Medical Journal News

The UN has declared November 24 as World Conjoined Twins Day,1 an initiative led by Saudi Arabia to raise global awareness about the medical and societal challenges faced by conjoined twins and their families. This rare condition occurs in approximately one in every 75 000 births, often resulting in miscarriage, stillbirth, or early death due to severe congenital disabilities.2 For those who survive, the challenges are immense, as some conjoined twins share vital organs such as the heart, brain, or liver.

The Abyei Area Administration (Abyei) is disputed between Sudan and South Sudan, having experienced conflict and tensions over the last 18 years. Despite international efforts, this dispute remains unresolved. In June, 2011, an agreement was made to establish joint administration,1 but this has not yet materialised. Currently, Khartoum (Sudan) manages the north region and Juba (South Sudan) oversees the south region. Both of these administrations face challenges in providing services to their communities, which are affected by humanitarian crises, drought, infectious disease outbreaks, armed conflicts, and population displacement.

In September, 2024, WHO announced a partnership between its Fides network of health influencers and the social media platform TikTok to promote science-based health information and encourage positive health dialogues to counter misinformation.1

For the first time since 1964, the revised Declaration of Helsinki provides an ethical framework for medical research and explicitly states that its provisions apply to all research participants, “whether patients or healthy volunteers”.1 This statement is important since, alongside patients, healthy people participating in biomedical research greatly contribute to advancing science. Globally, every year, thousands of healthy volunteers participate in clinical trials that include phase 1 first-in-human studies and studies that fulfil other research and regulatory needs that cannot be addressed by patients alone.

The recent update to the World Medical Association's Declaration of Helsinki,1 adopted at the 75th World Medical Association General Assembly in October, 2024, signals yet another milestone in the ongoing effort to safeguard ethical standards in medical research involving human participants. As with previous revisions, this update aims to reflect contemporary challenges, but it raises questions about the extent of its novelty and efficacy in addressing the evolving landscape of medical research.

We read with great interest the results from the ENGOT-cx11/GOG-3047/KEYNOTE-A18 trial reported by Domenica Lorusso and colleagues.1 The improvement in progression-free survival is exciting but difficult to interpret without additional radiation details and sites of progression. The total equivalent dose in 2 Gy fractions is reported as 87 Gy (IQR 83–92), which suggests that 25% of patients received less than 83 Gy. Data from EMBRACE-1 show that the minimum dose that covers 90% of the target volume of 85 Gy is required to offer a 95% chance of local control at 3 years for squamous cell cancers, and an even higher dose is needed for adenocarcinomas.

We read with interest the Article by Domenica Lorusso and colleagues about the ENGOT-cx11/GOG-3047/KEYNOTE-A18 trial.1 This phase 3 study showed that pembrolizumab, when administered in combination with chemoradiotherapy, resulted in a statistically significant improvement in progression-free survival, compared with chemoradiotherapy alone, for patients with locally advanced cervical cancer. However, the results are difficult to interpret.

We commend Domenica Lorusso and colleagues for their Article1 reporting a phase 3 clinical trial that analysed the comparison between pembrolizumab or placebo combined with chemoradiotherapy in the treatment of newly diagnosed, high-risk, locally advanced cervical cancer. However, the strength of evidence in this study could be enhanced by further discussion of some issues.

Regarding the Article by Domenica Lorusso and colleagues on ENGOT-cx11/GOG-3047/KEYNOTE-A18,1 this trial finally shows the long-awaited progress in patients with high-risk locally advanced cervical cancer: addition of pembrolizumab to chemoradiation statistically significantly improved progression-free survival at 24 months. We do not want to question the results of a randomised controlled trial or the potential role of pembrolizumab, but we would like to focus attention on the central treatment component, which is chemoradiotherapy, including brachytherapy.

We thank our colleagues for their interesting comments on our Article1 and the chance to expand on several study details. Mitchell Kamrava and Sushil Beriwal note that our patients received a lower total cervix equivalent dose in 2 Gy fractions than that reported in EMBRACE-I.2 Correspondence from Maximilian P Schmid and colleagues suggests an unused radiotherapy potential after adjusting the EMBRACE-I cohort to the high-risk definition in ENGOT-cx11/GOG3047/KN-A18. Such cross-study comparisons are challenging due to differences in endpoints, population risk, enrolment periods, and number of study sites and might yield misleading results.

Combining radiotherapy with standard of care plus abiraterone improves radiographic progression-free survival and castration resistance-free survival, but not overall survival in patients with low-volume de novo metastatic castration-sensitive prostate cancer. Radiotherapy reduces the occurrence of serious genitourinary events, regardless of metastatic burden and without increasing the overall toxicity, and could become a component of standard of care in patients with both high-volume and low-volume de novo metastatic castration-sensitive prostate cancer.

A 23-year-old woman with a 1-week history of a rash, fever, diffuse arthralgia, sore throat, and oral oedema attended our hospital. The patient had previously been fit and well; she had no medical history and was prescribed no medications.

Health workers, including doctors and other staff, staged a strike in Rome on 20 November in protest at proposals set out in the government’s budget.Anaao Assomed, Italy’s biggest trade union for national health service doctors, staged coordinated action with Nursing Up, representing nurses, and Cimop, representing private sector doctors, after the announcement of the draft budget law for 2025. The Italian government’s budget, which must be approved by the end of the year, will invest an additional €1.3bn (£1.1bn) in health, on top of the €1.2bn already allocated in last year’s budget law.But Nino Cartabellotta, founder of the Gimbe Foundation, a non-profit organisation working on health issues, told The BMJ that this investment fell short of what was needed. “These are a few extra decimals and not the breakthrough promised by health minister Orazio Schillaci, who in recent months had announced the likely allocation of ‘more than three billion euros’...

What is Enhertu?Trastuzumab deruxtecan (Enhertu), made by Daiichi Sankyo and AstraZeneca, is a treatment for adult patients with unresectable or metastatic HER2 low breast cancer who have received previous chemotherapy in the metastatic setting or developed disease recurrence during or within six months of completing adjuvant chemotherapy. In December 2023 the drug was approved for use on the NHS in Scotland after the Scottish Medicines Consortium used its own method to reach its decision.1 It is also available in 18 other European countries. Around 1000 women in England and Wales would have benefited if it had been approved by the National Institute for Health and Care Excellence (NICE).What has happened?Negotiations between NICE, NHS England, and the manufacturers have been ongoing since July when NICE issued final guidance rejecting Enhertu over concerns about its cost effectiveness.2 Clinical trial evidence shows that Enhertu gives an additional 6.4 months of overall survival (23.9...

Countries need to take urgent action to reduce the burden of cancer and curb “unsustainable” health costs for the disease, a report by the Organisation for Economic Cooperation and Development (OECD) has urged.An OECD analysis covering 51 countries1 modelled the economic costs and societal impacts of cancer and the potential impact of government policies.Michele Cecchini, the report’s lead author in the OECD’s health division, said, “We calculate that because of factors such as population ageing and better cancer outcomes, on average across the OECD health spending on cancer could increase by 83% by 2050.”“This trajectory is unsustainable, especially at a time when health systems are already under huge financial pressure,” he told The BMJ.Increasing investment in prevention could make a big contribution to mitigating these rising costs, the report said. “Action to meet internationally agreed targets on six risk factors for cancer, such as tobacco and alcohol use and diet,...

The temptations of doctors to act inappropriately are many and well documented. They include, among others, the temptation to put financial gain before patient wellbeing, to cut corners to reduce workload, to cover up errors for self-preservation, to speak ill of patients and colleagues in moments of frustration, and to engage in improper relationships with patients.Far less discussed are the temptations towards wrongdoing of medical students which, although usually less dramatic in nature, are nonetheless rife.Medical students are for the most part high achieving students, accustomed to success and in fear of failure. At medical school, they tend to have one overriding goal, which is to pass their exams and qualify as doctors. The desire to pass is so intense that it leaves them prone to the temptation of wrongdoing in order to secure a pass. As an example, solely from the domain of dishonesty, I have had medical students...

Across the globe, countries are grabbling with how to shield children from the dangers of the digital world. One idea is to prevent children from accessing the most harmful digital spaces. Australia has just introduced a bill to parliament proposing to ban children under 16 from using social media.1 If passed, it would make Australia the first country in the world to have such strict legislation. Mitigating the physical and mental health risks posed by digital platforms is an urgent public health priority that governments need to engage with, but limiting children’s online participation will not tackle the root causes of these harms.Australia’s proposed law will make it illegal for anyone under 16 to have a social media account and wouldn’t have exemptions for parental consent. Companies such as Meta, ByteDance, and Google will be responsible for checking that users are not under 16 and could face penalties if they...

Around 2000 claimants in the UK are proposing to take legal action against Johnson & Johnson over claims that its talcum powder products caused cancer.The law firm KP Law has sent a letter before action to the company, to be followed by an application for a group litigation order at the High Court in London. J&J has been hit by long running litigation in the US, but KP Law said the case would be the first in the UK. The claims will be brought on a no win, no fee basis, so claimants will not have to pay anything if they fail.Tom Longstaff, partner and head of product liability at KP Law, said in a statement on the firm’s website, “All of the claimants, predominantly women but also some men, who have sustained cancer after using Johnson & Johnson’s talcum powder products, have experienced a life changing illness, leaving their...

US president elect Donald Trump has nominated Mehmet Oz, a cardiothoracic surgeon and television celebrity doctor to run the Centers for Medicare and Medicaid Services (CMS), a large federal agency that provides health coverage to about 160 million Americans.CMS is part of the Department of Health and Human Services. Trump recently nominated Robert F Kennedy Jr as head of the DHHS.1 Both nominations require Senate confirmation, but Trump may try to bypass that by making a “recess appointment” when the Senate is not in session.Oz, 64, is the son of Turkish immigrants to the US and holds dual citizenship. He received his medical degree from the University of Pennsylvania and became a cardiothoracic surgeon and professor at Columbia University Medical Center in New York. His tie with the university ended in 2022. He also has an MBA from the Wharton School of the University of Pennsylvania.23In 2009 he appeared on...

Media coverage has been rightly sympathetic to Chris Hoy, one of the most successful cyclists in history, who recently disclosed that he has metastatic prostate cancer. The press has also taken up Hoy’s call that more men should be tested for the disease. He told the BBC that the age at which men can obtain a prostate specific antigen (PSA) test should be reduced from 50. “It seems a no-brainer,” he said. “Why would they not reduce the age? Bring the age down and allow more men to go in and get a blood test.”1In a commentary the Independent said that Hoy’s intervention could save thousands of lives: “Some 12 000 men die from prostate cancer each year, many after begging their doctors to be tested—after which they are told they only have months to live. The Olympic cyclist’s call for a rethink of GP screening could be a game-changer.”2The...