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Algorithmic decisions have a history of harming already marginalized populations. In an effort to combat these discriminative patterns, data-driven methods are used to comprehend these patterns, and recently also to identify disadvantaged communities to allocate resources. Huynh et al. analyse one of these tools and show a concerning sensitivity to input parameters that can lead to unintentional biases with substantial financial consequences.

Identifying a complex panel of bias dimensions to be evaluated, a framework is proposed to assess how prone large language models are to biased reasoning, with possible consequences on equity-related harms, and is applied to a large-scale and diverse user survey on Med-PaLM 2.

Using an agent-based model, Tiokhin, Yan and Morgan find that competition for priority harms the reliability of science. Their model highlights several potential solutions, including scoop protection and larger start-up costs for research.

Decentralized natural resource governance is thought to aid conservation and reduce poverty, but its heterogeneous local effects are under-explored. A study in Nepal shows that forest governance decentralization reduces poverty but the benefits are greater for dominant ethnic and caste groups compared with minority ones.

The prospect of genomic screening in newborns attracts both hype and criticism, but carefully designed, large-scale, prospective research studies are the only way to generate the data needed for its rigorous evaluation.

Global Burden of Disease estimates show that between 1990 and 2023, the prevalence and burden of drug use disorders, inclusive of amphetamine, cannabis, cocaine and opioid use, have been increasing in high-income countries, particularly in the USA.

A Bayesian analysis of diagnostic data reported to the World Health Organization reveals that approximately 2 million people were incorrectly diagnosed with tuberculosis (received a false-positive result) and 1 million received a false-negative result, emphasizing the critical need for higher-sensitivity bacteriological tests in the future.

This study develops a distributive justice framework for allocating subnational carbon budgets. Applying it to the EU, it reveals substantial within-country differences in production- and consumption-based allocations, with implications for designing equitable net-zero pathways.

Oceans are on the front line of new planned climate actions, but understanding of novel marine-climate intervention development and deployment remains low. Here a survey among intervention practitioners allows identification of science and governance gaps for marine-climate interventions.

Translation of evidence about dementia risk into effective public health policy is a challenge. In this Consensus Statement, Demnitz-King and colleagues present 56 policy recommendations for dementia prevention, providing policymakers with a foundation for designing and implementing evidence-based dementia prevention strategies, prioritizing clear communication, targeted intervention and sustained research investment.

Via high-throughput imaging and tracking over 140 million single mycobacteria, the authors show that drug- and strain-specific killing predict treatment outcomes, with potential to improve drug development and personalized therapy.

Equitable, just, and effective transformative change for sustainability requires diverse actors and knowledge systems. Indigenous Peoples and local communities play critical roles in advancing strategies and pathways that halt biodiversity loss and reverse nature’s decline.

Akinyemiju et al. develop and validate a theory-driven, empirical measure of cultural racism and identify its associations with public health disparities in the USA, including a positive association with mortality and a negative association with life expectancy.

A wide range of policies and actions can be used to address energy insecurity, and there are many actors and institutions to carry them out. This Perspective provides an overview of the many levers, or opportunities, that electricity sector actors have to reduce energy insecurity and affordability in the United States.

Aerosol impacts have not been comprehensively considered in the cost-benefit integrated assessment models that are widely used to analyze climate policy. Here the authors account for these impacts and find that the health co-benefits from improved air quality outweigh the co-harms from increased near-term warming, and that optimal climate policy results in immediate net benefits globally.

Frailty is common in older individuals, but can occur independently of advanced age, multimorbidity or disability. In this Review, Nguyen and colleagues draw on evidence from clinical guidelines and randomized controlled trials to provide an in-depth discussion of the unique challenges associated with cardiovascular pharmacotherapy in older patients with frailty.

Nature Reviews Clinical Oncologypresents a new form of article, a Viewpoint, which provides a forum for a number of researchers to discuss important ongoing issues in oncology. In this Viewpoint article, experts from the field of breast cancer screening discuss and offer insight into the controversy regarding the efficacy and optimal methods of screening.

Stroke affects the brain in complex, highly individual ways. Here, the authors show that applying generative and causal AI methods to routinely collected brain scans may enable more closely personalized treatment recommendations.

Here the authors provide an explanation for 95% of examined predicted loss of function variants found in disease-associated haploinsufficient genes in the Genome Aggregation Database (gnomAD), underscoring the power of the presented analysis to minimize false assignments of disease risk.

What we eat, as well as where and how it is grown, impacts species extinction risks through agricultural land use. Using a new global biodiversity impact data product, this study estimates how many species extinctions may potentially be caused by the production and consumption of different food types on a country-by-country basis.

A bacterial reverse transcriptase synthesizes polydeoxyadenylate to provide population-level immunity against viral infection.

Gender-based violence is widespread, affecting women and men worldwide. Stein et al. use a meta-analysis and the Burden of Proof methodology to evaluate associations between gender-based violence and eight health outcomes, including major depressive disorder, substance use and reproductive health.

Stimulant medications are the first-line treatment for ADHD, with non-stimulants often used if stimulants are ineffective. Here, by reinterpreting randomized controlled trials, addressing heterogeneity of treatment effects, and considering societal impact, we argue for equal consideration of stimulant and non-stimulants as first-line treatment options.

How we juggle morally conflicting outcomes during learning remains unknown. Here, by comparing variants of reinforcement learning models, the authors show that participants differ substantially in their preference, with some choosing actions that benefit themselves while others choose actions that prevent harm.

Around the world, more than a billion children are regularly exposed to violence or neglect. Flor et al. systematically review evidence that links childhood physical violence, psychological violence and neglect to increased risks for 14 health outcomes.

The authors find that TDP-43 loss of function—the pathology defining the neurodegenerative conditions ALS and FTD—induces novel mRNA polyadenylation events, which have different effects, including an increase in RNA stability, leading to higher protein levels.

When two similar, credible analyses of the same patient database report seemingly contrasting risk estimates for the association with cancer of a widely-prescribed therapy, it is difficult for clinicians, never mind for patients, to make decisions about treatment options. Nevertheless, clinicians can—and must—interpret the available evidence for their patients, helping them to weigh the potential benefits and harms of their prescription.

EchoNext, a deep learning model for electrocardiograms trained and validated in diverse health systems, successfully detects many forms of structural heart disease, supporting the potential of artificial intelligence to expand access to heart disease screening at scale.

The authors report findings from the MOBILIZE trial, which found that exercise therapy and self-management support improved patient-reported quality of life in individuals with multiple chronic conditions.

Analysis of data on six stable crops, capturing two-thirds of global crop calories, allows estimation of agricultural impacts and the potential of global producer adaptations to reduce output losses owing to climate change.

A nutrient profiling system is developed to incorporate 54 attributes across 9 domains, bringing together a broad and unique range of food characteristics and uniform scoring principles. The Food Compass presents a detailed profiling system for the healthfulness of foods.

Hydroxychloroquine and chloroquine have been investigated as a potential treatment for Covid-19 in several clinical trials. Here the authors report a meta-analysis of published and unpublished trials, and show that treatment with hydroxychloroquine for patients with Covid-19 was associated with increased mortality, and there was no benefit from chloroquine.

Analysis of 42 severe weather disasters (floods, storms and cyclones) in the United States between 2011 and 2016 reported associations with increased emergency department utilization and mortality in affected counties for up to 6 weeks.

Renal cell carcinoma (RCC) incidence is increasing worldwide. Here, the authors consider the potential benefits and harms of screening for RCC and discuss whether enough evidence is available to begin a clinical trial of RCC screening.

Here, the authors present multi-ancestry genome-wide meta-analyses of uterine fibroids, identifying 11 new gene associations, and demonstrating that heritability is higher in African ancestries.