'Tip of the Iceberg': Study Uncovers AI-Fabricated Citations in Research Papers

 

• Fabricated references to research that does not exist are an increasing problem, an analysis of biomedical research papers showed.
• About one in 2,828 papers contained at least one fabricated reference in 2023, and by 2025, this had increased to one in 458, and to one in 277 papers in the first 7 weeks of 2026.
• The spike in fabricated references aligns with the publication lag after widespread large language model adoption in writing and editing.

Fabricated citations are an increasing problem coinciding with the widespread use of artificial intelligence (AI) tools in writing and editing, an analysis of biomedical research papers showed.

Out of 97.1 million verified references on biomedical papers, 4,046 fabricated references across 2,810 papers were identified, reported Maxim Topaz, PhD, MA, RN, of Columbia University in New York City, and colleagues.

About one in 2,828 papers contained at least one fabricated reference in 2023, and by 2025, this had increased to one in 458, and to one in 277 papers in the first 7 weeks of 2026, they wrote in correspondence to The Lancet.

The fabrication rate increased by more than 12-fold, from 4.0 in 10,000 papers in 2023 to 56.9 per 10,000 papers in early 2026.

"I think we are catching just the tip of the iceberg," Topaz told MedPage Today.

Fabricated references have titles that don't correspond with an existing publication. Large language models (LLMs) are known for hallucinating plausible-sounding references that "are often correctly formatted, attributed to real researchers, and bear plausible publication dates, making them difficult to detect by conventional peer review," the authors explained, noting that the spike in fabricated references in mid-2024 coincided with the publication lag following growing LLM adoption.

Topaz told MedPage Today that this research stemmed from his own experience. He regularly uses AI tools to polish his writing. After submitting a paper to a journal, the editorial staff alerted him that one of his citations didn't lead to a source. Topaz said this "deeply embarrassed" him and inspired him to look further.

He and his team developed an automated reference verification system and scanned PubMed Central's Open Access subset. They looked at nearly 2.5 million biomedical papers published from January 2023 through February 2026, which had 125.6 million references; 77% had a PubMed identifier (PMID) and were verified; the rest were excluded. For each of the verified references, the team compared "the citing paper's claimed metadata with the use of text-similarity scoring" and flagged mismatches.

To minimize false positives based on formatting errors, flagged references underwent more filters. References that passed all filters were verified against PubMed, Crossref, OpenAlex, and Google Scholar. References that were not found in any database were considered fabricated and those found but linked to an incorrect identifier were considered reference errors.

In one particularly alarming example, 60% of the references on a 2025 paper on ureteroileal anastomotic techniques in an open access oncology journal were found to be fabricated. Each of the references was tailored to the paper's narrow surgical topic and attributed to real urologists.

The researchers also found patterns consistent with paper mill activity, like an author duo appearing across 11 papers in a single surgical journal in 2025 with 15 fabricated references.

Topaz said their findings emphasize that humans need to double check all parts of the research process "because AI can hallucinate at any point, and we need to really be careful about that." He said this responsibility falls to both authors and journals.

In an accompanying editorial, Howard Bauchner, MD, of Boston University Chobanian and Avedisian School of Medicine, and Frederick Rivara, MD, MPH, of the University of Washington and Seattle Children's Research Institute, argued that the onus for catching fabricated citations falls on authors.

They noted that fabricated references are only going to get worse with the increasing use of AI and LLMs in writing and editing.

Bauchner and Rivara, both former JAMA editors, stressed that papers in which a "fabricated reference is detected should be retracted."

"A fabricated reference in a published manuscript is consistent with research misconduct and should be treated as such," they wrote.

Arjun K. Manrai, PhD, of Harvard Medical School in Boston, who was not involved with the research, told MedPage Today that many AI researchers have known that fabricated references are a problem, yet it's barely been studied.

"Fabricated references should concern us all," Manrai said. "If our scientific foundation erodes, we are in deep trouble."

Topaz and co-authors recommended four strategies for handling the problem of fabricated citations. First, publishers should have automated reference verification before peer review. Second, indexing services should add integrity metadata to article records. Third, publishers should retroactively screen already published research. And finally, fabricated references should be established as a category in research integrity databases.

This study is limited by the exclusion of nearly a quarter of references that didn't have a PMID, which could bias estimates. Plus, the researchers only looked at PubMed Central, which is just a subset of all biomedical research.

Topaz said the team is doing further analysis and finding that fabricated citations are proliferating further down in the literature into systematic reviews and clinical guidelines.

"This is the most alarming piece, where you would find yourself providing clinical care as a clinician based on the guideline, and then you look at the ... articles that are cited in this guideline ... and you see that those citations lead to nowhere," Topaz said. "That's very concerning."

Disclosures

Topaz and co-authors reported no disclosures.

Bauchner reported consulting for Paper-Wizard and Medeloop. He also serves on the publication committee of the American College of Physicians (no compensation) and the scientific advisory board of Vivli (paid honorarium). Rivara had no relevant conflicts of interest.

Manrai had no disclosures.

Primary Source

The Lancet

Source Reference: Topaz M, et al "Fabricated citations: an audit across 2.5 million biomedical papers" Lancet 2026; DOI: 10.1016/S0140-6736(26)00603-3.

Secondary Source

The Lancet

Source Reference: Bauchner H, Rivara FP "Fabricated references: a new threat to editorial integrity" Lancet 2026; DOI: 10.1016/S0140-6736(26)00798-1.

https://www.medpagetoday.com/practicemanagement/informationtechnology/121165

'Leapfrog's Safety Grades Give 372 Hospitals Straight As, but 5 Get an F'

 by Cheryl Clark

Even amid an ongoing controversy, the Leapfrog Group released its semi-annual safety rankings, with hundreds of hospitals earning top marks, while just 5 got an F.

Four states have the highest percentage of top-scoring hospitals in the ranking: Connecticut, Virginia, South Carolina, and Utah. More than half of scored hospitals in those states earned an "A" in Leapfrog's spring edition of its Hospital Safety Grades.

The rankings assess performance on 22 metrics, including ICU physician staffing, nursing care hours per patient day, medical errors, healthcare-associated infections, and hand hygiene.

"For a very long time, those of us deeply concerned about patient safety lamented that it never seems to get better. Today we can say that has changed," Leah Binder, Leapfrog's president and CEO, told MedPage Today. "Across 17 patient safety metrics we see sustained unmistakable improvement nationally."

The latest scorecard showed 372 hospitals received not just an A, but a "Straight A," having sustained the highest grade for more than 2 years.

Only five hospitals received the lowest score, an F. They are CAMC Teays Valley Hospital in West Virginia; Roseland Community Hospital in Chicago; South Central Regional Medical Center in Laurel, Mississippi; Weirton Medical Center in West Virginia; and WVU Fairmont Medical Center in West Virginia.

Not all hospitals in the U.S. are scored, but among those that were graded, 917 received an A, 740 a B, 646 a C, and 55 a D.

Leapfrog's A-through-F scoring system for the nation's general acute care hospitals, which launched in 2012, now faces a significant setback. In March, it lost a lawsuit filed by five Tenet hospitals in Florida's Palm Beach County. The hospitals alleged deception in the way Leapfrog calculated its grades, and stopped submitting data to an annual Leapfrog survey that it uses for many of its metrics.

The plaintiffs claimed that because they refused to participate, Leapfrog assigned them lower scores "resulting in artificially deflated overall grades with no basis in fact and no correlation to a hospital's actual safety performance." In effect, its "imputation" methodology "was designed to punish non-participating hospitals," the hospitals alleged.

A U.S. District Court Judge for the Southern District of Florida agreed, calling Leapfrog's method "unfair and deceptive" and "in violation of the Florida Deceptive and Unfair Trade Practices Act." He ordered Leapfrog to remove scores for those five hospitals.

Although Leapfrog is appealing that decision, it also removed scores for another 445 hospitals that did not submit metrics to Leapfrog's survey. They now are scored as "GNA," or grade not assigned.

Instead of 2,813 general acute care hospitals, today's scorecard rated 16% fewer, or 2,363.

"We wouldn't change our methodology for just 5 hospitals so we applied the court's injunction nationally," Binder said. "We disagree with the ruling, but of course in the meantime we are complying with it."

In March, Leapfrog issued a statement calling Middlebrooks' decision "a threat to patient safety."

In its motion for reconsideration to the court filed last week, Leapfrog argued the court's decision is at odds with the First Amendment, which "protects subjective evaluations." Leapfrog warned that such a ruling could extend to many other online grading services, "which often rely on a subjective weighing of objective data."

Further, the motion maintains there was no factual misrepresentation in how it described its methodology. Even if there were, the plaintiffs would have had to prove malice, the motion said.

"Leapfrog respectfully urges the Court to take account of Plaintiffs' post-judgment efforts to anoint themselves as censors who could use the Court's order as a template to warp and silence unfavorable reporting by any healthcare or press organization, even beyond Safety Grades," the motion maintained.

"Absent the requested relief, this may become a case study in how Florida's law of 'unfair trade practices' can be deployed to shut down and penalize candid, incisive public reporting -- and how judicial power may be co-opted by deep-pocketed, litigious, for-profit corporations so as to bring under heel a nonprofit reviewer whose ratings displease them," it said.

Other metrics used in the algorithm include the hospital's use of computerized physician order entry, bar code medication administration, CMS-required patient experience survey results, and whether the hospital has structures encouraging a culture of leadership. Some of the metrics come from required reports to CMS, while some come from the Leapfrog survey.

https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/121134

CMS Mulls Auto-Enrolling Seniors Into Medicare Advantage

 When your patients turn 65, will they automatically be enrolled in a Medicare Advantage plan or accountable care organization (ACO)? That idea is now on the Trump administration's radar.

CMS is currently mulling a plan that would automatically enroll beneficiaries into either Medicare Advantage plans -- in which private insurers contract with CMS to serve Medicare beneficiaries -- or ACOs, such as those that participate in the Medicare Shared Savings Program, according to a report in STAT.

Currently, people who don't make a choice are enrolled in traditional Medicare, which offers seniors the opportunity to see any doctor that takes Medicare; however, traditional Medicare is not the option favored by the Trump administration. Would auto-enrollment in either an ACO -- which is financially incentivized to provide more efficient care at a lower cost -- or Medicare Advantage be better than fee-for-service (FFS) Medicare, "where there's not this long-term, secular relationship between the beneficiary, the patient, and their provider? Yes," Chris Klomp, director of CMS's Center for Medicare, said in the STAT interview.

Republicans argue that Medicare Advantage, with its smaller physician networks and stricter prior authorization rules, can save the Medicare program money. But a report by the Medicare Payment Advisory Commission (MedPAC) in March 2026 found that Medicare paid $76 billion more for Medicare Advantage patients in 2025 than it would have if those same patients had been enrolled in traditional FFS Medicare.

"The higher payments that we estimate relative to FFS vary significantly across MA [Medicare Advantage] parent organizations and are not an estimate of plan profits and administrative expenses," the report noted. "These increased payments to MA plans contribute to funding for the supplemental benefits plans provide. However, the relatively higher payments to MA plans are financed by the taxpayers and beneficiaries who fund the Medicare program. Higher MA spending increases Part B premiums for all beneficiaries, including those in FFS Medicare who do not enjoy subsidized supplemental benefits."

The idea of Medicare Advantage auto-enrollment is not a new one. Page 465 of the Heritage Foundation's Project 2025 report -- released in 2023 and considered by many to be a blueprint for the Trump administration -- lists several suggestions for strengthening the Medicare program, with the first one being "Make Medicare Advantage the default enrollment option."

Health policy analysts had mixed reactions to the idea, which Klomp said is something his team is just thinking about at this point. "It's a good thing," said Tom Campanella, a healthcare consultant in Cleveland, Ohio. However, "if [it] means we're denying needed and appropriate services, that's a bad thing. So there needs to be some form of guardrails or user-friendly transparency," especially in terms of posting patient outcomes, he said in a phone interview.

Campanella disputed the FFS comparison in the MedPAC report. "I think focal point should not be, in effect, to clone traditional Medicare as a benchmark," he said. "Traditional Medicare historically has been entrenched with high healthcare costs, many related to the fee-for-service policy of 'The more you do, the more you make.' And a good chunk of people have Medigap coverage, and they have all their healthcare services covered -- or a good chunk of them -- which results in increased utilization."

But Tricia Neuman, executive director for the Program on Medicare Policy at KFF, in Washington, had other concerns. "One question, for example, is how would the government choose a plan on behalf of a beneficiary?" she said in an email. "Some people, particularly people with serious chronic conditions, value their relationship with their doctors and place a high priority on continuity of care when they transition on to Medicare. Would the government assign a new Medicare beneficiary into a Medicare Advantage plan that allows them to continue treatment from their preferred doctors and specialists, or is there a risk they would be auto-enrolled into a plan with a provider network that would mean having to change doctors?"

"Would the assignment process give preference to insurers with certain characteristics, such as zero-premium products, plan type (HMO vs PPO), or plans with relatively high star ratings?" she continued. "Would the choice be based on random assignment?" And if Medicare Advantage auto-enrollment does result in higher costs for the Medicare program, "[that] could make the model less attractive to insurers," Neuman added.

At least one member of Congress also is interested in the auto-enrollment idea. Rep. David Schweikert (R-Ariz.) introduced a bill in May 2025 that would automatically enroll anyone eligible for Medicare parts A and B "into the MA plan with the lowest premium available to such individual." Although the bill says that each auto-enrolled person would be given "an opportunity to decline such enrollment," it also states that anyone who is auto-enrolled into a Medicare Advantage plan cannot, for the following 3 years, "elect to receive benefits under this title through traditional fee-for-service Medicare under part A or B," suggesting a 3-year lock-in period. Schweikert's bill currently has no co-sponsors.

https://www.medpagetoday.com/publichealthpolicy/medicare/121161

FDA Wants Better Pregnancy Safety Data on Approved Drugs

The FDA on Friday issued guidance for manufacturers collecting postmarketing data on the safety of approved drugs and biologics in pregnancy, with the goal of better understanding potential risks for the pregnant patient and fetus.

"Currently many medical products may be recommended to pregnant women by healthcare providers in spite of the fact that data from the clinical trials used for FDA approval were insufficient to assess safety during pregnancy," Tracy Beth Hoeg, MD, PhD, the agency's top drug regulator, said in a press release. "This guidance provides specific recommendations about how postmarketing data can be leveraged and studies can be designed so clinicians and the public can be better informed about product safety and pregnancy-related risks can be more promptly identified."

The guidelines address three distinct scenarios -- drug exposure prior to pregnancy, drug exposure during pregnancy, and postpartum monitoring -- and come on the heels of a 2-day public workshop on optimizing pregnancy registries for evaluating the safety of drugs and biologics.

Although observational studies such as pregnancy registries can provide useful information, "because of the recurring challenges of achieving sufficient enrollment, pregnancy registries are often not sufficient by themselves to assess the safety of drugs used during pregnancy; therefore, other study designs and data sources capable of adequately assessing the occurrence of pregnancy outcomes are used."

The guidance, which finalizes a draft first issued in 2019, explains three different approaches -- case reports and case series, prospective primary data collection through pregnancy registries, and complementary data sources -- that manufacturers can use in the postmarketing phase to evaluate safety of use during pregnancy. However, the authors cautioned, "These approaches are not intended to imply a hierarchy of evidence from the different study methods."

HHS Secretary Robert F. Kennedy Jr. has previously expressed concern about the use of certain drugs in pregnancy -- including acetaminophen (Tylenol) and selective serotonin reuptake inhibitors (SSRIs) -- citing without evidence that the products could be tied to autism or other fetal harms.

Kennedy, who recently launched a deprescribing initiative for antidepressants, reportedly has been exploring the possibility of banning SSRIs. And the AP reported earlier this year that Hoeg had been working to hire a researcher and friend who has been petitioning the FDA to add warnings to SSRIs about unproven pregnancy risks, including miscarriages and fetal brain abnormalities.

https://www.medpagetoday.com/obgyn/pregnancy/121191

'AP: Cosmetic Interventions Are Booming. Many Say Ethical Conversations Are Lagging'

 Shula Jassell is insecure about the size of her chin and has periodically considered getting filler to make it bigger.

But when the 25-year-old from Southern California gives serious thought to the idea of repeatedly having to get the cosmetic procedure -- it only lasts about a year -- she wonders if a surgical implant would be more practical, even though the prospect of surgery scares her.

"I just try to remember self-love, you know? Beauty is in the eye of the beholder," she says as she verbally processes her internal struggle and talks herself out of getting any work done for now.

Technological advancements over recent decades have made various forms of body modification increasingly accessible -- and inescapable on many social media algorithms.

As injectables like botulinum toxin (Botox), cosmetic plastic surgeries, and GLP-1 medications such as semaglutide (Ozempic, Wegovy) become more pervasive, people -- often but not exclusively women -- are grappling with the philosophical and ethical implications of turning to these interventions in a ceaseless quest for beauty, youth, and conformity.

"We need to have a wider conversation about how to think about this in a way where we're not putting the burden squarely on women, while also not taking away their moral agency," said Natalie Carnes, PhD, a feminist theologian at Duke Divinity School. "Beauty is something that's good. And beauty is something that is good to pursue. Botox and Ozempic and face-lifts, they're all ways of really narrowing the cultural ideals of beauty."

There has been little in the way of official guidance or explicit prohibitions from major religions. But a growing chorus of theologians, philosophers, and bioethicists are calling for more conversations surrounding these procedures and treatments.

In March, the Vatican released a document on Christian anthropology decrying the "cult of the body." "Once modified, often with relentless frenzy, the body becomes a body-object in which the person-subject mirrors themselves, creating a relationship in which the person is no longer his or her body but 'owns' a body," it said.

Increased -- and Younger -- Demand for Intervention

Demand for cosmetic surgery in the U.S. has increased in recent years across all age demographics and ethnic backgrounds, says C. Bob Basu, MD, president of the American Society of Plastic Surgeons. "Forty years ago, perhaps people would think, 'Cosmetic surgery is for the super-rich or the celebrity elite. It's not for regular folk.' That's not the case anymore."

One of the biggest changes he's seen is more young people opting for interventions.

"They're being proactive and thinking about preventive measures, whether it be baby Botox at a younger age to prevent wrinkles from starting or maybe considering a deep plane face-and-neck-lift in the late 30s or early 40s, rather than waiting until you're in your 60s," he said.

But despite its increasing ubiquity, many bioethicists say plastic surgery is not prioritized in their training.

"If you're getting into bioethics and you rotate to learn about medicine, you go to the ICU, you go to places where the palliative care is for dying people, you're looking at transplants. Nobody rotates to plastic surgery," said Arthur Caplan, PhD, founding head of the Division of Medical Ethics at New York University Grossman School of Medicine.

As a result, plastic surgeons often must set their own boundaries for what they will and won't do, without much specialized ethical training.

Faith in the Operating Room

Many religions condemn vanity and praise modesty, which can inform attitudes toward cosmetic work.

Jerry Chidester, MD, a member of the Church of Jesus Christ of Latter-day Saints, said he sees a broad spectrum of stances on plastic surgery within the church. Although some stricter interpretations of the faith may discourage interventions, Chidester said that attitude contrasts with the broader cultural landscape of Salt Lake City, where he's based. Several studies suggest the area has a high number of plastic surgeons and procedures performed per capita.

When patients wrestle with whether to have an operation, Chidester tells them to not worry about what others will think.

"I'm like, 'Look, if you want to do this or not, it's up to you,'" he said. "It's literally your body. Who cares if they think you're doing it for vanity or for function or whatever? It is none of their business."

Sheila Nazarian, MD, a Jewish board-certified plastic surgeon, incorporates her interpretations of parts of the Torah for guidance on thinking about when it is appropriate to modify one's body.

"If it's bringing distress, then it's OK," she said. "My patient population, they're all pretty well-adjusted, happy, successful, intelligent people. But they need help with one little thing that they'd just rather not think about anymore."

Michael Obeng, MD, a Christian, has seen a dramatic shift in acceptance of cosmetic procedures in the nearly 20 years he's been practicing.

"Now people are not even hiding it. They show their plastic surgery as a badge of honor, like somebody wearing their expensive bag," he said. "We are aging slower and of course we are working much longer than our moms and grandmothers worked. In the marketplace, we have to look presentable."

Obeng, a board-certified surgeon in Beverly Hills, specializes in a wide range of procedures from tummy tucks and Brazilian butt lifts to rib removal surgeries. He says he rarely feels tension between his faith and his work. It wasn't until he came to a "crossroads" in 2018, when he began thinking through his willingness to perform certain gender transition surgeries.

He sought the advice of several pastors and religious leaders about what to do. "Nobody could give me an answer," he recalled.

He said his faith ultimately led him to limit his practice to some gender-related procedures like breast augmentation, stopping short of genital gender-affirming surgeries, which he sees as harder to reverse.

Agency Versus Constraint

Ivory Kellogg, a 29-year-old actor in Los Angeles, has been grappling with the tension she feels as a woman while pondering cosmetic interventions.

"There's this expectation that once you hit 35, you think about doing a mini face-lift. That's a lot of pressure," she said. "At the same time, I do want women to feel like they're allowed to do whatever they want. Like if you want to have a face-lift, that's your prerogative."

Though opting for these interventions is often framed as a personal decision, many experts say it's hardly that simple.

"It's important to think about how those choices are constrained and to think about the social pressures," said Abigail Saguy, PhD, a sociologist at the University of California Los Angeles. "This is a social issue. It is a collective problem. But it's continually treated as an individual issue and what individual people should do."

In some cases, as with drugs like semaglutide, these interventions can offer real health benefits. But as their use expands beyond medical need, questions arise about how medical resources are used.

Aasim Padela, MD, who studies bioethics and Islamic thought at the Medical College of Wisconsin, thinks a broader conversation is needed. His primary issues are the ways in which the field of medicine suffers as a result and what resources are poorly distributed when cosmetic surgery is prioritized within a society.

"The profession is supposed to be about restoring health or preventing loss of health," he said. "Certain types of procedures, body modifications, interventions -- whatever you want to call them -- may not meet those goals or even be aimed at those goals."

https://www.medpagetoday.com/surgery/plasticsurgery/121173

Where Is the Off Ramp for Psychotropic Medications?

When I first started taking an antidepressant as a teenager, no one talked to me or my parents about how I might eventually stop. Instead, the conversation was entirely centered on finding and starting the right medication. Since then, my prescription list has quietly grown -- fluoxetine (Prozac) replaced with escitalopram (Lexapro), then venlafaxine (Effexor), the dose creeping upward, and eventually the addition of aripiprazole (Abilify), an antipsychotic used as an adjunct for treatment-resistant depression. Now, at 40, 8 years into sobriety and decades of mental health care, I'm beginning to question why my medications have only increased, never decreased.

Why does psychiatric treatment rarely include an exit strategy? We have well-worn roadmaps for starting psychotropic medications, but the field is just starting to develop guidelines for stopping them -- a conversation largely lacking the voices of people with lived experience. Worse, there is a stunning lack of evidence documenting the long-term effects of these medications, even as this is how they are increasingly being used in the real world.

This gap has hit close to home for me. After years of treatment, significant behavioral and life changes, and months of contemplation, I recently began working with my prescriber to reduce my medication. I've been slowly tapering my dose of venlafaxine for the last few months and have now returned to the dose I was originally prescribed. Despite my steely resolve, the process has been difficult -- fluctuating moods, low motivation, headaches, and the dreaded "brain zaps" that I've come to recognize as withdrawal. Continuing toward eventual cessation seems daunting.

My experience is not unique; in fact, it's strikingly common. National data show that the number of prescriptions for psychiatric medications has risen significantly, even as research on their long-term benefits and risks remains limited. Antidepressants are usually prescribed during acute periods of distress, yet in the U.S. the median user will stay on them for approximately 5 years and the majority (70%) will take them for more than 2 years. This is striking given that the evidence of effectiveness for antidepressants is generally derived from clinical trials ranging in length from 6-to-12 weeks.

In practice, treatment often defaults to continuation, not because it is always necessary, but because there are few established pathways for safely stopping. Unlike many other areas of medicine, there are few widely implemented or well-established standards for when and how to taper or discontinue psychiatric medications. Patients may feel reluctant to lead the charge lest they be characterized as difficult, lacking insight, or "non-compliant."

For those who do consider stopping, the process is rarely straightforward. Many patients experience withdrawal symptoms, sometimes called "discontinuation syndrome." In online patient communities, they report symptoms that can include anxiety, insomnia, and the "brain zaps" I've experienced. Research suggests that these withdrawal symptoms may be more common and longer-lasting than previously recognized.

These symptoms are often difficult to distinguish from relapse, creating a clinical gray area where both patients and providers may default to resuming medication. Without clear guidance, patients are often left to interpret withdrawal symptoms on their own -- and to decide whether to continue, taper, or stop medications without adequate support.

While emerging guidelines are a start, the fact remains that there is little formal training in deprescribing education for providers. Unlike other areas of medicine, where medication reviews and step-down plans are more routine, mental health care rarely builds in regular reassessment with a goal of deprescribing. More tools to support equitable shared decision-making are needed. The field has invested decades in developing and prescribing these medications; it's past time to invest similarly in understanding how to use them safely over the long term, and how to stop them when appropriate.

This inertia has real consequences. Common and serious risks of psychotropic medications include weight gain, metabolic syndrome, sedation or mental fogginess, and drug-induced movement disorders (e.g., tardive dyskinesia). Patients should not be subject to potential side effects longer than necessary, and especially not for medications for which the long-term health consequences are unknown.

Public discourse, including recent comments from HHS Secretary Robert F. Kennedy Jr. questioning antidepressant prescribing practices, has brought renewed attention to these concerns. But this conversation should not devolve into simplistic pro- or anti-medication narratives. Psychiatric medications help many people, including me. The real issue is whether patients and clinicians have the evidence, guidance, and support needed to make informed decisions about long-term use and safe discontinuation. Clinicians should build regular medication reviews into care, with explicit discussion of whether tapering is appropriate, and patients should be informed from the outset about the challenges of discontinuation.

To support this shift, we also need to invest in research on the long-term efficacy of psychotropic medications as well as their adverse effects and how to taper them safely. We cannot provide truly evidence-based care without robust data on how these medications are used -- and discontinued -- in the real world.

Starting medication should never be the only plan. An exit strategy should be part of the conversation from the very beginning.

Megan Evans, PhD, is an associate research scientist at the Yale Program for Recovery and Community Health

https://www.medpagetoday.com/opinion/second-opinions/121182

Iran Responds To US Peace Proposal, As Ayatollah Meets With Top General To Discuss 'Readiness'

 

Summary

• Iran responds Sunday to US peace proposal, finally submitting something official to Pakistan. Details not initially disclosed. 

• IRGC new warning: will unleash "heavy attack" on US bases in region if more Hormuz aggression persists.

• The still not publicly seen Supreme Leader has met with a top Iranian military commander to talk 'readiness' against US-Israeli aggression.

US x Iran permanent peace deal by June 30, 2026?
Yes 52% · No 49%
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Iran Finally Responds To US

After days of waiting, Iran has submitted its response to the latest US peace proposal to mediator Pakistan, despite the recent flare-up in renewed exchanges of fire in the contested Strait of Hormuz this past week.

"Iran has submitted its response to the latest US proposal to end 10 weeks of war, the state-run Islamic Republic News Agency reported on Sunday, without providing any further details," Bloomberg confirms in a fresh headline. "Tehran hasn't yet given any public indication it would accept President Donald Trump’s plan that stipulates Iran permits passage through the Strait of Hormuz and Washington ends its blockade on Iranian ports in the next month."

This comes as Qatar's PM has warned Iran that using the Strait of Hormuz as a pressure card, to choke the global economy, "would only lead to deepening the crisis" - and amid reports there could still be sporadic attacks on Gulf countries like the UAE. According to more of the limited details:

Sources in both camps have told Reuters the latest peace efforts are aimed at a temporary memorandum of understanding to halt the war and allow traffic through the Strait of Hormuz while they discuss a fuller deal, which would have to address intractable disputes such as Iran’s nuclear program.

The latest from Iran's president:

President Trump told Fox News days ago, "They want to make a deal. We've had very good talks over the last 24 hours, and it's very possible that we'll make a deal." He had said if this happens "it'll be over quickly" and oil prices will plummet.

IRGC Fresh Warning on US Bases

Iran's Islamic Revolutionary Guard Corps (IRGC) has warned any attack on Iranian oil tankers and commercial ships will be met with assaults on US bases and "enemy ships" in the region, Al Jazeera reports.

"Warning! Any aggression against the oil tankers and commercial vessels of the Islamic Republic of Iran will be met with a heavy attack on one of the American centers in the region and the enemy’s ships," the IRGC Navy said in the statement.

“Iran will no longer allow passages that are harmful to its interests”

Brigadier General Akrami Nia, the spokesman of the Iranian army, says countries that comply with US sanctions against Iran will surely have problems crossing the Strait of Hormuz. pic.twitter.com/6EZ6NWsZse

— Press TV 🔻 (@PressTV) May 10, 2026

Tehran is accusing the US side of severely violating the ceasefire earlier this week, by firing on and disabling two Iranian-flagged tankers trying to reach Iranian ports. State media reviewed of these hostile incidents:

In a statement, the spokesman for Iran’s Khatam al-Anbiya Central Headquarters said the “aggressive, terrorist and marauding US military” had targeted an Iranian oil tanker sailing from Iran’s coastal waters near Jask toward the Strait of Hormuz, as well as another vessel entering the strategic waterway near the UAE port of Fujairah.

The spokesman also said civilian areas along the coasts of Bandar Khamir, Sirik and Qeshm Island came under aerial attacks carried out “with the cooperation of some regional countries.”

The IRGC further said it will respond "powerfully and without the slightest hesitation" to any aggression or attack. Indeed there are reports that during the past week's skirmishes Iran fired on three US warships seeking to exit waters of Iran's coast.

Ayatollah Meets With Military Commander

We reported earlier that in an official update Iran said that Supreme Leader Mojtaba Khamenei had been 'moderately injured' but is recovering, and he had met with the president of the Islamic Republic. On Sunday he also met with a top military commader, per state Mehr, which writes: "In a meeting with Leader of the Islamic Revolution Ayatollah Seyyed Mojtaba Khamenei, Commander of Khatam al-Anbiya Central Headquarters Major General Ali Abdollahi presented a comprehensive report on the preparedness of the powerful Armed Forces of the country to confront enemies' strategic mistake."

via Mehr

According to more of the state readout:

Abdollahi said “all fighters of Islam” possess high readiness in terms of morale, defensive and offensive preparedness, strategic plans, and the equipment and weaponry required to confront hostile actions by the “American-Zionist enemies.”

He warned that if the enemies commit any “strategic mistake, aggression, or invasion,” Iranian forces would respond “swiftly, intensely, and powerfully.”

The commander also assured the Leader that the armed forces would, “with full obedience” to his orders, defend “the ideals of the Islamic Revolution, our beloved land Iran, sovereignty, national interests, and the brave Iranian nation until the last breath and to the death.”

During the meeting, Ayatollah Khamenei praised the country’s armed forces and issued new directives for continuing action and confronting enemies decisively following the 40-day US-Israeli war against the country.

The Wall Street Journal wrote Saturday of the Ayatollah, "A government official claimed Khamenei, who hasn't been seen in public since that attack, is now in good health." However, there's still a lot of speculation on his role in national decision-making, and over whether he will ever make a public appearance.

https://www.zerohedge.com/geopolitical/iran-responds-us-peace-proposal-ayatollah-meets-top-general-discuss-readiness