Medical Journal News

In the Chief Medical Officer for England's 2018 independent annual report, we called for the creation of a Composite Health Index (CHI)1,2 to track and inform efforts to improve the nation's health. The UK Office for National Statistics (ONS) responded by developing a beta Health Index3 followed by three updates, the latest covering 2015–21, which was published in June, 2023.4 We commend the ONS for their work, although funding constraints have since halted updates. With the new Secretary of State prioritising health-driven economic growth, we believe a renewed CHI should play a key part in tracking and informing these efforts over the coming years.

Gene therapy for hearing disorders is a promising advancement in the treatment of genetic hearing loss, particularly OTOF-related deafness. Mutations in OTOF disrupt synaptic transmission in cochlear inner hair cells, leading to profound congenital deafness and being a major cause of autosomal recessive non-syndromic auditory neuropathy (DFNB9). For individuals affected, cochlear implants restore partial hearing but cannot fully replicate natural hearing, with limitations in sound quality and speech recognition, especially in noisy environments.

The increase in Alzheimer's disease worldwide1 poses an urgent need for a collaborative approach to use imaging data for enhanced diagnostic, predictive, and therapeutic strategies. Inspired by the success and mission of the European Federation for Cancer Images (EUCAIM), we urge the Alzheimer's research community to consider establishing a similar federated infrastructure specifically focused on Alzheimer's disease.

Early in epidemics of emerging infections, health agencies often restrict testing criteria to people who fit within a case definition or who have had a high-risk exposure. In the recent avian influenza A(H5N1) outbreak in the USA, the US Centers for Disease Control and Prevention recommended that H5N1 testing be limited to patients meeting epidemiological criteria, including those having close contact with birds or other animals known to be infected, those having contact with surfaces contaminated with infected animal products (eg, faeces, organs, or unpasteurised dairy products), or those visiting a live bird market with confirmed cases.

Low-income and middle-income countries (LMICs) host nearly 85% of the world's population and bear a disproportionate burden of critical illness. Yet, knowledge generation and dissemination in critical care remain dominated by academics from high-income countries (HICs). A key tool of this dominance is medical journals. The structural biases within the current publishing system prioritise the visibility of work from HIC-based academics, marginalising contributions from LMICs.1 This academic divide has historical roots in colonialism.

We read with interest the study by Peter A Campochiaro and colleagues on RGX-314 for neovascular age-related macular degeneration (AMD),1 which suggests that gene therapy could reduce the need for frequent intravitreal anti-vascular endothelial growth factor (VEGF) injections. However, some methodological concerns warrant further attention.

We thank Huixun Jia and Xiaodong Sun for their perspective on our study.1 The goals of this first-in-human trial were to identify safe doses of RGX-314 and an optimised protocol for advanced studies. Doses in cohorts 1 and 2 were very low, resulting in little expression of anti-vascular endothelial growth factor (VEGF) protein, and, reassuringly, supplemental anti-VEGF injections were needed (these cohorts were vector-treated controls). In cohorts 3–5, there was good expression of anti-VEGF protein: most participants had good control of exudation and many of those with persistent exudation did not improve with monthly supplemental injections.

We read with great interest the Article by Victor Tumukunde and colleagues on kangaroo mother care (KMC).1 The authors conducted a meta-analysis pooling the results from the OMWaNA trial with the WHO iKMC trial2 and eKMC trial in The Gambia. We strongly believe this pooling is unjustified because the OMWaNA study is not comparable with the iKMC trial in terms of participants, intervention, comparisons, and outcomes.

We read with considerable interest the Article by Victor Tumukunde and colleagues1 on the effectiveness of kangaroo mother care (KMC) before clinical stabilisation in sub-Saharan Africa. Although we commend the authors for their extensive research, we believe that their findings necessitate a deeper examination of the practicality and universal applicability of KMC in resource-constrained settings.2

We thank these colleagues for their letters regarding our OMWaNA trial.1 First, in response to Harish Chellani and colleagues from WHO's Immediate Kangaroo Mother Care (iKMC) trial,2 we welcome their insights on our meta-analysis pooling neonatal mortality effects of the OMWaNA trial with similar trials in sub-Saharan Africa, where neonatal mortality is highest. This meta-analysis was important in showing a significant relative reduction in 28-day mortality of 14% across the African sites of all three trials to date, with consistency across five of the six sites,1 all lower than the effect at the iKMC Indian site.

Ivonescimab significantly improved PFS compared with pembrolizumab in previously untreated patients with advanced PD-L1 positive non-small cell lung cancer. Therefore, ivonescimab might represent another treatment option in the first-line setting for PD-L1-positive advanced non-small cell lung cancer.

Tuberculosis is a leading cause of death globally. Given the airborne transmission of tuberculosis, anybody can be infected, but people in high-incidence settings are more exposed. Risk of progression to disease is higher in the first years after infection, and in people with undernourishment, immunosuppression, or who smoke, drink alcohol, or have diabetes. Although cough, fever, and weight loss are hallmark symptoms, people with tuberculosis can be asymptomatic, so a high index of suspicion is required.

Dengue virus, a WHO grade 3 emergency, infected over 10 million individuals in 2024. With no population-effective prophylaxis or direct treatment, there is an urgent need for immediate vector control to protect the 3·9 billion individuals at risk globally.1,2

Over the past year, a firestorm of debate has been swirling around the role of physician associates (PAs) in the NHS. Many commentators have used the lack of regulation of PAs and oversight of their education as evidence that PAs are trying to hide their practice or escape the consequences of their actions. Nothing could be further from the truth.PAs, like doctors, nurses, physiotherapists, pharmacists, and all NHS professionals, want to ensure that only highly qualified people are admitted to their profession and that there is a mechanism to manage those who are not performing to standard. Just as all doctors do not bear responsibility for the mistakes of other doctors, nor do all PAs bear responsibility for every mistake made by another PA. Yet the government has been slow to respond to the need for regulation.The lack of statutory regulation has meant that the PA profession took the initiative...

The BMA has announced plans to take legal action over an exam error that left some doctors facing the risk of unemployment.The error affected nearly 300 candidates who sat part 2 of the membership of the Royal College of Physicians (MRCP) exam in September 2023.1 A total of 61 doctors who were originally told they failed were informed 18 months later that they had passed, while 222 doctors who had been told they passed were belatedly informed that they had failed.Some doctors who thought they had passed were in the process of applying for higher specialty training when the error was announced in February. They have now had their applications withdrawn from the process, as they no longer meet the eligibility criteria for the roles.2 Doctors who have been affected told The BMJ they were concerned about becoming unemployed when their current training programmes end in August.The decision to withdraw...

Nottingham University Hospitals NHS trust is investigating allegations that healthcare staff illegally accessed medical records of the victims of a stabbing attack that left three people dead.Barnaby Webber and Grace O’Malley-Kumar, both 19 year old university students, and Ian Coates, a 65 year old school caretaker, were stabbed to death by Valdo Calocane in June 2023.The claims that their medical records had been accessed illegally were first reported by the Daily Mirror.1 In a joint statement the families of the three victims described the news as “distressing and traumatic.”The statement said, “These are not just alleged data breaches but gross invasions of privacy and civil liberty. For individuals to choose to access information regarding the vicious attack and murder of Barney, Grace, and Ian with no reason to do so is sickening. It’s gross and inexcusable voyeurism at the most repugnant level.”The families found out about the potential breach in...

A most beautiful word?During his presidential campaign in 2024 Donald Trump was heard to say that “the most beautiful word in the dictionary today is the word ‘tariff.’ It’s more beautiful than ‘love’. It’s more beautiful than anything. It’s the most beautiful word. This country can become rich with the use—the proper use—of tariffs.”1If President Obama modelled himself on President Lincoln, Trump seems to be modelling himself on William McKinley, who was president from 1897 until his assassination in 1901, having been re-elected in 1900, and whom Trump has called the Tariff King: “He spoke beautifully of tariffs. His language was really beautiful: ‘We will not allow the enemy to come in and take our jobs and take our factories and take our workers and take our families unless they pay a big price, and the big price is tariffs.’” Trump made it sound as if he was quoting McKinley...

Stephen Powis, NHS England’s national medical director and one of the government’s most prominent communicators during the covid-19 pandemic, is to step down this summer.1His departure, announced on 6 March, creates another gap in NHS England’s senior leadership after Amanda Pritchard’s sudden decision to quit as its chief executive.2Powis, who has served more than seven years as national medical director, gave notice of his intentions in January in a letter to Pritchard, NHS England said.The departures come as health secretary Wes Streeting considers overhauling NHS England’s role and how it relates to the Department of Health and Social Care as part of reforms to improve NHS accountability and productivity, amid calls from some critics for NHS England’s abolition.3Streeting praised Powis’s “outstanding leadership” and “professionalism,” saying “his contribution to the NHS and the country was enormous during the pandemic.”“I would like to thank Steve, not only for his pivotal role in...

Hospital consultants have urged the BMA to lobby for a national, anonymous reporting structure for staff who experience sexual harassment at work.Doctors at the BMA’s UK consultants annual conference on 4 March also called for NHS organisations to investigate reports of sexual misconduct using external investigators trained in trauma investigations.A motion carried by the conference also stated that NHS trusts should include active bystander training within mandatory training programmes for all staff.Proposing the motion, perinatal psychiatrist Bhairavi Sapre referenced an investigation by The BMJ and the Guardian which found that more than 35 000 sexual safety incidents were reported to 212 NHS trusts in England between 2017 and 2022.1Figures from the 2023 annual NHS staff survey showed that 9% of NHS staff in England were sexually harassed while at work.2Sapre said that the lack of national reporting structure for sexual harassment left victims “without the support or confidence to report...

The National Institute for Health and Care Excellence (NICE) has decided to reconsult on draft guidance for Alzheimer’s treatments donanemab and lecanemab, six months after initially rejecting the drugs, in light of new evidence provided by the manufacturers.The new draft guidelines, published on 6 March,12 have again not recommended the treatments be available on the NHS as they do not provide “good value” with “relatively small” benefit and high rollout costs, including regular infusions and side effect monitoring.However, the guidelines are now undergoing public consultation during which manufacturers and other stakeholders can “submit new evidence or commercial proposals that might tackle the problems that have so far been a barrier to the use of these new treatments in the NHS.”The consultations will close on 27 March and the NICE committee will consider all responses during a meeting in May, after which their recommendations will be finalised.The re-review of the drugs...