Medical Journal News

The Scandinavian social democracies are widely admired for their world class public services, which are supported by high levels of taxation, productivity, and education, and equality of income and opportunity. In 2021, for example, Norway had a tax-to-GDP (gross domestic product) ratio of 42.2% compared with 33.5% in the UK and 24.5% in the US.12 Conversely, income inequality is notably low in Norway, which has a Gini coefficient—a measure of income distribution within a population—of just 22.7 compared with 32.6 in the UK and 39.8 in the US, where inequality approaches that in many Latin American and African countries.3But is this egalitarianism translatable to other settings? Can other nations longing for better public services learn from this? In the Scandinavian virtuous cycle of welfare, equality, happiness, and trusted governments and institutions, it is hard to distinguish cause from effect. The fact that Scandinavians expect, and get, high quality public services...

Our oldest stories begin in the soil or by the sea, myth being the original ecological narrative. The Mandé and Sumerians tell of people growing from seeds or moulded from earth; Rigveda, the ancient Hindu sacred text, and the Kojiki, the earliest written Japanese chronicle, speak of births from primordial oceans; and Abrahamic traditions place us in Eden’s lushness. With industrialisation came a new imperative: writers began exploring not just our connection to nature but also our power to destroy it.Climate fiction is a recent literary genre confronting environmental and societal breakdown. But literature has grappled with the interplay of people and environment long before “cli-fi” exploded in the 2010s. These works offer more than historical perspective. They reveal how story and imagination might help us grasp what climate data alone cannot—the full scope of our crisis—while helping us to envision paths beyond catastrophe.Last Man by Mary Shelley (1826)Lionel Verney...

Six hundred miles north of mainland Norway, deep in the Arctic Circle, the Svalbard archipelago spans over 60 000 km2, with a population of just 2596. Longyearbyen, the “capital city,” has a small hospital to provide primary and emergency care. The hospital has 24 staff,1 including three doctors and at least one surgeon. Longyearbyen also has a fire department that has one ambulance with a stretcher.With few roads and rugged terrain, Svalbard has two search and rescue helicopters that also provide helicopter emergency medical service (HEMS)—and unusual transfer missions.2 Each helicopter crew includes a medical rescue technician, and one has an anaesthetist. The helicopters carry the same equipment as mainland HEMS bases, including a handheld ultrasound machine and blood products.2 Annually the crews conduct over 80 missions, mostly search and rescue or as primary responders to medical emergencies. Authorities have recorded fewer than five cardiac arrests that occurred outside of...

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New England Journal of Medicine, Ahead of Print.

bmj;387/dec18_4/q2802/FAF1faLeslie was born in Southampton in 1928 but when he was 8 his family returned to Aberdeen, which remained his spiritual home. He qualified from Aberdeen University in 1951 and his first house job was, unusually, in a mental hospital in Scotland. In 2017 he published a vivid account of his time there, noting the seismic change in psychiatric practice during his long career.After house jobs he undertook national service, treating soldiers during the Korean War. As the only qualified doctor in his unit, and with no senior support, he relied on his resilience and intuition to make clinical judgements. He reported that he gained more valuable experience in one year in Korea than in 10 years in the NHS.After this Leslie returned to Scotland to work in mental health departments, followed by a senior registrar post in Hertfordshire, before being appointed as a consultant child psychiatrist for Hampshire.Leslie was...

Women aged 30 to 65 should be screened for cervical cancer every five years with a test for human papillomavirus, the US Preventive Services Task Force has recommended in draft recommendations.1For the first time, new draft guidelines include self-collected HPV tests, where women can use a swab to collect their own samples, alongside the other options. The task force said that this choice was just as effective as when a clinician collects the sample to be tested for HPV, and it increases testing in groups in whom screening is traditionally lacking.For women aged 21 to 29 the task force continues to recommend screening every three years with a cervical smear test, called a Pap test in the US.In a change from previous guidelines, the task force recommended that women aged 30 to 65 be screened every five years with an HPV test. Alternatively, women in this age group could be...

The search for effective therapies in ulcerative colitis, a chronic inflammatory condition affecting the colon and rectum with a relapsing–remitting course, has been a long and challenging journey, especially for patients who do not reach remission with the current treatment options. Therapeutic limitations, such as the therapeutic ceiling, especially for bio-exposed patients, and the loss of response over time with long-term remission rates below 50% with advanced therapies, highlight the complexity of treating ulcerative colitis.