Medical Journal News

Regulation of healthcare and other services typically involves on-site assessments by teams of inspectors. The scrutinised organisations invest large amounts of time and energy in preparation, which is diverted away from other priorities. The verdicts issued by national inspectors have strong consequences for service providers, users, and wider society. Given the high stakes involved, it is remarkable that the quality of the assessment measurement has never been evaluated. Assessing the reliability of inspection systems in healthcare and other sectors should be an urgent priority for policy makers.Policy regarding healthcare regulation is in flux. In England, the health secretary Wes Streeting has promised “comprehensive reform” after an unfavourable review of the Care Quality Commission (CQC).1 In Denmark, the Institute for Quality and Accreditation in Health Care has phased out national hospital inspections in favour of a less punitive local scheme.2 In the US, the Joint Commission on Accreditation of Healthcare Organizations...

Medicines bring health benefits but may also cause harm. These benefits and harms are often uncertain initially because regulatory approval for new medicines is inevitably based on limited data.1 For example, over two thirds of new cancer medicines, which now comprise the largest category of new treatments, are approved based on single arm trials that have no control groups and only short follow-ups.2 These trials increasingly measure intermediate (surrogate) endpoints that do not reliably predict longer patient survival or improved quality of life.3 Despite these limitations, patients often assume that new treatments are underpinned by high quality evidence.45To make informed and evidence based decisions about new medicines, patients need to consider the benefits, harms, and uncertainties associated with different treatment options. Patients therefore require access to relevant, useful, and trustworthy information about individual medicines, as well as alternative treatments.6789 However, the medicine information landscape is fragmented and inadequate in meeting...

bmj;387/oct29_3/q2370/FAF1faAnnie Sara Mathew—known as Joyce to her family—was born in Nellikala, a village in the southern Indian state of Kerala. She was an academically gifted and diligent student who completed a bachelor of science and moved to Kerala’s capital to study medicine at the Government Medical College, Thiruvananthapuram. Here she met Mathew, a fellow medical student, whom she married in 1983.In 1987, Annie and Mathew moved to Oman to run a private health clinic together. This was a great success, but around 10 years later they decided to emigrate to Ireland to further their medical education. Annie attained her Membership of the Royal Colleges of Physicians there, though it was only when she decided to pivot to psychiatry that she found her true calling.The family moved to Scotland where Annie worked at the Woodlands Mental Health Resource Centre in Kirkintilloch and then at the Parkview Resource Centre in Shettleston, in...

bmj;387/oct29_2/q2360/FAF1faDavid was born in Grantchester, Cambridge, in 1925. His parents had moved to the UK from South Africa in 1911. His father was a lecturer in electrical engineering at Cambridge University and his mother was a teacher. He had a happy childhood with his older brother John and younger sister Elizabeth.David won a scholarship to Winchester College where his initial interest was in classics, later moving to sciences. In 1943 he won a scholarship to study medicine at Caius College, Cambridge. His studies were interrupted by the second world war—and around this time he also developed tuberculosis and had to spend a year in an isolation hospital. He completed the clinical part of his course at the Middlesex Hospital in London, subsequently returning to Cambridge as a junior doctor at Addenbrooke’s Hospital.He worked as a senior registrar at the Central Middlesex Hospital, where he met Margaret Woods, an anaesthetist from...

bmj;387/oct29_1/q2374/FAF1faChuda was born in Bhojpur, India, in the foothills of the Himalayas, the eldest of nine siblings. He only started his education at the age of 8. There was no local school so his grandfather sent him to Kathmandu in Nepal. He quickly caught up and every six months his headteacher promoted him to the next class. He was the first in his family to go to university where he initially studied botany before graduating from MLN Medical College, Allahabad, India in 1972. There were no medical schools in Nepal at the time.He returned to Nepal to work in remote areas and came to the UK in 1979, initially working in Scotland before training in England where he developed his special interest in learning disabilities. He was appointed as a consultant at New Possibilities NHS Trust in Essex in 1989. He initially wanted to be a paediatrician but realised that...

The headquarters of the Royal College of Surgeons of England (RCS England) in London, UK, is a building that is designed to impress. Portraits of past RCS Presidents, most of them white men, stare down from an imposing staircase. Immediately in front is a da Vinci surgical robotic system, while beyond is the entrance to the Hunterian Museum. The objects in the museum are rooted in the 18th-century collection of John Hunter (1728–93), but alongside the history of surgery and human anatomy the displays also examine surgery in the 21st century.

After years of iterative refinements, drug-eluting stents (DES) have become the standard for percutaneous coronary intervention (PCI). 1-year rates of revascularisation and thrombosis with newer-generation DES are reported to be around approximately 3% and 0·5%, respectively, setting a high benchmark.1 However, DES still have limitations that raise concerns over a patient's lifetime. Their permanent metallic structure interferes with coronary artery angulation and dynamics, disrupting physiological properties such as vasomotion and adaptive remodelling.

Among patients with coronary artery disease, including those with acute coronary syndrome, treatment with the bioadaptor was non-inferior to contemporary DES, showing potential to mitigate non-plateauing device-related events and improving outcomes in patients undergoing PCI. The additional planned follow-up will help to reinforce the clinical significance of the 1-year findings.

bmj;387/oct28_17/q2376/FAF1faKen undertook GP training in Ipswich after junior hospital appointments, and became a partner in Woodbridge. Moves to Chagford and Elsenham preceded an appointment to Teignmouth in 1973 where he remained a single handed family doctor for the rest of his career. He was medical officer at Teignmouth Hospital and port, radiotherapy clinical assistant at Torbay Hospital, and medical officer at Marks and Spencer. He also undertook research into hypertension and obesity. After retirement Ken was a Maritime and Coastguard Agency examiner, a cruise liner doctor, and Medical Practitioners Tribunal Service member. He was a man with many interests outside medicine, particularly history and boats. He leaves his wife, Vivienne; three children by his first marriage; eight grandchildren; and six step grandchildren.

bmj;387/oct28_16/q2372/FAF1faAlexander was born in 1940 in Alexandria, Egypt, the son of a Greek mother and an English father stationed there as a Royal Air Force pilot. His father was killed while taking part in a bombing raid over Libya in 1940. He and his mother travelled to England in 1946, and he grew up in Sussex in the home of his paternal grandparents. He attended Brighton Grammar School, where he was a boarder.He obtained a place to study at St Mary’s Hospital Medical School, where he captained the soccer team and made many lifelong friends. He also enjoyed all that London had to offer, including being a film extra.After qualifying in 1964 he did his house jobs in Windsor and then progressed to anaesthetic training posts at St Thomas’ and Great Ormond Street hospitals. He became a consultant anaesthetist at St George’s Hospital in London in 1972 and specialised in...

bmj;387/oct28_15/q2371/FAF1faGillian (also known as Gillian Gee) was born in Canberra, Australia, but spent most of her childhood in Formby near Liverpool, going to Merchant Taylors’ School in Crosby. She studied medicine at Birmingham and after house jobs she worked as a GP trainee in Birmingham for three years. She was a GP partner at Newtown Health Centre between 1990 and 1995 before moving to Stoke-on-Trent to be with her husband Martin, a consultant psychiatrist.She became a GP principal at Stoke Health Centre in 1998 and became senior partner in 2002. In 2018 Gillian and her colleagues took over a neighbouring practice and the centre was renamed Honeywall Medical Practice.The practice prided itself on its small size and ability to offer continuity of care. In 2014 it was ranked the top local practice, receiving a 100% patient satisfaction rating. In 2016 it was rated “outstanding” by the Care Quality Commission and...

In this paper by Vollmer and colleagues (BMJ 2020;368:l6927, doi:10.1136/bmj.l6927, published 20 March 2020), the typeset PDF included an incorrect summary box, which has now been corrected.

Medical students across Algeria have boycotted classes and demonstrated daily for two weeks, demanding more residency posts and an end to a government policy of refusing to accredit their diplomas, denying them the opportunity to work abroad. Demonstrations last week took place at faculties in Algiers, Oran, Constantine, Sétif, and Annaba.The strike raises the prospect of a second North African medical education system falling into crisis. In neighbouring Morocco, a year’s studies have already been lost since the country’s 25 000 medical students revolted in January against government reforms that would shorten their courses from seven to six years. About 99% of students have boycotted multiple exams this year.Last week, the author of Morocco’s reforms, higher education minister Abdellatif Miraoui, was replaced along with the minister of health Khalid Ait Taleb, after deputies from Miraoui’s own governing party attacked his handling of the students’ strike in parliament, in scenes described...

In this paper by Lee and colleagues (BMJ 2024;387:e077262, doi:10.1136/bmj-2024-077262, published 23 October 2024), a typographical error was corrected in the article’s title.

Israel’s military operations in northern Gaza have caused “widespread devastation and deprivation” and made “conditions of life untenable for the Palestinian population,” the United Nations has said.1Stéphane Dujarric, spokesman for António Guterres, secretary general of the UN Office for the Coordination of Humanitarian Affairs (OCHA), said that there have been “harrowing levels of death, injury, and destruction” in the area and “little regard for the requirements of international humanitarian law.” He added that “repeated efforts to deliver humanitarian supplies essential to survive—food, medicine, and shelter—continue to be denied by the Israeli authorities, with few exceptions, putting countless lives in peril.”Israeli forces began issuing mass evacuation orders in the north of Gaza in early October, saying that Hamas had regrouped there.2 People were told to move south to a “humanitarian” zone, but the charity Human Rights Watch said these areas lacked food, shelter, water, and medical care. Israeli forces have “frequently...

More American women have had abortions each year since the Supreme Court overturned the constitutional right to abortion in June 2022 and returned decisions to individual states, the Society of Family Planning has found.1An analysis by the society shows how abortion access has changed in the two years since the court’s decision.2 Abortions have increased in all but three states even though it is banned or severely limited in about half.The study, called #WeCount, reported changes in abortion access during the 24 months following the Supreme Court’s decision. It covers the period from April 2021, when abortion was legal nationwide, to June 2024. The study used data collected by states, including clinician provided abortions (including medication or procedural abortions) in a clinic, private medical office, hospital, or virtual clinic.The study found that abortions increased because of a rise in the use of medication abortions and because of telehealth prescribing under...

AbstractClinical questionIn adult patients with inflammatory bowel disease, inflammatory arthritis (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis), or psoriasis taking biologic drugs, does proactive therapeutic drug monitoring (TDM) improve outcomes as compared with standard care?Context and current practiceStandard care for immune mediated inflammatory diseases includes prescribing biologic drugs at pre-determined doses. Dosing may be adjusted reactively, for example with increased disease activity. In proactive TDM, serum drug levels and anti-drug antibodies are measured irrespective of disease activity, and the drug dosing is adjusted to achieve target serum drug levels, usually within pre-specified therapeutic ranges. The role of proactive TDM in clinical practice remains unclear, with conflicting guideline recommendations and emerging evidence from randomised controlled trials.The evidenceLinked systematic review and pairwise meta-analysis which identified 10 trials including 2383 participants. Inflammatory bowel disease, inflammatory arthritis, and psoriasis were grouped together as best current research evidence on proactive TDM did not suggest heterogeneity of effects on outcomes of interest. Proactive TDM of intravenous infliximab during maintenance treatment may increase the proportion of patients who experience sustained disease control or sustained remission without considerable additional harm. For adalimumab, it remains unclear if proactive TDM during maintenance treatment has an effect on sustained disease control or sustained remission. At induction (start) of treatment, proactive TDM of intravenous infliximab may have little or no effect on achieving remission. No eligible trial evidence was available for proactive TDM of adalimumab at induction (start) of treatment. No eligible trial evidence was available for proactive TDM of other biologic drugs in maintenance or at induction (start) of treatment.RecommendationsThe guideline panel issued the following recommendations for patients with inflammatory bowel disease, inflammatory arthritis, or psoriasis:1. A weak recommendation in favour of proactive TDM for intravenous infliximab during maintenance treatment2. A weak recommendation against proactive TDM for adalimumab and other biologic drugs during maintenance treatment3. A weak recommendation against proactive TDM for intravenous infliximab, adalimumab, and other biologic drugs during induction (start) of treatment.Understanding the recommendationsWhen considering proactive TDM, clinicians and patients should engage in shared decision making to ensure patients make choices that reflect their values and preferences. The availability of laboratory assays to implement proactive TDM should also be considered. Further research is warranted and may alter recommendations in the future.How this guideline was createdAn international panel including patient partners, clinicians, and methodologists produced these recommendations based on a linked systematic review and pairwise meta-analysis which identified 10 trials including 2383 participants. The panel followed standards for trustworthy guidelines and used the GRADE approach, explicitly considering the balance of benefits and harms and burdens of treatment from an individual patient perspective.

AbstractObjectivesTo assess trends and differences in child malnutrition by population subgroups among infants aged 6-23 months in China’s poorest rural counties.DesignSix consecutive cross sectional surveys were conducted annually.SettingThe study was conducted in 116 counties in 19 provinces from 2016 to 2021, representing China’s 832 poorest counties.ParticipantsA total of 210 088 participants were selected through a multistage cluster sampling procedure; all participants were infants aged 6-23 months.Main outcome measuresPrevalence of anaemia, stunting, wasting, overweight, and growth status in children (measured by length-for-age and weight-for-length z scores).ResultsFour main malnutrition forms were prevalent in 2016: anaemia (prevalence 18.3%), stunting (7.5%), wasting (4.7%), and overweight (3.1%). The prevalence of any two coexisting malnutrition forms was low. All four forms of malnutrition decreased from 2016 to 2021. Anaemia decreased by more than half, with an annual reduction rate of 9.11% (95% confidence interval (CI) 4.83% to 13.20%). Stunting was reduced by over a third, with an annual reduction rate of 10.44% (7.56% to 13.22%), which is faster than the World Health Organization’s target of 3.9%. Differences in child growth by county gross domestic product quarters were small and decreased over time, but growth differences related to education persisted. Infants whose mothers completed education up to primary school level had approximately twice the risk of stunting (adjusted rate ratio 2.29 (95% CI 1.87 to 2.81)) and wasting (1.73 (1.40 to 2.13)) compared with children whose mothers had an education level of a college degree or above. Boys had poorer growth and higher anaemia than did girls. For all outcomes, differences related to sex and education were greatest at 6 months of age.ConclusionsEducation related inequalities in growth of infants persists, with these differences particularly affecting children whose mothers completed education only up to primary school level.

Blackburn and colleagues discuss the reduction of drug waste in hospitals.1 Every prescribing clinician is responsible, so being mindful of the drug supply chain is essential for the whole healthcare team.Initiating drug treatment with generic versions as much as possible would help with cost and logistics, as well as help to reduce confusion with different brand names. All clinicians need to be aware of the cost of the items they are initiating or changing and to consider cost effective alternatives.Using digital or barcode tracking of drugs and digitalising stocks in the trust are not onerous and would enable stock taking and tracking. Digitalising the drug supply might also shed light on the hoarding of medicines, which on occasion might artificially inflate costs.Reviewing the use by dates might be a good idea. If a drug is stored and transported in an acceptable temperature zone, should the use by date be extended?...

The Danish drug company Novo Nordisk has been sanctioned by the UK pharmaceutical industry regulator over the way it has promoted its weight loss medications semaglutide (Ozempic/Wegovy) and liraglutide (Saxenda), including through an article in the Sunday Times, and “inappropriate sponsorship arrangements.”The Prescription Medicines Code of Practice Authority (PMCPA), the self-regulatory body that administers the code of practice of the Association of the British Pharmaceutical Industry (ABPI), assessed allegations made in two separate complaints against the company and ruled that it was in breach of several clauses of the code as it had failed to maintain high standards and had provided misleading or unbalanced information.A notice highlighting the company’s breaches will be published by the PMCPA in The BMJ in the 2 November print edition and in the Nursing Standard on 5 November. The notice states that Novo Nordisk has “brought discredit upon, and reduced confidence in, the pharmaceutical industry.”1Last...