slow,” it backs other go-tos: “the lower, the better—for longer,” and “the earlier, the better.” For patients already on the edge, the study suggests that a more aggressive, front-loaded approach with a statin plus ezetimibe may drive LDL-C down faster, hit targets sooner, and translate into real survival gains. The authors don’t tiptoe: “We recommend combination therapy should be considered the gold standard of treatment for these patients and included in all future treatment guidelines.” Because as they say, “Aggressive early beats desperate late,” and “There’s no statin strong enough to reverse a missed opportunity.”
The H Factor Behind Gastric Cancer Prevention
GI GIST
A new paper in Nature Medicine does what you wish every intern would do when dropping a catastrophic problem: offer a solution. The authors open with a stark projection—a sharp global rise in gastric cancer among adults under age 50. Then they pivot to an actionable fix to prevent the majority of cases: widespread screening and treatment for Helicobacter pylori.
Gut check reveals common culprit
Researchers at the WHO International Agency for Research on Cancer (IARC) tapped global cancer and mortality data to project gastric cancer risk for those born between 2008 and 2017. The forecast: 15.6 million new cases worldwide in this group if prevention stays on autopilot. Then they asked the question that might change everything—how many of those cases are driven by H pylori infection? The answer: a staggering 76%. And you know the rest—a short course of antibiotics and a proton pump inhibitor can negate 100% of those infections.
There are limits, of course. The models assume H pylori rates stay flat, which may not hold. Data from low-income regions are patchy, and scaling up screening won’t be easy—logistics, resources, and access all get in the way.
Key takeaways
H pylori is the canary in the coal mine—spot it early, wipe it out, and you can derail the path to gastric cancer, experts suggest. This spiral-shaped menace burrows in stomach linings and lingers for decades before triggering malignancy. The solution? Implement population-based H pylori screening and hit infections with short-course antibiotics and a proton pump inhibitor. The authors set out to equip policymakers with evidence strong enough to drive action—a feat with roughly the same success rate as giving a cat a bath. But the case is airtight: catch the infection, stop the cancer, and prevent a surge that doesn’t have to happen.
Low-Dose Relief in Osteoarthritis Care
OSTEOARTHRITIS OUTCOMES
Sometimes Europeans get there first—printing books, perfecting public transit, and turning August into a collective out-of-office. And new research suggests they may have been ahead of the curve on something else: low-dose radiation therapy (LDRT) for osteoarthritis. This nonpharmacologic approach could offer real relief and improved mobility for patients who find limited benefit from standard therapies.
In a double-blind, randomized, placebo-controlled trial from Korea, researchers tested whether LDRT could relieve pain in mild-to-moderate knee osteoarthritis. More than 100 participants received either 0.3 Gy, 3 Gy, or a sham treatment over six sessions. After four months, the 3 Gy group pulled ahead, with 70% hitting responder criteria. The 0.3 Gy group barely edged out placebo (a nonsignificant 58% vs 42%), and that 42% placebo response—while high—reminds us that in osteoarthritis trials, belief can be as potent as biology.
A little radiation goes a long way
Patients may recoil at the word “radiation,” often equating any exposure with oncologic treatment levels, but principal investigator Dr. Byoung Hyuck Kim quickly dismantled that misconception. In osteoarthritis, he explained, the dose is a sliver of what’s used in oncology (<5%) and="" directed="" only="" at="" the="" joint—well="" clear="" of="" vital="" organs.="" the="" study="" reported="" zero="" radiation-related="" side="">
Key takeaways
LDRT for osteoarthritis isn’t new—it finally has the rigorous, placebo-controlled evidence to back it up. Long used in European clinics, the therapy now comes with validation and greater insight into dosing, safety, and patient selection. Next up: extended follow-up to test durability, imaging studies to track joint changes, and larger trials to define when—and for whom—this approach fits best.
Seven Steps for Reducing Plastic Consumption
LONGEVITY LEARNINGS
“I just want to say one word to you. Just one word—plastics.” Baby Boomers who took career advice from The Graduate made out pretty well. But the pendulum swung too far. A spoonful of microplastics and nanoplastics (MNPs) now live rent-free in the human brain, with even higher levels found in people with dementia. Plastic-free living may be unrealistic—the honey is already out of the plastic bear—but simple mitigation steps based on a recent review of the evidence may help reduce MNP intake.
Seven simple steps for minimizing MNP intake
- Switch from bottled to filtered/tap water to cut MNP intake from 90,000 to 4,000 particles/year.
- Stop microwaving food in plastic to avoid releasing billions of MNPs into meals (up to 4.22 million microplastic and 2.11 billion nanoplastic particles/cm2 in only three minutes).
- Swap plastic tea bags for loose-leaf tea to prevent leaching trillions of particles into mugs.
- Use a HEPA air filter to trap nearly 99.97% of airborne MNPs and reduce inhalation exposure.
- Store food in glass or stainless steel instead of plastic containers.
- Limit canned foods, which are lined with plastic coatings that contain bisphenol A (BPA) and can spike BPA levels by >1,000% in just five days.
- Choose whole foods over processed ones, as items like chicken nuggets contain 30 times more microplastics than chicken breasts.
To be clear:
Cutting MNP ingestion and consumption as outlined above makes sense, but clinical trials have yet to show if these steps will lead to a measurable drop in MNP buildup in the human body.
Key takeaways
MNP ingestion and inhalation can sabotage cellular function and cripple organ systems through oxidative stress, inflammation, metabolic disruption, and carcinogenesis. Worse, these particles lurk in everything from food to cleaning supplies to beauty products. But let’s reclaim the keyboard from Debbie Downer. A reassuring finding from the study is the apparent disconnect between age and microplastic buildup, hinting that the body purges MNPs through sweat, urine, and feces—despite constant environmental assault. And patients may tilt the odds further by adopting the steps above. Number one—ditch the plastic water bottle.
Study Debunks Digital Dementia in Older Adults
LONGEVITY LEARNINGS
The first generation to “Twist” by the transistor radio is also the first to wield touchscreen phones into the golden years. This means most Baby Boomers likely went from memorizing Sgt. Pepper track sequences to outsourcing birthdays, directions, and phone numbers to the cloud. So, what are the repercussions? Have these digital habits triggered “digital dementia” or built a “technological reserve” that protects cognition?
The data just dropped
In a sweeping meta-analysis, researchers sifted through 57 high-quality studies tracking >400,000 adults aged 50 years and up. Older adults who used digital tech had 58% lower odds of cognitive impairment and a 26% slower rate of decline than nonusers. The study showed a clear link between tech use and better cognition—but which came first? Do sharper minds gravitate toward Wordle, or does Wordle help keep minds sharp? Most likely, it’s both.
Key takeaways
Baby Boomers navigating the untrodden path of aging in the digital age have reason for optimism. These findings dismantle the “digital dementia” narrative and point to a more protective role for technology. The mechanism isn’t fully clear, but co-author Dr. Jared Benge offers an alliterative theory: “complexity, connection, and compensatory.” Digital tools may support cognitive health by engaging users in complex tasks, fostering social ties, and compensating for decline—think GPS for navigation. Of course, says co-author Dr. Michael Scullin, it all depends on how users engage. Treat your device like a TV—endlessly scrolling as if channel surfing—and the benefits diminish. Worse, use it mindlessly and suddenly you’re Michael Scott yelling “The machine knows!” as you drive into a lake.
Can One Therapy Session Have a Meaningful Effect?
MENTAL HEALTH MUSINGS
One—besides being the loneliest number—is also the most common number of therapy sessions patients access for mental health care. Why? Likely because that first intake session typically hits the ground limping, drowning patients in more paperwork than a mortgage closing while delivering little real intervention. A new study highlights a shift in strategy to optimize this vital first visit.
One opportunity
“You only get one shot, do not miss your chance …”—this pearl from Eminem also defines single-session interventions, or SSIs—an acronym just one typo away from SSRIs. An SSI is a mental health program that packs meaningful support, guidance, or treatment into the one and only session patients may attend. But does it work? Investigators at Northwestern Medicine combed through 24 systematic reviews covering 415 clinical trials and found that 83% showed a beneficial effect on at least one key outcome—anxiety, depression, substance use, eating disorders, and treatment engagement.
Paradigm shift
“We’re often taught that therapy is supposed to be a journey, a lifelong process, and that ‘change never happens overnight,’” says one study author, Dr. Jessica Schleider. “While that's often true, people can also have meaningful moments or turning points within one session.” Of note, Schleider’s team at Northwestern has a vested interest. Their Project YES! program is one of the US’s flagship SSI initiatives.
Key Takeaways
SSI programs borrow from the prestige television playbook—grab your audience before they disengage. Schleider emphasizes, “If a therapist is spending their first session with somebody exclusively diagnosing them, they’ve lost the opportunity to take advantage of the first and potentially last encounter to actually do something that helps them.” While SSIs—especially digital, self-guided ones—could address a critical blind spot in mental health care, they shouldn’t erode existing support systems. Research on integrating SSIs into broader care models will guide the way. Notably, other countries, like the UK, are already ahead of the curve on implementation.
New Colonoscopy Prep Guidelines—A Movement in the Right Direction?
GI GIST
Colonoscopy attendance rivals that of a high school reunion—plenty of “I’ll be there!” before only the yearbook committee and the guy recalling his 40-yard-dash time show up. Between dread, logistics, and the urban legend of bowel prep, nearly half of eligible adults skip the procedure. But fresh guidelines try to lure them back by shifting the prep ordeal from survival-show challenge to a mildly inconvenient Tuesday.
Task force puts punishing bowel prep in the rear view—for some
The American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy banded together to deliver their first overhaul of colonoscopy prep guidelines since 2014. And average-risk patients are going to like it. Dietary changes now start only the day before—low-fiber or clear-liquid meals for breakfast and lunch, capped with a clear-liquid dinner. And the dreaded 4-liter chug has been downsized to a 2-liter split dose (night before, then morning of)—so the taste will haunt patients for only half as long. Patients with afternoon appointments can tackle the entire prep in a single day. Additionally, the task force suggests adding oral simethicone to give doctors a clearer view.
Patients at higher risk for inadequate prep—including those with chronic constipation, slowed gut motility, or conditions such as cirrhosis, Parkinson disease, dementia, or diabetes—still face a stricter routine. Their regimen starts three days in advance, with tighter dietary limits, larger prep volumes, and boosters like bisacodyl to thoroughly flush the colon.
Key takeaways
The task force insists the new regimen goes down easier for average-risk patients without sacrificing colon clarity. The guideline authors wager that the looser rules will push prep success rates higher—ideally to 90% (up from 85% in 2014). They’re calling on GIs to track adequate and inadequate prep, along with “no shows.” For the GIs’ tallying purposes, “adequate” means a colon clear enough for them to confidently decide when the patient needs their next screening—a “you’ll know it when you see it” thing.
Time to Loosen the Cap in HF Fluid Restriction?
CARDIO CORNER
Fluid restrictions have long layered additional hardship onto patients living with heart failure (HF)—and you, the clinician, feel the strain of enforcing them. But is this practice still justified? Do patients really need to live like a Three Amigos Steve Martin, dry-sipping a canteen? Perhaps not, according to fresh data presented at the American College of Cardiology annual meeting.
Let them drink (more) water
In the open-label FRESH-UP trial, researchers assigned 504 adults with NYHA class II/III HF to either liberal (~1.76 L/day) or restricted (~1.48 L/day) fluid intake. After three months, quality-of-life scores (KCCQ) landed about the same. But thirst distress and clinical summary scores tipped in favor of liberal intake. Safety outcomes—mortality, hospitalizations, kidney function—held steady. Bottom line: no harm, slight gain, and freer access to fluids.
Watering down the results
The trial excluded patients with recent cardiac events, severe renal dysfunction, or hyponatremia, and the overwhelmingly White cohort limits generalizability. Also, baseline fluid intake was already moderate in both groups. That and the lack of blinding in the study may dilute the findings. Still, the authors see no compelling evidence for enforcing strict fluid caps.
Key takeaways
“It’s not just about whether patients live or die anymore—there are so many treatments improving mortality now, that the focus needs to shift to quality of life,” said cardiologist Shelley Hall. FRESH-UP shows that more lenient fluid intake may ease thirst without compromising safety. The study suggests that for stable patients on guideline-directed therapy, relaxing fluid limits to 1.7–2.0 L/day is reasonable—especially for those struggling. “Let’s be a little kinder to our patients and ourselves. We don’t have to be so harsh pounding fluid restriction,” said Hall. As always, individualization guides treatment—but this study offers welcome flexibility for those facing quality-of-life trade-offs.
Rising Doubts About Non-Celiac Gluten Sensitivity
GI GIST
|
In 2025, gluten’s public image lies somewhere between AI deepfakes and government shutdowns—blamed for everything from bloating to gut pain to Tinder mistakes. Hence the boom in pricey, fiber-thin gluten-free products. But while gluten can trigger serious autoimmune responses for the 1% with celiac disease, new research in The Lancet suggests that for the 15% globally with non-celiac gluten sensitivity (NCGS), gluten may not be the culprit. Going against the grain “Contrary to popular belief, most people with NCGS aren’t reacting to gluten,” says Dr. Jessica Biesiekierski, co-author of a new analysis that synthesizes decades of research on NCGS. In controlled trials, only a small number of people had consistent symptoms after consuming gluten. Most reacted similarly to placebos or experienced relief on a low-FODMAP diet, suggesting that other dietary components—or gut–brain interactions—may be the real drivers. Gluten may no longer be the fall guy for the modern buffet of bodily complaints. “We would like to see public health messaging shift away from the narrative that gluten is inherently harmful, as this research shows that this often isn’t the case,” Biesiekierski says. Instead, experts are calling for a more nuanced, evidence-based understanding of NCGS—one that accounts for gut–brain interactions as much as food components. Effective care, she adds, should blend targeted dietary changes (consider low-FODMAP) with psychological support (encourage mindful eating practices), while ensuring nutritional adequacy. Meanwhile, somewhere in a marketing lab, Big Gluten-Free is already redesigning labels to read, “Now with gut–brain synergy.” |