Medical Journal News

“We need more activity, and less waste,” says Wes Streeting in his introduction to NHS England’s plan to reform elective care.1 The recently published proposals set out how this will be achieved via: “productivity-boosting tools,” a “focus on improving experience and convenience,” and paying £20 to GPs who use the advice and guidance system to seek a secondary care opinion before, or instead of, making a formal onwards referral. The plan was illustrated by the story of a patient named Sarah, whose convoluted route to receiving a diagnosis of rhinitis and a hearing aid exposes the risks of focusing on itemisable activity instead of solutions to the deeper problems overwhelming the health service.The case study featuring Sarah was quietly removed from the document after a flurry of GPs pointed out that her treatment managed to be both idealistic and wholly inappropriate. But the most bemusing fact about her meandering clinical...

In mid-March 2020 and into April 2020, paediatric wards in England—usually full with children needing medical care due to respiratory diseases and other illnesses—were empty. The UK, and other countries in the world, were in a covid-19 lockdown. Schools were closing and children were staying at home and not mingling. The usual infectious disease mix that would result in children needing hospital care had a break. Paediatricians expected a quiet few months while NHS resources were directed towards the mounting wave of covid-19 hospital admissions, which were expected to be largely in the older and middle-aged population.And then incredibly unwell children started showing up in hospital.1 First one, then another one, and then several more. The children all had symptoms similar to the rare Kawasaki disease, an autoimmune disease, which can cause cardiac arrest and result in children being admitted to intensive care (ICU). Within the span of 10 days...

Médecins Sans Frontières (MSF) has withdrawn from a key hospital in Sudan’s capital Khartoum following months of violent attacks on patients and staff.1The aid organisation announced the “very difficult decision to suspend all medical activities” at Bashair Teaching Hospital—which is in an area controlled by the paramilitary Rapid Support Forces—on 9 January. It said extensive engagement with all sides in the conflict regarding keeping the hospital safe had failed.In November a patient was shot and killed inside the hospital, and in December attackers fired weapons inside the emergency ward and threatened medical staff. Bashair Teaching Hospital is one of the last functioning hospitals left in south Khartoum that offers free medical care. MSF has had a team working there since May 2023, the month after the civil war between the Sudanese Armed Forces and the Rapid Support Forces began.Claire San Filippo, MSF emergency coordinator, said, “Intense and extreme violence continues...

Providing calorie information labels on menus and food products has a small but important effect at a population level on the choices that people make, a large Cochrane review has concluded.1UK researchers analysed findings from 25 studies and found that calorie labels on supermarket products and on menus in restaurants lead people to select food with a smaller number of calories. They identified a 1.8% reduction in calories selected when labelling was in place, which they calculated meant 11 fewer kilocalories for a 600 kilocalorie (2.5 MJ) meal.Their results indicated that there may be a bigger effect of labelling on the food that people actually consumed (rather than just selected), with a 5.9% reduction, but the evidence to support this finding was weaker.A previous Cochrane review published by the same team suggested a bigger effect of calorie labelling,2 but more high quality research has been done since then. If sustained...

Wilkinson and colleagues1 and Simpson2 argue that the General Medical Council should overlook criminal behaviour when it aligns with their personal beliefs. Wilkinson and colleagues question the fairness of suspending a doctor involved in unlawful protests, while Simpson advocates sabotaging infrastructure. Both letters downplay the importance of professional accountability and public trust, prioritising personal views over professional obligations.The GMC’s role is to uphold public confidence in doctors, not to excuse criminal activity because it aligns with a specific cause. Activism does not require unlawful behaviour, and public trust in the medical profession depends on adherence to ethical and legal standards. Excusing criminal acts for any kind of activism sets a dangerous precedent. Would the public accept doctors going unsanctioned by the GMC for engaging in illegal activity while protesting against the tobacco industry, for example, despite its demonstrable harm to public health?Wilkinson and colleagues and Simpson must also recognise that...

In the UK, 2.8 million people are economically inactive and in receipt of health related welfare benefits.1 Almost a million young people aged 18-24 years are not in education, employment, or training, and one in five of those receives health related benefits, largely for mental health conditions.2 Following a decade of austerity, and exacerbated by the covid-19 pandemic, ill health and health inequalities have worsened in the UK such that it is the “sick (wo)man of Europe.”3The UK has far higher rates of health related worklessness than most other comparable economies (including Germany, Sweden, and France).4 It faces a serious economic challenge because of stagnating growth and widening inequalities in productivity, which contribute to rising rates of poverty and further inequalities in health.5Health related worklessness became a problem for the UK in the 1980s when rapid deindustrialisation led to mass unemployment, particularly in the north of England, Scotland, and Wales.1...

A nurse forced to change an incontinent patient with dementia beside a vending machine and a patient dying from a cardiac arrest who couldn’t be given adequate cardiopulmonary resuscitation (CPR) because of overcrowding in the corridor are just two examples from a stark new report from the Royal College of Nursing.1The report is based on a survey of 5408 UK nursing staff carried out from 18 December to 11 January 2025, in which more than two thirds (66.8%) said they had on a daily basis treated patients in inappropriate settings such as a corridor, bathroom, cloakroom, bereavement room, or converted cupboard. More than nine in 10 of those surveyed believed that patients’ safety was being compromised. Nurses reported caring for up to 40 patients in a corridor but unable to access oxygen, cardiac monitors, and other vital equipment.The report also highlights serious concerns about infection prevention and control. One nurse...

The theme of the 2024 Wakley-Wu Lien Teh Prize essay contest was women and health.1 We are delighted and grateful to have received 159 submissions in response to our call. The essays cover an exceptionally wide range of topics, including the normalisation of pain related to menstruation and childbirth and the health of women in rural areas. They are deeply touching, beautifully crafted, and profoundly thought provoking. The competition has been incredibly fierce; it has been a challenging task for us to make a final selection.

For over a century, radiotherapy has revolutionised cancer treatment. Technological advancements aim to deliver high doses to tumours with increased precision while minimising off-target effects to organs at risk. Despite advancements such as image-guided, high-precision radiotherapy delivery, long-term toxic effects on healthy tissues remain a great clinical challenge. In this Review, we summarise common mechanisms driving acute and long-term side-effects and discuss monitoring strategies for radiotherapy survivors.

bmj;388/jan16_7/r92/FAF1faWhile he was a senior house officer in Ashington, Northumberland, Mike Snow developed open tuberculosis. He had a considerable amount of time off work, including 100 days of intramuscular injections of streptomycin.This experience may have coloured his choice of career. Despite infectious diseases being prevalent in the 1970s the specialty was in its infancy and most patients, apart from the most serious cases, were treated by general physicians.In 1978 Snow was appointed to a new post at Newcastle General Hospital, where most of the serious infectious diseases were treated. There was a small isolation unit to which any consultant in Newcastle could refer patients for nursing care, while their medical care would be delivered by the referring consultant. Snow took a strong interest in developing the unit.He completed his training as a physician and then spent six months in Birmingham with Alastair Geddes, a specialist in infectious diseases. HIV and...

Next week the US president elect, Donald Trump, will take office with a mandate to make radical changes to the government’s approach to medicine and public health.Health insurance coverage in particular faces massive, potentially harmful, reform (doi:10.1136/bmj.q2801).1 Republicans in Washington plan to shrink Medicaid, the programme for people on low incomes, potentially leaving millions of Americans uninsured. Traditional Medicare (for people over 65 and those with disabilities) could also reduce to the point that it covers only a small fraction of the current Medicare population.In the meantime, public frustration with insurers has been evident after the murder of Brian Thompson, chief executive of UnitedHealthcare (UHC) (doi:10.1136/bmj.q2879).2 It has exposed the healthcare giant’s high rate of insurance coverage denial and the misery this has caused. The fact that Luigi Mangione, who is accused of the murder, left a note accusing the US healthcare system of corruption and greed has been widely...

Shhhh. Stop eating so loudlyWe’re not talking about crisp crunching in the cinema. “Food noise” refers to the constant and obsessive thoughts some people report having about food.Noise cancelling?In effect, yes. The term is currently being discussed in relation to glucagon-like peptide-1 receptor agonist (GLP-1RA) weight loss drugs, such as semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), and tirzepatide (Mounjaro), with people reporting that these drugs have silenced their internal food chatter. Videos on the subject have gained millions of views on platforms like TikTok,1 and major outlets such as the New York Times have covered the concept.2Where did it come from?The origins of the term aren’t clear, but a Google search shows that the term “food noise” has been around for at least a decade, being used in nutrition blogs3 and by celebrities promoting their brands.4 The meaning of the term seems to have evolved in recent years, however, from the...

In September 2024 NHS England published Principles for providing safe and good quality care in temporary escalation spaces1—in short, a guide to the ethics of corridor care. There wasn’t much fanfare on publication. It wasn’t shouted from the rooftops. Reading the document it is obvious why: this is a protocol issued from a system in serious trouble.It cannot have been easy to draft. The title is a contradiction. Its basic premises are at loggerheads. Safe and good quality care cannot co-exist with treatment in corridors. “Our aim,” says NHS England, “is always to deliver high standards of care for patients in the right place and at the right time.” From the beginning, therefore, it announces its failure. No patient ill enough to be in hospital can be properly cared for in a corridor—or car park, storeroom, or waiting area. Yes, they can be cared for. Yes, it may be better...

I’ve only been working as a foundation year 2 doctor in an emergency department for six weeks and already I’m physically and mentally exhausted. Our department has far too few staff to match the ever increasing demand—a familiar story that is playing out across the country.1Every day I see colleagues working tirelessly to offer the best care they can for their patients, but the current provision doesn’t let us deliver the gold standard care I was taught to give and aspire to provide. As doctors, we’ve had years of practice interacting with patients under our care to hone our empathy. In this dystopian system, however, it’s not only doctors empathising with patients but also patients empathising with doctors. I’ve had patients commiserate with me over the relentless conditions in the emergency department. They can see the environment that my colleagues and I are working in and are often very understanding,...

by Nathaniel Z. Counts, Noemi Kreif, Timothy B. Creedon, David E. Bloom

Background

Federal policy impact analyses in the United States do not incorporate the potential economic benefits of adolescent mental health policies. Understanding the extent to which economic benefits may offset policy costs would support more effective policymaking. This study estimates the relationship between adolescent psychological distress and later health and economic outcomes and uses these estimates to determine the potential economic effects of a hypothetical policy.

Methods and findings

This analysis estimated the relationship between psychological distress in those aged 15 to 17 years in 2000 and economic and health outcomes approximately 10 years later, accounting for an array of explanatory variables using machine learning–enabled methods. The cohort was from the National Longitudinal Study of Youth 1997 and nationally representative of those aged 12 to 18 years in 1997. The cohort included 3,343 individuals under age 18 years in round 4 who completed the Mental Health Inventory-5 (MHI-5). Round 1 captured 50 explanatory variables that covered domains of potential confounders, including basic demographics, neighborhood environment, family resources, family processes, physical health, school quality, and academic skills. The exposure included a binary variable of clinically significant psychological distress (MHI-5 score of less than or equal to 3) and a categorical variable of symptom severity on the MHI-5. Outcomes covered domains of employment, income, total assets at age 30 years, education, and health approximately 10 years later.Forty-seven percent of the cohort were black and Hispanic, and 4.4% had past-month clinically significant psychological distress. Past-month clinically significant psychological distress in adolescence led to a 6-percentage-point (95% confidence interval [CI] [−0.08, −0.03]) reduction in past-year labor force participation 10 years later and $5,658 (95% CI [−6,772, −4,545]) USD fewer past-year wages earned. We used these results to model the labor market impacts of a hypothetical policy that expanded access to mental health preventive care and reached 10% of youth who would have otherwise developed clinically significant psychological distress. We found that the hypothetical policy could lead to $52 (95% credible interval [51,54]) billion USD in federal budget benefits over 10 years from labor supply impacts alone. This study faced limitations, including potential unmeasured confounding, missing data, and challenges to generalizability.

Conclusions

Our findings showed the impacts of adolescent mental health policies on the federal budget and found potentially large effects on the economy if policies achieve population-level change.

by Karin Källén, Mikael Norman, Charlotte Elvander, Christina Bergh, Verena Sengpiel, Henrik Hagberg, Teresia Svanvik, Ulla-Britt Wennerholm

Background

The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy. We evaluated maternal and perinatal outcomes after a national shift from expectancy and induction at 42+0 weeks to a more active management of late-term pregnancies in Sweden offering induction from 41+0 weeks or an individual plan aiming at birth or active labour no later than 42+0 weeks.

Methods and findings

Women with a singleton pregnancy lasting 41+0 weeks or more with a fetus in cephalic presentation (N = 150,370) were included in a nationwide, register-based cohort study. Elective cesarean sections were excluded. Outcomes during period 1, January 2017 to December 2019 (before the shift) versus outcomes during period 2, January 2020 to October 1, 2023 (after the shift) were analysed. For comparison, outcomes of pregnancies lasting 39+0 to 40+6 weeks (N = 358,548) were also studied.Primary outcomes were: First, peri/neonatal death (stillbirth or neonatal death before 28 days); second, composite adverse peri/neonatal outcome (peri/neonatal death, Apgar score <4 at 5 min, hypoxic ischemic encephalopathy grades 1–3, meconium aspiration syndrome, birth trauma, or admission to a neonatal intensive care unit (NICU) ≥4 days); third, composite adverse peri/neonatal outcome excluding admission to NICU; and fourth, emergency cesarean section. Secondary outcomes included the components of the primary composite outcomes. Relative risks (RRs) with 95% confidence intervals (CIs) for binary outcomes period 2 versus period 1 were computed using modified Poisson regression analyses with adjustments for maternal age, parity, body mass index (BMI), smoking, and educational level.Induction rates among pregnancies lasting 41+0 weeks or more increased from 33.7% in period 1 to 52.4% in period 2. Mean (standard deviation) gestational age at birth decreased from 290.7 (2.9) days to 289.6 (2.3) days. Infants born during period 2 were at lower risk of peri/neonatal death compared to infants born during period 1; 0.9/1,000 versus 1.7/1,000 born infants (adjusted RR 0.52; 95% CI [0.38, 0.69]; p < 0.001), and they had a lower risk of having the composite adverse neonatal outcome, both including (50.5/1,000 versus 53.9/1,000, adjusted RR 0.92; 95% CI [0.88, 0.96]; p < 0.001) or excluding NICU admission (18.5/1,000 versus 22.5/1,000, adjusted RR 0.79; 95% CI [0.74, 0.85]; p < 0.001). The cesarean section rate increased from 10.5% in period 1 to 11.9% in period 2 (adjusted RR 1.07; 95% CI [1.04, 1.10]; p < 0.001). For births at 39 to 40 weeks the adjusted RR for peri/neonatal death was 0.86 (95% CI [0.72, 1.02]). One limitation of the study is that we had no data on to what extent monitoring of fetal health was performed.

Conclusions

A more active management of pregnancies lasting 41+0 weeks or more was associated with a decrease in peri/neonatal deaths, and a decrease in composite adverse peri/neonatal outcomes. Increased rate of emergency cesarean sections was observed. Women with pregnancies advancing towards 41 gestational weeks should be given balanced information on the benefits and risks of induction of labour at 41 weeks compared to expectant management until 42 weeks and be offered induction of labour at 41 weeks or active surveillance of pregnancies from 41 weeks in order to decrease peri/neonatal mortality.

A former paediatric surgeon has been jailed for five years and seven months for offences committed while operating an unsafe and unsanitary mobile child circumcision service.Mohammad Siddiqui, 58, was sentenced at Inner London Crown Court after pleading guilty in October at Southwark Crown Court to 12 counts of assault occasioning actual bodily harm, five counts of child cruelty, and eight counts of administering a prescription only drug to young and vulnerable patients while ignoring basic hygiene rules.He operated the private home service between June 2012 and November 2013 while working for the NHS as a clinical fellow in paediatric surgery at University Hospital Southampton NHS Foundation Trust. In this role he was able to source the local anaesthetic bupivacaine hydrochloride, a prescription only drug.In 2015 he was struck off the medical register for various failures in performing circumcisions in the homes of four babies. In one case a baby was...

Alcohol is widely available and drunk by around 80% of adults in the UK. No safe level of alcohol consumption has been established,1 and the physical and mental health harms increase (at different rates) with the amount consumed.2 Alcohol is well recognised as a leading preventable cause of cancer.3The health and social harms of alcohol are higher in socially disadvantaged groups4 despite lower rates of use than in more advantaged groups. This “alcohol harm paradox” means that alcohol consumption has the greatest detrimental effect on the most vulnerable in society and is a significant contributor to health inequalities and premature death.567The challenges faced during the covid-19 pandemic89 resulted in an increase in the number of people drinking alcohol at increased and higher risk levels.1011 Deaths from alcohol specific causes in England also rose by 42.2% between 2019 and 2023, the highest number on record, most of them from alcohol related...

Every year, as the weather turns colder, we can’t go far without hearing someone cough or sniffle. The “cold and flu” season is nothing new, but we need to do more to tackle winter illness.The end of 2024 saw a “quademic,” with high incidence of influenza, respiratory syncytial virus (RSV), covid-19, and the winter vomiting bug (norovirus) all putting pressure on the NHS. The number of hospital admissions with influenza rose from 1190 to 5074—more than 300%—from the end of November to the end of December.1 This was triple the number of admissions recorded at the same point last year.As hospitals throughout the UK declare critical incidents, we shouldn’t be surprised by the demand on healthcare services during winter. High rates of hospital admissions with flu aren’t unprecedented: we saw a similar peak in the 2022-23 winter season.2But we should be doing more to tackle the winter viruses that in...