Medical Journal News

Road traffic injuries are the leading killer of children and adults aged 5-29 years globally.1 Low and middle income countries are disproportionately represented in this statistic; Africa has the highest road crash mortality of all global regions. Increasing urbanisation and motorisation in many African countries are not yet matched by safer road infrastructure, safer vehicles, and public education on safer road use. Road traffic injuries rob these nations of their workforce and their future.The World Health Organization status report on road safety in the African region for 2023 highlights the urgent need for concerted global action.1 Whereas recorded road deaths have decreased by 5% globally in the past decade, in Africa they have increased by 17%. The demographics of deaths also differ. In high income countries road deaths are mostly among vehicle drivers and passengers; in Africa, half of the deaths are among vulnerable road users—pedestrians, cyclists, and motorcyclists—with pedestrians...

A patient association has lodged a complaint with the Paris criminal court alleging that Androcur, the antiandrogen drug cyproterone acetate, manufactured by Bayer, has caused benign brain tumours in hundreds of women. In France Androcur is authorised for hirsutism, but has been prescribed off label mainly for endometriosis, as well as for acne, alopecia, and contraception.The charges include administration of a harmful substance, involuntary attacks on the physical integrity of the person, endangerment of the lives of others, aggravated deception, and failure to report side effects, the newspaper Le Monde confirmed to The BMJ.The association Amavea has more than 1150 members who have reported adverse effects from Androcur. Five other progesterone derivatives also present meningioma risk, and studies are underway on other potentially harmful drugs, the association says.Charles Joseph-Oudin, the lawyer representing the association, will shortly file separate complaints for five women, and expects more to follow from among the...

In the 1950s, smoking was proven beyond doubt to cause cancer and yet efforts to curb this pandemic were stalled over the next half century by a network of individuals and institutions with competing interests. The industry paid doctors, academics, charities, and policy makers to dilute and distort the science and public health messaging.1 By the 1980s, the largest tobacco companies bought the largest food companies2 and used the same methods to create a food environment where poor diet has overtaken tobacco as the leading cause of early death globally.3Food and tobacco are just two of the industries that use their economic power to evade effective regulation; food, alcohol, pharmaceuticals, gambling, and fossil fuels, among others, have the same commercial incentives and obligations as the tobacco industry and directly impact human and planetary health.The World Health Organization (WHO) has defined these commercial determinants of health as “…private sector activities that...

The aim of an integrated neighbourhood team (INT) is to bring medical, nursing, and social care services to the patient’s home (or nearby) in a timely fashion, which should prevent unnecessary hospital admissions and enable earlier discharge, thus saving the NHS money and minimising disruption for patients. These ideas seem so obvious that it’s hard to work out why they haven’t been tried before. They have, of course—but because such programmes identify unmet health needs, they usually result in more spending rather than less.1In trying to understand the latest neighbourhood team iteration, one stumbling block is the definitions: what do we mean by a neighbourhood? It can’t be based on the area of a GP surgery, as they vary so much in size. Perhaps the unit could be the primary care network—but the hurried and bizarre way they were constructed means that the areas they serve can be many miles...

The US clinical market for ketamine, estimated at $3.1bn in 2022 and expected to expand at 10.6% a year until 2030,1 is just one of many signs of renewed interest in the use of psychedelics to treat psychiatric conditions.2 Various mind altering drugs have already entered the market, including esketamine nasal spray, which the US Food and Drug Administration approved in 2019. And in 2022 the Australian Therapeutic Goods Administration (TGA) allowed psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) to be prescribed by authorised physicians for psychiatric conditions such as depression and post-traumatic stress disorder. The decision was taken despite an independent scientific report commissioned by the TGA advising against authorisation because the certainty of evidence for benefits was low or very low.3Psychedelics, the lay term for substances classified as hallucinogens, have various targets and distinct purported mechanisms of action. For instance, psilocybin is a serotoninergic agonist, whereas esketamine is a N-methyl-D-aspartate (NMDA)...

Two medical professionals were among the 45 people sentenced on 19 November in Hong Kong, convicted of conspiracy to commit subversion.1The group have been held on remand, along with two others, for more than three years under the city’s national security law. The convictions relate to their participation in an unofficial primary election in July 2020, which was organised by pro-democracy politicians and activists to choose candidates to stand on the city’s legislative council.A panel of three designated national security judges ruled that their intention was to “undermine, destroy, or overthrow the existing political system” and plunge the city into a “constitutional crisis” by vetoing the government budget and forcing the resignation of the chief executive.2Winnie Yu, a nurse, who pleaded not guilty to the charge, was sentenced to six years and nine months in prison. She was formerly the chair of the Hospital Authority Employee Alliance, which represented around...

by Jean Adams

by Erikka Loftfield, Steven C. Moore, Susan T. Mayne

Ultra-processed food consumption has increased worldwide, but associations with cancer risk remain unclear and potential underlying mechanisms are speculative. A robust, multidisciplinary, research agenda is needed to address current research limitations and gaps.

The US has reported its first confirmed case of clade Ib mpox in a person who is thought to have become infected while travelling and is experiencing mild illness.1In an announcement on 16 November, officials from the county of San Mateo in California said that the person is “isolating at home and recovering” and there is “no concern or evidence that mpox clade I is currently spreading in San Mateo county or elsewhere in the US.”The county’s health officer Kismet Baldwin-Santana said, “While clade I may be new to the US, we and other counties have been responding to mpox since 2022 with contact tracing, guidance, and vaccine support. Given the very low risk to the public of exposure to clade I the guidance for preventing mpox has not changed.”Earlier this month, the UK reported a fourth clade I case in a person from the same household as the first...

Like many people, I can no longer find effective dental treatment locally on the NHS. Against my personal preference and political views, I’ve been to a private dentist for some years now. He’s a decent man, charges relatively modest prices, and is conservative (in the best sense) in his interventions. We banter nicely about my need for elephantine quantities of local analgesia, as well as other matters.Recently, I developed some root canal issues. Having done x rays, my dentist sent me for a CT scan costing over £200. I bit the bullet, if you’ll excuse the pun. Looking at the images, he advised me to see someone more specialised for treatment. I dutifully went to see the man he recommended in Harley Street—possibly my least favourite road in London. Almost the first thing this superspecialist did was to explain that the kind of CT scan my own dentist had ordered...

bmj;387/nov19_12/q2562/FAF1faDavid Watkin was a firm believer in the importance of teaching, but he felt that the training he received was inadequate. “The number of operations for which a consultant directly supervised me could be counted on the fingers of one hand,” he wrote.He worked tirelessly to do better for his staff—and not just doctors and medical students. Shortly after taking up his consultant post in general surgery at Leicester Royal Infirmary in 1971, he set up training for intensive care nurses and created a course for the new grade of operating department assistants.When he was appointed inaugural clinical subdean for the new Leicester Medical School, which opened in 1975, he was given a free hand to set up clinical training, which included designing the course, allocating clinical attachments, running the exams, and caring for the students.He believed in the importance of informal chats during training and felt that the team...

The apparent increase in pancreatic cancer among young people in the US may be because of earlier detection rather than increasing incidence, researchers have suggested.1In light of concerns over a reported increase in pancreatic cancer in young people, and especially young women, researchers at Brigham and Women’s Hospital in Boston looked at prevalence and mortality among those aged 15 to 39 in the US.They found that between 2001 and 2019 the incidence of pancreatic cancer increased 2.1 fold among young women (3.3 (95% confidence interval 2.8 to 3.8) to 6.9 (95% CI 6.2 to 7.6) per million) and 1.6 fold among young men (3.9 (95% CI 3.3 to 4.4) to 6.2 (95% CI 5.6 to 6.9)).Additionally, the rate of cancer directed pancreatic surgery more than doubled in both women (from 1.5 to 4.7 per million) and men (1.1 to 2.3 per million), “indicating a substantial increase in surgical interventions in...

The centrality of the first 1000 days—from conception to 2 years of age—for early childhood development is recognised in global research, policy, and practice as a crucial period for physical growth and brain development in children.1 In 2017, the Lancet Series on early childhood development reported that 250 million children (43%) were at risk of not realising their development potential based on proxy measures of child stunting and child poverty in early life, key indicators and predictors of poor development in children.

Following the first 1000 days of life that span from conception to two years of age, the next 1000 days of a child's life from 2–5 years of age offer a window of opportunity to promote nurturing and caring environments, establish healthy behaviours, and build on early gains to sustain or improve trajectories of healthy development. This Series paper, the first of a two-paper Series on early childhood development and the next 1000 days, focuses on the transition to the next 1000 days of the life course, describes why this developmental period matters, identifies the environments of care, risks, and protective factors that shape children's development, estimates the number of children who receive adequate nurturing care, and examines whether current interventions are meeting children's needs.

Building on the evidence from the first paper in this Series highlighting the fundamental importance of healthy and nurturing environments for children's growth and development in the next 1000 days (ages 2–5 years), this paper summarises the benefits and costs of key strategies to support children's development in this age range. The next 1000 days build on the family-based and health-sector based interventions provided in the first 1000 days and require broader multisectoral programming. Interventions that have been shown to be particularly effective in this age range are the provision of early childhood care and education (ECCE), parenting interventions, and cash transfers.

The football-loving medical philosopher, founder of the Italian Cochrane Centre, and former member of the BMJ editorial board Alessandro Liberati died 12 years ago, but he was remembered with great fondness earlier this year when Mariangela, his wife, donated almost 150 of his books to the hospital library of Reggio Emilia Arcispedale, one of the finest and best restored medical libraries in Italy.1Alessandro was passionate about some of the most famous writings on evidence based medicine, including the 1994 BMJ editorial by statistician Doug Altman, who wrote: “We need less research, better research, and research done for the right reasons.”2 Alessandro tried to improve the quality of research by increasing the funding for independent and relevant clinical trials and research. He feared that the well of research might be poisoned, and 12 years after Alessandro’s death Altman’s words have not been heeded. There is vastly more research, and much of...

This year’s annual confidential inquiry on maternal deaths–MBRRACE saving lives, improving mothers’ care 2024–finds evidence of high levels of inequality and little progress.1 Many trajectories have worsened. The maternal death rate is at its highest level for almost 20 years and inequities for race and deprivation are enduring or widening. We cannot reverse these trends without tackling the structural issues and social determinants at play.For the fifth year running, the number of women who died while known to social services has risen, now standing at 22% of the deaths reported. Maternal suicide remains the leading direct cause of death between six weeks and a year after giving birth. Past MBRRACE reports have highlighted that a large proportion of the women who died by suicide or because of substance use were at risk of having their baby removed from their care.Birth Companions has been campaigning for improvements in the care of...

A consultant gynaecologist has been ordered to be struck off the UK medical register for sexual harassment of a woman who was both his junior work colleague and his patient.The actions of Usama Abuzoda, who worked at Peterborough City Hospital, caused his victim, named only as Miss A, to have panic attacks. “Eventually I left the trust because I did not feel safe to come to work,” she told the medical practitioners tribunal.In January 2021 Miss A arranged for Abuzoda to call her at home after she had left work feeling unwell. In a first call, he inquired after her welfare and asked medically relevant questions. But he asked if he could call back later to check on her, and in that call he said words to the effect of, “If I wanted to have a one night stand, I’d have it with someone like you.” He inquired about the...