Medical Journal News

New England Journal of Medicine, Volume 392, Issue 13, Page 1344-1345, April 3, 2025.

New England Journal of Medicine, Volume 392, Issue 13, Page 1335-1342, April 3, 2025.

New England Journal of Medicine, Volume 392, Issue 13, April 3, 2025.

New England Journal of Medicine, Ahead of Print.

bmj;389/apr02_1/r631/FAF1faChristian Ip-Yam was born in Mauritius, the eldest of four sons. He attended Royal College Port Louis, a prestigious state grammar school in the island’s capital. Being academically gifted and diligent, he was awarded the Mauritian state scholarship in 1979 and applied successfully for medicine at Manchester Medical School where he was a friendly, easy going, and hardworking student who seemed to sail through his undergraduate exams. He qualified with honours in 1984 and opted for a career in anaesthesia.He trained at Northwick Park, Charing Cross, and Harefield hospitals in London and undertook lectureships in cardiothoracic anaesthesia at the University of Liverpool. He published at least 20 research papers in highly respected academic journals.In 1994 he took a sabbatical in Singapore, where he met his future wife, Georgia, a doctor in aesthetics. He settled permanently in Singapore in 1995 and he and Georgia were married in 1996. He quickly established...

The death toll continues to rise in central Myanmar after a 7.7 magnitude earthquake hit South East Asia on 28 March. Over 2700 people have died so far, with another 4521 injured and 441 reported missing.1The disaster prompted Myanmar’s ruling military junta, the State Administration Council (SAC), to make a rare call for humanitarian aid on 29 March, despite the ongoing civil war. On 1 April, however, aid agencies reported that the junta was preventing humanitarian assistance from reaching earthquake survivors.2 SAC resumed airstrikes in rebel areas barely three hours after the earthquake struck.3A UN assessment found that many health facilities in Myanmar have been damaged by the earthquake and warned that a “severe shortage” of medical supplies, including trauma kits, blood bags, anaesthetics, and assistive devices, was hampering response efforts. According to the World Health Organization4 three hospitals were severely damaged, with 22 sustaining partial damage.In a 30 March...

by Lin Geng, Lilith K. Whittles, Borame L. Dickens, Martin T. W. Chio, Yihao Chen, Rayner Kay Jin Tan, Azra Ghani, Jue Tao Lim

When hurricane Helene flooded a North Carolina plant that made 60% of the US’s intravenous fluids in October 20241 it was a grimly familiar situation. The damage worsened a shortage that had lingered since hurricane Maria hit the same company’s production in Puerto Rico in 2017.Medical procedures had to be altered to reduce the use of IV products. Fluids were rationed and surgeries postponed, and some patients had to get by with sports drinks.2 It took three months to bring the crisis under control.A broader, more intractable crisis has replaced it. Trump’s aggressive reconfiguration of US trade relations and a pledge to make all of the country’s essential drugs and their inputs at home is threatening the stability of medical supply chains that have only just recovered from covid.Additionally, tariffs targeting both traditional US allies and rivals are likely to hamper progress already made on relocating some medical sourcing from...

In this feature by Sally Howard (BMJ 2025;388:r305, doi:10.1136/bmj.r305, published 6 March 2025) we have removed a sentence stating that more than 1000 women a year die each year from unsafe abortion in Malawi—a statistic that has been disputed, including in the paper originally referenced in our article (Miller C. Maternal mortality from induced abortion in Malawi: what does the latest evidence suggest? Int J Environ Res Public Health 2021;18:10506. doi:10.3390/ijerph181910506. https://pmc.ncbi.nlm.nih.gov/articles/PMC8507663/).

The World Health Organization will slash its budget for 2026-27 by more than a fifth after the US withdrew, and other nations reduced, its funding.WHO plans to cut back the scale of its projects and its workforce to tackle a funding gap of nearly $600m (£464m; €555m) this year, Reuters reported after seeing an internal memo from 28 March. WHO proposes cutting its 2026-27 budget by 21%, from $5.3bn to $4.2bn. It had initially proposed a more modest cut, reducing spending to $4.9bn.“Despite our best efforts, we are now at the point where we have no choice but to reduce the scale of our work and workforce,” the memo reportedly said. Staff numbers will be cut by the end of April.In an earlier memo dated 10 March, WHO announced a one year limit on staff contracts and was working to alleviate the funding shortfall with more contributions from countries, private...

Singh and colleagues answer questions on managing HIV in primary care.1 Several other aspects are relevant to primary care clinicians caring for people with HIV.Many people with HIV, such as men who have sex with men, are at higher risk of mpox infection and are therefore recommended to receive mpox vaccination by the UK Health Security Agency.2Patients who have taken pre-exposure prophylaxis drugs and have suspected recent HIV acquisition might present atypically with, for example, HIV indeterminate serology and an undetectable or low RNA viral load. Discussion with a local expert or with a national clinical service for people with unusual HIV test results is recommended in this circumstance.3Although Singh and colleagues are right that HIV-2 infections are observed mainly in people with links to West Africa, HIV-1 is probably still more common than HIV-2 in many countries in that region, although data on HIV-2 prevalence are generally more limited.45Regarding...

We have a capacity problem in general practice. There are too few GPs, either as partners or employed, for the number of patients who need looking after. This is despite there being GPs unable to find work and practices that would like to employ them but lack the money or space.1Unsurprisingly, capacity and access are a priority for the government—perhaps because nothing says that the system is broken quite as effectively as an 8 am queue for appointments snaking around the block. Last year’s primary care network contract included extra payments related to this, with a number of boxes that needed to be ticked to earn them.2 Unfortunately, the focus was entirely on ease of access (how the patient makes contact with the surgery through new telephone systems and online triage) rather than on increasing capacity (the number of GP appointments available). This doesn’t help patients or doctors, and it...

The philosopher Derek Parfit, introducing his 1984 book Reasons and Persons, sets out a few basic concepts—that we have reasons for acting, that some ways of acting are morally wrong, and that some outcomes are good or bad in a sense that has moral relevance.1 Reaching for what he presumably judged to be an uncontroversial example of a poor outcome, he notes that “it is bad, for example, if people become paralysed.” Whatever hopes one might have about the arc of the moral universe bending towards justice, the US elections have placed enormous power in the hands of a Republican Party intent on sabotaging vaccination programmes and medical research, while withdrawing support from international programmes funded by USAID.2 This threatens the health and wellbeing of millions of people risking the resurgence of polio (and thus paralysis) as well as other existing and novel infectious diseases.While basic human decency calls for...

bmj;389/apr01_2/r614/FAF1faSteve was born in Preston, only two miles from where he would later practice as a consultant physician for 28 years. The maternity ward was hit by an outbreak of neonatal diarrhoea and there were several tragic deaths. Steve teetered on the brink but survived, according to his mother’s account, as a result of copious amounts of Lourdes holy water sprinkled daily on his forehead. Some 60 years later, by complete coincidence, he attended a domiciliary consultation with a lady with a similar birth date—and discovered that she also was one of the Preston outbreak survivors.Steve was the middle of three boys. His father was an engineer, his mother a teacher. Secondary education was at the Bishop Ullathorne School in Coventry. He commenced medical training at University College London, proceeding to Westminster Hospital Medical School in 1968. As a medical student, his artistic talents were in great demand and he...

bmj;389/apr01_1/r621/FAF1faChris Howard studied medicine at Liverpool University, qualifying in 1968. He completed his houseman, senior house officer, and registrar training in medicine and paediatrics at Leeds General Infirmary and in hospitals across Liverpool, obtaining his membership of the Royal College of Physicians in 1973.In 1974 he saw a “positions vacant” advertisement for a paediatrician in a private practice in Hong Kong and immediately applied. He got the job and moved to Hong Kong that summer, joining the Dr Oram and Partners practice where he worked as a paediatrician and GP for the next 23 years. He retired temporarily from medicine in 1997 to embark on a round-the-world sailing trip, returning to practise in his beloved Hong Kong in 2000.Chris had many interests outside of work. He was a keen yachtsman, a member of his university sailing team, and a member of the Royal Hong Kong Yacht Club, where he raced...

For decades, the clinical approach to coronary artery disease has been centred on the acute effects of coronary occlusion and its culmination in myocardial ischaemia—a focus that has shaped both diagnostic and treatment strategies. However, atherosclerotic coronary artery disease is a lifelong, progressive condition that begins well before clinical symptoms arise. Without a change in thinking, opportunities for early detection, prevention, and long-term management are being missed; atherosclerotic coronary artery disease is therefore expected to cause 10·5 million deaths annually by 2050.

Atherosclerosis starts early in life, progresses with age, with lesions distributed across the vasculature, including coronaries, and is responsible for adverse cardiac events, such as myocardial infarction and sudden cardiac death. The major thrust of current diagnostic and therapeutic strategies for coronary artery disease has overwhelmingly focused on late-stage atherosclerosis—ie, obstructive coronary artery disease—and its consequent clinical signature, inducible ischaemia. Significantly, obstructive coronary lesions found in patients dying of myocardial infarction led to the seemingly logical conclusion that fixing luminal stenosis would prevent events.

Coronary artery disease has long been understood through the paradigm of epicardial coronary artery obstruction, causing myocardial ischaemia (a mismatch between myocardial blood supply and demand). However, this model, which focuses on diagnosing and managing coronary artery disease based on ischaemia and cardiovascular events, is flawed. By the time ischaemia manifests, it is often too late for optimal intervention, limiting the effectiveness of treatment options. Despite decades of medical advances, coronary artery disease continues to be a leading cause of morbidity and mortality globally, highlighting the inadequacy of this traditional ischaemia-centric model.

by Reina Tonegawa-Kuji, Yuan Hou, Bo Hu, Noah Lorincz-Comi, Andrew A. Pieper, Babak Tousi, James B. Leverenz, Feixiong Cheng

Background

While recently U.S. FDA-approved anti-amyloid beta (anti-Aβ) monoclonal antibodies (mAbs) offer new treatment approaches for patients suffering from Alzheimer’s disease (AD), these medications also carry potential safety concerns and uncertainty about their efficacy for improving cognitive function. This study presents an updated meta-analysis of cognitive outcomes and side effects of anti-Aβ mAbs from phase III randomized controlled trials (RCTs) in patients with sporadic AD.

Methods and Findings

Phase III randomized, placebo-controlled blinded trials evaluating the efficacy and safety of anti-Aβ mAbs in patients with AD were identified through a search in clinicaltrials.gov, PubMed and Embase on January 14th, 2024. The retrieved studies were further screened from January 15th, 2024, to February 14th, 2024. We included studies that had been published in any language. Quality of trials was assessed using the Jadad score and publication bias was assessed using Egger’s test and Funnel plot. Primary outcomes were mean changes from baseline to post-treatment in Clinical Dementia Rating scale-Sum of Boxes (CDR-SB) and AD Assessment Scale-Cognitive Subscale (ADAS-Cog) scores, and secondary outcomes were adverse events, including amyloid-related imaging abnormalities with edema (ARIA-E), and ARIA with hemorrhage (ARIA-H). Random-effects meta-analysis and meta-regression analyses were conducted. The literature search identified 13 phase III RCTs, which included 18,826 patients with mild cognitive impairment or dementia due to AD. Compared with placebo, treatment with mAbs significantly improved cognitive performance on CDR-SB (mean difference −0.25, 95% confidence interval [CI] [−0.38, −0.11]) and ADAS-Cog (standardized mean difference −0.09, 95% CI [−0.12, −0.06]), in which a negative change indicates improvement for both scores. Meta-regression analysis suggested that trials enrolling patients with early-stage AD were associated with better efficacy. Elevated risk of ARIA-E (risk ratio [RR] 9.79, 95% CI [5.32,18.01]), ARIA-H (RR 1.94, 95% CI [1.47,2.57]), and headaches (RR 1.21, 95% CI [1.10,1.32]) were noted. Statistical heterogeneity was relatively high for ARIA-E and ARIA-H, leading to wide confidence intervals and considerable variability in effect sizes, though meta-regression was conducted to address this. Furthermore, differences in trial designs introduce limitations in cross-trial comparisons.

Conclusions

Anti-Aβ mAb therapy slows cognitive decline, but with small effect sizes, and raises potential concerns about ARIA and headaches.