BMJ - British Medical Journal

Health officials overseeing the city of Wuhan in China have been forced to stop HIV clinics from uploading results to a new digital system for test sharing after two HIV positive patients were refused hospital treatment.One man was turned away from a dental hospital in the city on 30 November, and another with cold symptoms was rejected from a general hospital on 1 December. In both instances staff told the men that they had seen their positive HIV status in an interhospital test system and were unable to treat people with HIV, said local reports verified by The BMJ.1These incidents highlight the ongoing problem of medical discrimination in China and show how this is complicating a major government effort to curb costs and overtreatment by making hospitals share information such as x ray imaging and blood test results.The orders to HIV clinics to stop uploading results were issued on 4...

I welcome the Medical Protection Society’s report calling for all NHS trust staff who deal with disciplinary procedures to have specialised training.12 As one of the people involved in setting up new guidelines for NHS trusts to follow in respect of human resources disciplinary procedures (outlined on page 3 of the report), I consider that three key things must happen.Firstly, as noted in the report, managers and healthcare staff in management roles need to be properly trained and properly accountable when they are involved in NHS disciplinary procedures. Managers should therefore be regulated just like doctors and nurses. Secondly, there should be a requirement that principles of fairness are imprinted into NHS disciplinary procedures. These are what I have termed PIE principles—plurality, independence, and expertise in panels. Thirdly, there should be an independent body—a “Staff Care Quality Commission”—that has the power to prosecute and fine trusts that abuse NHS disciplinary...

The government has announced the launch of an independent commission into adult social care in England, which will inform the creation of its proposed National Care Service.1The commission, led by the cross bench peer Louise Casey, will be split into two phases and will make “clear recommendations for how to rebuild the adult social care system to meet the current and future needs of the population.”The first phase, expected to report in mid-2026, will identify the main problems with the current care system and set out recommendations for “effective reform and improvement in the medium term.” These recommendations will be aligned with the government’s spring spending review. The second phase, set to report in 2028, will then make longer term recommendations for the transformation of adult social care.The health and social care secretary, Wes Streeting, said, “I have written to opposition parties to invite them to take part in the...

The UK is not a good place to be poor. It is not even a very good place if you are middle income or below. Over the past 14 years, life expectancy has not improved, health inequalities have increased, and reported health has not improved for the poorer half of the population.1 Housing has played an important role in this crisis.A new report from the UCL Institute of Health Equity, Building Health Equity: the Role of the Property Sector in Improving Health, outlines the consequences of housing problems for health equity and details what needs to be done to tackle these.2The report draws attention to three aspects of housing that are important for health: affordability, quality, and supply. Affordability implies some relation between price and ability to pay the price. In the past 15 years income growth in the UK has fallen behind that of other European countries, and income...

Crider and colleagues discuss the availability of personal and private medical records held by the NHS.1 Cybercrime is another area of concern.I recently researched occurrences of cybercrime against medical records.2 It occurs worldwide and is often attached to ransom demands. Intel Security McAfee Laboratories says that cybercriminals are investing more time and resources into exploiting and selling healthcare data.3 On 3 June 2024 the UK firm Synnovis, an NHS pathology testing provider, was hacked, causing massive disruption to multiple London hospitals. The hack disrupted more than 3000 hospital and primary care appointments and operations. Synnovis resisted paying a ransom, and on 24 June 2024, the cybercrime group Qilin shared almost 400 GB of private information on their darknet site. A sample of the data seen by the BBC includes patient names, dates of birth, NHS numbers, and blood test descriptions. It is not known whether test results are also in...

In December 2024, negotiations led by the United Nations to finalise a treaty to end plastic pollution concluded without agreement, pushing discussions into 2025.1 Plastic pollution is now recognised as not only an environmental crisis but also a critical human health crisis. The need for decisive international action to tackle plastic pollution has never been more urgent.The health focus is reflected in the objective of the current treaty draft “to protect human health and the environment from plastic pollution.”2 With the world’s annual plastic production at 400 million tonnes and projected to double by 2040, the scale of plastic pollution is staggering.3 Without intervention on a global scale, this trajectory will worsen.The treaty negotiations have highlighted divisions among countries on critical issues, including the treaty’s scope, limits on plastic production, controls on toxic chemical additives in plastics, and financing for treaty implementation in the regions most affected. These unresolved disagreements...

AbstractCritical illness is a complex condition that can have a devastating impact on health and quality of life. Nutritional support is a crucial component of critical care that aims to maintain or restore nutritional status and muscle function. A one-size-fits-all approach to the components of nutritional support has not proven beneficial. Recent randomized controlled trials challenge the conventional strategy and support the safety and potential benefits of below-usual calorie and protein intakes at the early, acute phase of critical illness. Further research is needed to define optimal nutritional support throughout the intensive care unit stay. Individualized nutritional strategies relying on risk assessment tools or biomarkers deserve further investigation in rigorously designed, large, multicenter, randomized, controlled trials. Importantly, although nutritional support is crucial, it might not be sufficient to enhance the recovery of critically ill patients. Thus, achieving the greatest efficacy may require individualized nutritional support combined with early, prolonged physical rehabilitation within a multimodal, holistic care program throughout the patient's recovery journey.

Are you making a meal over New Year’s resolutions?Absolutely. As the name suggests, Veganuary encourages people to go vegan at the start of every year.Turning over a new leaf?Exactly! And eating more leaves too. The benefits of a plant based diet are well documented.1 It’s good for the planet: plant based foods produce fewer greenhouse gas emissions than animal based foods. And it’s good for human health, reducing the risk of chronic disease, including cardiovascular conditions. Abstinence, you might say, makes the heart grow stronger.I don’t like fadsA vegan diet isn’t a fad. Neither is Veganuary a flash in the pan, as it’s now marking its 10th year. Veganism is now baked into our culture.OK, veggie burgers here I comeSteady on. A study published in the Proceedings of the National Academy of Sciences ranked 24 meat and milk alternatives in terms of nutrition, health, environmental, and cost perspectives.2 It found...

A consultant psychiatrist has been struck off the UK medical register after a tribunal found that he had engaged in “scaremongering” over coronavirus vaccines in an online video.Daniel Armstrong accused governments, health authorities, and drug companies of mounting a “monumental cover-up operation” to hide vaccine harms in his video, entitled Navigating the Truth-Deception Duality Brought to you by Dr Daniel Armstrong MBChB. The video was reported to the General Medical Council (GMC) by an anonymous email.“I am using my doctor title, my registration under the GMC in the UK, to bring you this message about what the truth is, but also highlight the deception,” said Armstrong in his video. “You’ve a doctor here, he’s got his licence on the line—given it up. Don’t take any more of the injections. These guys are evil.”The European Convention on Human Rights guarantees the right to free speech, and case law has upheld the...

Pilot medical apprenticeship programmes in England, which were being trialled as a new route into the profession, have been paused by the government.Peninsula Medical School in Plymouth, one of the universities in the pilot scheme, has been told not to recruit for the course—due to start in September 2025—pending a review of doctor apprenticeships, which were intended to widen access to medical careers. The arm’s length agency Skills England told course leaders at the medical school that it would review and “discuss areas where funding for level 7 apprenticeships will be restricted, and a decision will follow in due course.”Laura Bowater, head of the Peninsula Medical School, described the government’s move as “disappointing.” She told The BMJ that the change was part of the government’s cooling towards level 7 apprenticeships, which include medicine.Anglia Ruskin University has 25 medical apprentices on its course, which started in September 2024. The University of...

Davis and colleagues highlight the critical need for clearer and more accessible information about medicines for patients.1 As an anaesthetist, I often encounter challenges in communicating the risks and benefits of perioperative drugs, particularly as we cannot always predict every medication that might be required during an operation.A key example is sugammadex, a neuromuscular blockade reversal agent that can reduce the efficacy of hormonal contraceptives by binding to steroidal molecules, thus increasing the risk of unintended pregnancy. Patients must be advised to use alternative contraceptive measures for up to seven days after its administration. Such vital information is often overlooked, however, creating a potential gap in patient understanding. This emphasises the need for accessible drug information that can be easily conveyed in time critical scenarios.The unpredictability of anaesthetic practice further complicates the consent process. It is often not possible to foresee every medication that might be given during surgery, such...

Preliminary laboratory findings suggest that a mystery illness in the Democratic Republic of the Congo is a combination of common and seasonal viral respiratory infections and malaria, the World Health Organization (WHO) has said.1WHO described the previously undiagnosed disease as “acute respiratory infections complicated by malaria,” which had led to an increase in severe infections and death when compounded by acute malnutrition.A broad surveillance case definition was established in absence of a diagnosis, which included patients who presented with fever, cough, body weakness, and runny nose. Other signs and symptoms may include chills, headache, difficulty breathing, malnutrition, and body aches.From 24 October to 16 December a total of 891 cases and 48 deaths from the Panzi health zone in the Kwango province met the case definition. More cases occurred in females (58%), especially adults (66%). The disease disproportionately affected children under 5 years old, who made up 47% of all...

The last major hospital in northern Gaza is now out of commission after a raid by Israeli forces left its surgical unit, medical store, and laboratory “burnt and severely damaged.” Staff and critically ill patients have been forced to leave, and the hospital’s director, Hussam Abu Safiya, has been detained.The World Health Organization (WHO) said that it was “appalled” by the raid, which “put the last major health facility in North Gaza out of service,” and was “deeply concerned” for the patients moved to a hospital that cannot care for them, as well as for Abu Safiya. “Kamal Adwan is now empty,” said WHO. “Some people were reportedly stripped and forced to walk toward southern Gaza.”Since early October WHO has confirmed at least 50 attacks on healthcare that took place on or around the hospital. It said, “Attacks on the hospitals and on health workers have occurred almost daily. This...

Davis and colleagues share their concern about the lack of accessible information on both the magnitude and nature of the benefits of new drugs.1 Without such information, it is impossible for patients, or clinicians, to balance the benefits against the adverse effects of the medicine and so arrive at an informed choice.I have been an independent adviser for the UK medicines regulator, the Medicines and Healthcare Products Regulatory Agency, for 40 years and have for many years urged the agency to explore ways of filling this astonishing gap. Almost insurmountable problems exist in two forms: current information for patients is almost entirely with the manufacturers, who would have to be persuaded to invest in the initiative, and many of the clinical rating scales used in the pivotal clinical trials cannot readily be translated into language that means much to patients. These are huge problems, but as the article points out,...

AbstractObjectiveTo identify clusters of women with similar trajectories of breast density change over four longitudinal assessments and to examine the association between these trajectories and the subsequent risk of breast cancer.DesignRetrospective cohort study.SettingData from the national breast cancer screening programme, which is embedded in the National Health Insurance Service database in Korea. Breast density was assessed using the four category Breast Imaging Reporting and Data System (BI-RADS) classification. Group based trajectory modelling was performed to identify the trajectories of breast density.ParticipantsWomen aged ≥40 years who underwent four biennial mammographic screenings between 2009 and 2016.Main outcome measuresBreast cancer development was determined to 31 December 2021. Cox proportional hazard models were used to assess the associations between trajectories and breast cancer outcomes after adjusting for covariates.ResultsAmong a cohort of 1 747 507 women (mean age 61.4 years), five breast density trajectory groups were identified. Group 1 included women with persistently fatty breast tissue, group 2 included women with fatty breast tissue at baseline but increased breast density over time, and groups 3-5 included women with denser breasts, with a slight decrease in density over time. Women in group 2 had a 1.60-fold (95% confidence interval 1.49 to 1.72) increased risk of breast cancer compared with those in group 1. Women in groups 3-5 had higher risks compared with those in group 1, with adjusted hazard ratios of 1.86 (1.74 to 1.98), 2.49 (2.33 to 2.65), and 3.07 (2.87 to 3.28), respectively. Similar results were observed across different age groups, regardless of changes in menopausal status or body mass index.ConclusionsThis study identified five distinct groups of women with similar trajectories of breast density change over time. Future risk of breast cancer was found to vary in these groups. Increasingly dense or persistently dense breasts were associated with a higher risk. Changes in breast density over time should be carefully considered during breast cancer risk stratification and incorporated into future risk models.

AbstractObjectiveTo compare the effectiveness and safety of budesonide-glycopyrrolate-formoterol, a twice daily metered dose inhaler, and fluticasone-umeclidinium-vilanterol, a once daily dry powder inhaler, in patients with chronic obstructive pulmonary disease (COPD) treated in routine clinical practice.DesignNew user cohort study.SettingLongitudinal commercial US claims data.ParticipantsNew initiators of budesonide-glycopyrrolate-formoterol or fluticasone-umeclidinium-vilanterol between 1 January 2021 and 30 September 2023 who had a diagnosis of COPD and were aged 40 years or older.Main outcome measuresIn this 1:1 propensity score matched study, the main outcome measures were first moderate or severe COPD exacerbation (effectiveness) and first admission to hospital with pneumonia (safety) while on treatment. Potential confounders were measured in the 365 days before cohort entry and included in propensity scores. Hazard ratios and 95% confidence intervals (CIs) were estimated using a Cox proportional hazards regression model.ResultsThe study cohort included 20 388 propensity score matched pairs of new users initiating single inhaler triple therapy. Patients who received budesonide-glycopyrrolate-formoterol had a 9% higher incidence of first moderate or severe COPD exacerbation (hazard ratio 1.09 (95% CI 1.04 to 1.14); number needed to harm 38) compared with patients receiving fluticasone-umeclidinium-vilanterol and an identical incidence of first admission to hospital with pneumonia (1.00 (0.91 to 1.10)). The hazard of first moderate COPD exacerbation was 7% higher (1.07 (1.02 to 1.12); number needed to harm 54) and the hazard of first severe COPD exacerbation 29% higher (1.29 (1.12 to 1.48); number needed to harm 97) among those receiving budesonide-glycopyrrolate-formoterol compared to fluticasone-umeclidinium-vilanterol. Prespecified sensitivity analyses yielded similar findings to the primary analysis.ConclusionsBudesonide-glycopyrrolate-formoterol was not associated with improved clinical outcomes compared with fluticasone-umeclidinium-vilanterol. Given the added climate impact of metered dose inhalers, health systems seeking to decrease use of these products may consider steps to promote further prescribing of fluticasone-umeclidinium-vilanterol compared with budesonide-glycopyrrolate-formoterol in people with COPD.Study registrationCenter for Open Science Real World Evidence Registry (https://osf.io/6gdyp/).

The incoming US administration has signalled its intent to make large changes to the federal government’s approach to medicine and public health. With Republicans holding control of both houses of Congress and a conservative Supreme Court, the potential for change is high if the administration can address internal disagreements.Much of that change is likely to centre on health insurance coverage, which for most Americans is provided through Medicaid (the federal and state programme for people on low incomes), Medicare (for people over 65 and those with disabilities), or private insurance, obtained either through employers or through the public marketplaces (exchanges) created under the Affordable Care Act (ACA).Most policies available through Medicaid, Medicare, and ACA exchanges are decided at federal level, but healthcare is mostly administered by states. This means health outcomes may largely depend on how individual states can adjust to likely changes in federal policy or funding.Policy challengesMedicare, Medicaid,...