It can be incredibly frustrating being constantly told that you have a drinking problem when you've never had a drop but for this 61-year-old Pennsylvania woman, each and every effort to become eligible for a life-saving liver transplant was thwarted by an insurmountable hurdle—she kept testing positive for alcohol. No matter how many times she asserted that she had not been drinking, her urine drug screens read otherwise. Accordingly, she was refused entry on the liver transplant waiting list numerous times, the doctors presuming she was struggling with alcohol addiction.

But the reality was much stranger than anyone might have dreamed. In what seems to be a first in medical history, physicians found that her own bladder was secreting alcohol—a process so unusual that it had not been given an official name yet. Her case sheds new light on how the human body, under abnormal circumstances, can simulate effects of alcohol use without ingestion.

The patient had severe liver cirrhosis, a scarring and liver function loss that requires a transplant to save her life. She also had diabetes that was uncontrolled, leading to high levels of glucose (sugar) in her urine.

Initially, physicians at one hospital brushed off her assertion that she was sober, believing that she was denying alcohol addiction. When she subsequently reported for assistance at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital, the same problem persisted. Her urine samples consistently registered the presence of ethanol, the beverage type of alcohol, further increasing the medical staff's suspicion. Yet there was a critical discrepancy: whereas her urine tested positive for ethanol, it was free of the usual metabolic byproducts—ethyl glucuronide and ethyl sulfate—seen days after drinking.

This contradiction interested Dr. Kenichi Tamama, a senior researcher on the study and an associate professor of pathology and medical director of UPMC's Clinical Toxicology Laboratory. If the woman was consuming alcohol, the metabolites should have been found in her urine. Also, her blood alcohol tests were negative, and she never showed any symptoms of being intoxicated.

Following more research, the doctors discovered a surprising cause: yeast in the woman's bladder was fermenting sugar into alcohol. The process, normally related to making beer or wine, was occurring within her body. Consequently, they suggested calling her condition "urinary auto-brewery syndrome" or "bladder fermentation syndrome."

This condition is similar to, but different from, a rare disorder called auto-brewery syndrome (ABS), also referred to as gut fermentation syndrome. ABS happens when some microbes in the gut ferment carbohydrates into alcohol, leading to people with the condition becoming intoxicated without consuming alcohol. In the case of the Pennsylvania woman, however, her condition was confined to her bladder, so the alcohol did not reach her bloodstream. She therefore never seemed drunk, although her urine was ethanol-positive.

To be sure about their suspicion, scientists performed an experiment. The researchers took a fresh urine specimen from the patient and incubated it at a temperature of the human body (98.6°F or 37°C). Ethanol in the sample zoomed within no time. The sample did not yield any alcohol, however, if it were incubated below normal temperature (39°F or 4°C) or after the addition of a chemical for stopping fermentation. This test conclusively established that the yeast in her bladder was the cause of the alcohol production.

Additional lab tests determined the offender—Candida glabrata, a yeast that is normally present in the human microbiome. Candida glabrata is closely related to brewer's yeast, which is employed in alcoholic fermentation. Under conditions of excess sugar, as in the case of the woman with uncontrolled diabetes, Candida glabrata metabolized the glucose in her bladder to ethanol.

Due to these observations, the woman was finally reevaluated for liver transplant, a move that could turn around her condition and save her life. Her case highlights the need to cast aside standard assumptions of diagnosis and to explore infrequent metabolic phenomena.

Although sporadic reports of such cases have appeared, they were usually considered postmortem changes or laboratory artifacts due to the improper storage of urine samples. This case presents tangible evidence that bladder fermentation is possible in living patients and serves to increase awareness among medical professionals regarding distinguishing between true alcohol intake and endogenously produced alcohol.

What Is Auto-Brewery Syndrome?

Auto-brewery syndrome, or gut fermentation syndrome, is a rare condition where carbohydrates ferment to alcohol within the gastrointestinal tract. Patients can present with signs of intoxication, such as dizziness, slurred speech, and coordination impairment, without alcohol consumption. This results from an imbalance in gut microbiota, typically yeasts such as Candida.

The syndrome is well-documented in medical literature for more than 50 years, yet it remains significantly underdiagnosed. A study published in 2021 estimated that fewer than 100 cases had been reported globally. Experts, however, estimate that numerous other people might be suffering from the condition unknowingly, as the symptoms might be confused with alcohol intake, metabolic conditions, or psychiatric issues. In severe instances, people with ABS have been charged with DUI, even though they consumed no alcohol.

How Is Urinary Auto-Brewery Syndrome Different From Typical Auto-Brewery Syndrome?

Urinary auto-brewery syndrome (bladder fermentation syndrome) and conventional auto-brewery syndrome (gut fermentation syndrome) are similar but differ significantly.

In urinary auto-brewery syndrome, alcohol is synthesized in the bladder because of microbial fermentation of sugar. It may also happen in an open sample of urine outside the refrigerator. But as the alcohol is contained within the bladder and does not get into the bloodstream, individuals who have it do not have symptoms of being intoxicated.

In contrast, classical auto-brewery syndrome happens within the gastrointestinal tract, where fermentative microbes metabolize carbohydrates into alcohol. This alcohol is absorbed into the bloodstream, resulting in a positive plasma ethanol reading and creating symptoms of intoxication similar to that following alcohol intake.

Kate Middleton or Catherine, Princess of Wales reflected on the aftermath of chemotherapy in her first public appearance since she had unexpectedly withdrawn from Royal Ascot just two weeks ago.

She has called the entire experience "really difficult". On her visit to a wellbeing garden at Colchester Hospital in Essex, England on Wednesday, she told the patients, "You put on a sort of brave face, stoicism through treatment, treatment’s done – then it’s like ‘I can crack on, get back to normal.’ But actually the phase afterwards is really difficult, you’re not necessarily under the clinical team any longer, but you’re not able to function normally at home as you perhaps once used to."

The reason she visited the hospital garden in the Southeast of England was to "celebrate the incredible healing power of nature", noted Kensington Palace.

She also met with patients and hospital staff at the Cancer Wellbeing Centre "to understand how gardens in healthcare setting play a crucial role in promoting good health outcomes, preventing poor health and supporting increased recovery time."

Now 43, Kate herself has pointed out to the importance of nature in her health journey over the last year.

Is There Any Scientific Proof That Nature Could Actually Heal You?

Lisa A Cooper, MD, MPH writes in the 'Letter from the Director' at John Hopkins Medicine that nature does have healing power. She notes that green spaces play a role in cardiovascular health, and also facilitates to interact with other people who are there to enjoy nature. The American Psychological Association (APA) also noted that spending time in nature is linked to both cognitive benefits and improvements in mood, mental health and emotional well-being. The University of Cincinnati also points out that being out in nature can further reduce anxiety, lower blood pressure, enhance immune system function, and boost self esteem and mood.

In fact in a video, which was posted by Kate on X to mark Mental Health Awareness Week in May, she said, "over the past year, nature has been my sanctuary."

Kate's Cancer Timeline

In March, Princess Kate publicly shared her cancer diagnosis and confirmed she had begun chemotherapy. As she focused on her recovery, she stepped away from the public eye, making only a few limited appearances over the summer. By September, she announced she had completed chemotherapy and was "doing what I can to stay cancer-free."

Since then, the Princess of Wales has been gradually re-engaging with her royal responsibilities. While she has increased her public appearances this year, palace insiders say she is carefully managing her return to balance her health with her official duties.

Earlier this summer, Kate made high-profile appearances at key royal events, including the Trooping the Colour parade in London and the Order of the Garter service in Windsor. However, she later withdrew from the Royal Ascot at the last minute, signaling that her return to full-time royal duties is still being handled with care.

Just last week, Kate resumed in-person engagements, joining Prince William in hosting philanthropist Melinda French Gates at Windsor Castle. The meeting, reportedly focused on their shared philanthropic interests, marked one of her first official engagements in recent weeks.

On Wednesday, the Princess made a meaningful visit to Colchester Hospital, where she helped plant several “Catherine’s Rose” plants—a specially bred rose named in her honor by the Royal Horticultural Society. The visit coincided with the hospital receiving a donation of 50 such plants.

The rose holds special significance: proceeds from its commercial sale will go to The Royal Marsden Cancer Charity, supporting cancer patients through treatment and beyond. The funds will help the charity develop a dedicated program focused on improving quality of life for those living with cancer and those who have completed treatment.

Princess Kate has deepened her connection with the Royal Marsden since her diagnosis. In January, Kensington Palace announced she had been named joint patron of The Royal Marsden NHS Foundation Trust, the specialist cancer center in Chelsea, west London, where she received treatment.

Her involvement with the charity and efforts to raise awareness reflect her commitment to supporting others navigating a cancer diagnosis. While her return to public life is cautious and measured, each appearance signals both her resilience and her intention to use her platform for meaningful causes.

As she continues to recover and adjust, the Princess of Wales remains one of the most admired and closely followed members of the royal family—balancing personal healing with her public role.

The global community seems to have received a stark warning based a new study published in The Lancet, President Donald Trump's drastic cuts of US foreign humanitarian aid could lead to over 14 million extra deaths by 2030. The study, based on two decades of global health data, highlights the alarming consequences of retracting the US support to vulnerable groups, especially in low- and middle-income nations. With an estimated third of these deaths likely to be children, the results have left the global aid and public health communities in shock.

The Trump administration's wholesale slashing of foreign assistance programs was grounded in the "America First" doctrine, a political ideology that subordinates global involvement to domestic priorities. In March, US Secretary of State Marco Rubio said more than 80% of all USAID programs had been cut. The sudden rollback came as billionaire Elon Musk—then leading a federal workforce reduction effort—sought to re-make the delivery of aid programs, which critics claim were more concerned with trimming costs than with saving lives.

America has traditionally been the globe's biggest giver of humanitarian aid, with the US Agency for International Development (USAID) active in over 60 countries. In 2023 alone, America spent $68 billion on foreign aid. But in March this year, US Secretary of State Marco Rubio declared that the Trump administration had terminated more than 80% of all USAID programmes due to a desire to cut wasteful spending, as the administration claimed. It was an effort to cut the federal workforce and trim government operations, led in part by billionaire Elon Musk.

As per the Lancet research, written by Davide Rasella of the Barcelona Institute for Global Health and colleagues, the suggested 83% funding reduction has the potential to halt or even reverse two decades of improvement in global health. The researchers simulated the probable effect on low- and middle-income countries' mortality and opined that the end of U.S. support would unleash a devastating increase in avoidable deaths.

The team from The Lancet study examined data from 133 nations and projected the effect of the cuts over the period to 2030. Their forecasts are grim:

• Over 14 million extra deaths worldwide by 2030 if the cuts are not reversed.
• Over 4.5 million of those deaths would be children under the age of five, representing around 700,000 child deaths annually.

The impact on global health systems would be "comparable in magnitude to a global pandemic or a major war," co-author Davide Rasella of the Barcelona Institute for Global Health said.

The findings of the study are especially concerning for low- and middle-income countries, whose health, nutrition, and development programs have been a lifeline for USAID funding. The sudden cutoff in support risks stopping—and even reversing—two decades of advances in decreasing mortality and enhancing health outcomes among the world's most vulnerable citizens.

The United States' withdrawal has had spillovers. In Washington's wake, a number of other donor states, such as the UK, France, and Germany, also reduced their own contributions. The chain reaction has exacerbated the worldwide funding gap for humanitarian projects. The United Nations says that the global humanitarian community is now experiencing "the deepest funding cuts ever," as needs continue higher than ever in response to conflict, climate-related disaster, and pandemic fallout.

Between 2001 and 2021, estimated lives saved in developing countries through USAID-supported programmes are 91 million, including 30 million children. The effect was particularly significant among recipient countries with high volumes of aid, where all-cause mortality reduced by 15%, and child mortality declined by 32%. In focus disease areas, mortality due to HIV/AIDS, malaria, and neglected tropical diseases decreased by 74%, 53%, and 51% respectively in recipient countries with significant USAID presence.

The cuts now in place risk reversing these hard-won achievements. The authors of the study say the withdrawal of US funding will not only raise mortality but also destabilize health systems, undermine disease control, and deny millions access to life-saving services

Ironically, the release of the Lancet report happened at the same time that a large United Nations-sponsored aid conference took place in Seville, Spain—the largest one in a decade. The lack of U.S. participation in this pivotal meeting did not escape attention. Critics point out that Washington's absence belittles decades of American dominance in global health diplomacy and squanders its credibility as a humanitarian leader.

President Trump has consistently justified the cuts as a way to eliminate waste and make sure US spending is aligned with America's national interests. Secretary of State Rubio said the remaining 1,000 or so aid programs will be handled "more effectively" by the State Department and in coordination with Congress. Critics counter that the cuts are short-sighted and could jeopardize both global stability and America's international reputation.

Human rights activists and world health professionals warn that the erosion of US leadership in humanitarian assistance could spur other nations to do the same, further exacerbating the crisis. The authors of the Lancet study emphasize that if the sudden funding reductions are not reversed, the world will see a "staggering number of avoidable deaths" in coming years

They also support more intelligent, effective aid delivery systems that focus on transparency, local participation, and evidence-based action. The bottom line: investing in global health is not only a moral imperative but a strategic one that ensures world stability, economic growth, and public health security.

With the world confronting increasing challenges—from climate change and pandemics to conflict and displacement—the demand for strong, united global assistance has never been greater. The future of millions of people is at stake, and the choices that are made today will determine the future of global health for generations to come.

Medicine is evolving—and quickly. With chronic diseases surging and scientific innovations accelerating, a new generation of best-selling medicines is revolutionizing the way we treat cancer, diabetes, autoimmune diseases, and obesity. These are not merely pharma successes—these are clinical game changers fueling billions of dollars in investment, research, and optimism.

These most-anticipated drugs in 2025 reflect this shift. Cancer drugs such as Keytruda are raising the bar in oncology, and metabolic medicines such as Ozempic and Mounjaro are transforming the treatment of diabetes and weight. And drugs such as Dupixent and Skyrizi are breaking ground in treating chronic inflammatory diseases, bringing targeted comfort to tens of millions.

The best-selling medications in the world are not only business blockbusters—they are also medical breakouts in the treatment of cancer, diabetes, obesity, and chronic disease. Although sales estimates provide mind-boggling numbers—such as Merck & Co.'s Keytruda poised to exceed $31 billion—the tale behind the tabulation is based on mighty innovations that are transforming how we address some of the globe's most urgent health issues.

The pharma landscape of 2025 is considerably characterized by a focused attempt to address some of the most debilitating and entrenched health issues of our era. Cancer, especially aggressive and difficult-to-treat types such as non-small cell lung cancer, melanoma, and multiple myeloma, continues to remain high on the agenda, with cutting-edge immunotherapies and biologics at the forefront. Simultaneously, increasing worldwide incidence of metabolic disorders like type 2 diabetes and obesity has fueled a new generation of therapies targeted at controlling blood sugar, facilitating weight loss, and lowering cardiovascular risk.

What Diseases are The Main Focus?

Cancer (Oncology)

Cancer is still the biggest and best-funded field in contemporary medicine, with non-small cell lung cancer, melanoma, multiple myeloma, and triple-negative breast cancer ranking high. New immunotherapies and monoclonal antibodies are transforming therapy by educating the immune system to recognize and destroy cancer cells more precisely and with fewer side effects than conventional chemotherapy.

Leading the charge is Keytruda (pembrolizumab), an immunotherapy medication that's transforming cancer treatment. Approved for use to treat several kinds of cancer, including melanoma, non-small cell lung cancer, head and neck cancer, and others, Keytruda functions by strengthening the immune system so it can more effectively find and kill cancer cells. This type of mechanism, referred to as a checkpoint inhibitor, has significantly enhanced survival rates for many aggressive cancers.

Its estimated $31 billion worth of sales in 2025 attests to more than pure economic success—it is a testament to the extent to which immunotherapies have become integrated in oncology therapy worldwide. The rising cancer burden across the world and high growth in the use of immunotherapies in early-stage treatment are among the principal factors propelling its quick ascension.

Type 2 Diabetes

Type 2 diabetes is a metabolic disorder with insulin resistance and persistent hyperglycemia, resulting in long-term damage to the heart, kidneys, and nerves. New drugs not only are enhancing glucose control but also are showing substantial reductions in cardiovascular risks, making them an dual solution for two of the world's top causes of death.

Then come Ozempic and Wegovy, which are trade names for semaglutide, made by Novo Nordisk. The two drugs, though chemically the same, have very different uses. Ozempic is indicated for the treatment of type 2 diabetes, whereas Wegovy is indicated for long-term weight management in people who have obesity or overweight and one or more weight-related conditions.

Semaglutide is a mimic of the GLP-1 hormone, controlling insulin secretion, appetite, and digestion. Its success is representative of the increasing convergence between metabolic health and management of chronic disease. Together, these drugs are expected to account for more than $36 billion in 2025, not just an indication of their medical importance but also of society's increasing interest in the prevention of diabetes and obesity.

Obesity

Obesity is increasingly being seen as a chronic, complex disease rather than merely a matter of lifestyle, and it's firmly connected with diabetes, heart disease, and some types of cancer. New generation weight-loss medications imitate gut hormones to reduce hunger, control blood sugar, and achieve long-term weight loss without surgery.

Eli Lilly's blockbuster, tirzepatide, takes a parallel course with its two brand names, Mounjaro for type 2 diabetes and Zepbound for weight loss. With its novel dual-action mechanism acting on GLP-1 and GIP receptors, it has even more potent appetite suppression and glucose lowering compared to earlier treatments.

Mounjaro's $19.8 billion forecasted sales, combined with Zepbound's $11.3 billion, are testament to the status of tirzepatide as a next-generation therapy for the obesity-diabetes continuum. With obesity as a gateway disease for cancer, cardiovascular disease, and type 2 diabetes, the role of drugs such as these in the preventive sphere cannot be overemphasized.

Chronic Inflammatory Diseases

Diseases like eczema (atopic dermatitis), asthma, nasal polyps, and eosinophilic esophagitis are fueled by hyperactive immune reactions that lead to ongoing inflammation and tissue injury. Biologics for targeted therapies are enabling patients to control these diseases over the long term by silencing particular immune pathways, leading to enhanced quality of life and reduced flare-ups.

Outside of cancer and metabolic disorders, chronic inflammatory and viral diseases also top the list of 10:

Dupixent (dupilumab) is revolutionizing treatment of patients with atopic dermatitis, asthma, and eosinophilic esophagitis by addressing the IL-4 and IL-13 pathway responsible for allergic inflammation. Its estimated $16.9 billion indicates the increasing application of biologics in dermatological and respiratory conditions.

Skyrizi (risankizumab), for plaque psoriasis, psoriatic arthritis, and Crohn's disease, employs IL-23 blockade to decrease systemic inflammation. Its increasing popularity indicates an increased emphasis on fewer side effects and targeted immunomodulators.

HIV/AIDS

Treatment for HIV has improved with once-daily combination tablets that suppress the virus, prevent transmission, and promote near-normal life expectancy. The regimens are now maximized for tolerability and long-term administration, including pediatric and adolescent options.

Biktarvy, which is an HIV drug made by Gilead, combines three antiviral medicines to hold back the virus and make treatment regimens easier. As HIV progresses to become a chronic manageable disease, Biktarvy's projected $13.4 billion sales reflect its place in contemporary, once-daily HIV treatment.

Cardiovascular Disease

The prevention of strokes, blood clots, and heart attacks is a central focus in world health, especially in older adults. Oral anticoagulants are commonly used to treat atrial fibrillation and prevent thromboembolism after surgery or due to chronic disease without the requirement for ongoing blood monitoring.

Eliquis (apixaban), an anticoagulant for stroke prevention and deep vein thrombosis, remains a best-seller. With aging populations and increasing cases of atrial fibrillation, so does demand for safer anticoagulants increase. Its $13 billion forecast confirms the value of preventive cardiology.

COVID-19

Although the pandemic's peak has already gone, innovation in vaccines continues to safeguard susceptible groups and look ahead to future variants. mRNA-based platforms became a template for rapid-response vaccine development, representing a pivot in infectious disease prevention.

At the same time, Comirnaty, the Pfizer-BioNTech COVID-19 vaccine, holds its commercial value at $13.5 billion in anticipated 2025 sales. While demand for vaccination on a worldwide scale has leveled off, booster drives, new strains, and breaking into mRNA-based flu and RSV vaccines keep Comirnaty in worldwide circulation.

Top 10 Drugs Projected by Global Sales in 2025

What holds all of these number-one-selling medications together is their evidence of a larger shift in world medicine. The action is more personalized, with gene-targeting and biologics mirroring the old one-size-fits-all approach. There's a discernible trend toward preventive health, where problems like diabetes, obesity, and cardiovascular disease are treated early and aggressively.

Additionally, the triumph of drugs such as Keytruda, Dupixent, and Skyrizi reflects the broadening scope of immune-based treatments, not only in cancer but in dermatology, gastroenterology, and pulmonology. Likewise, the call for metabolic treatments reflects public health efforts addressing global epidemics such as obesity and diabetes.

Though forecasted 2025 revenues of leading medicines present stunning numbers, the actual story involves what these medications are accomplishing for patients. From transforming cancer treatment to allowing long-term weight management, to allowing people with HIV to live longer and healthier—these drugs are milestones in contemporary medicine.