Medical Journal News

The Editorial on the fertility industry rightly stated that insufficient public funding has driven the commercialisation and financing of assisted reproductive therapies.1 However, if it were not for the private sector, no effective fertility treatment would be possible in many countries. In Poland, for example, there was scarce access to in-vitro fertilisation (IVF) for many years due to a paucity of public financial support. According to the recent data, Poland had one of the worst rates of access to fertility treatment in Europe.

We were pleased to read the Editorial on cholera1 and its emphasis on water, sanitation, and hygiene practices to address the root cause of the cholera pandemic. However, what we missed was emphasis on strengthening local health systems to detect and respond to these outbreaks—axis 1 of the Global Task Force on Cholera Control roadmap.2 Strengthening local health systems has synergistic potential to improve health in relation to other pathogens and diseases, and has been advocated as best practice for interventions in low-resource settings.

Médecins Sans Frontières (MSF) set up its Access Campaign in 1999 to tackle the policy, legal, and political barriers that prevent people from accessing health tools in the communities where MSF work and beyond.1 In its Nobel Peace Prize speech, MSF demanded “change, not charity”, and has since challenged systemic inequities where pharmaceutical companies price lifesaving health tools out of reach and determine research priorities based on commercial prospects.2

In the World Report, Talha Burki1 reported on what we believe to be the misguided decision by a consortium of senior leaders in Médecins Sans Frontières (MSF) to dismantle its highly regarded Access Campaign.

We read with interest the results of the iCOMP collaboration from Anna Lene Seidler and colleagues.1,2 These individual participant data meta-analyses comparing immediate cord clamping, delayed cord clamping, and umbilical cord milking, including short, medium, and long deferral of delayed cord clamping, are commendable for their size and quality. In particular, we welcome the exclusion of 14 trials following integrity concerns.

We thank Jeremy Nielsen and Ben W Mol for their interest in our iCOMP Articles,1,2 and for commending our assessments of study integrity. They raise two key points: they suggest integrity assessments should be made available for each trial to increase transparency and they express concerns about the randomisation process of two included studies based on observed baseline characteristics.

FT596 was well tolerated as monotherapy or with rituximab and induced deep and durable responses in patients with indolent and aggressive lymphomas and the RP2D was preliminarily identified to be 1·8 × 109 cells for three doses per cycle. This study supports that cell therapy using iPSC-derived, gene-modified NK cells is a potent platform for cancer treatment and suggests that such a platform might address limitations of currently available immune cell therapies, including manufacturing time, heterogeneity, access, and cost.

Dazukibart resulted in a pronounced reduction in disease activity and was generally well tolerated, supporting IFNβ inhibition as a highly promising therapeutic strategy in adults with dermatomyositis.

A 62-year-old man with a parastomal hernia at the site of a urinary conduit and symptoms of urinary obstruction lasting several months presented to our hospital.

Axial spondyloarthritis manifests as a chronic inflammatory disease primarily affecting the sacroiliac joints and spine. Although chronic back pain and spinal stiffness are typical initial symptoms, peripheral (ie, enthesitis, arthritis, and dactylitis) and extra-musculoskeletal (ie, uveitis, inflammatory bowel disease, and psoriasis) manifestations are also common. Timely and accurate diagnosis is challenging and relies on identifying a clinical pattern with a combination of clinical, laboratory (HLA-B27 positivity), and imaging findings (eg, structural damage on pelvic radiographs and bone marrow oedema on MRI of the sacroiliac joints).

The US Food and Drug Administration (FDA) has published draft guidance aimed at improving the performance of pulse oximeters across all skin colours, following research suggesting the medical devices may be less accurate in people with darker skin.1Once finalised, the guidance could see a prominent label added to the packaging of pulse oximeters proven to perform “comparably across groups of individuals with diverse skin pigmentation.”It also provides manufacturers with actions they can take to better assess their products, such as increasing the number of clinical trial participants and using the Monk skin tone scale2 alongside other methods for classifying skin pigmentation.Pulse oximeters became more widely used during the covid-19 pandemic as a way for people to monitor blood oxygen levels while at home. But research published in the New England Journal of Medicine in 2020 found that the devices may be missing three times as many cases of occult hypoxaemia...

“Eco-anxiety” is growing worldwide, especially among young people.1 Considerable anxiety about the climate crisis is rational, particularly for young people, for whom even 2100 is a tangible date. Deep concern for future human and ecological wellbeing is justified among all ages, not only because of the disturbing evidence of climate breakdown, but also because of the apparent climate change policy paralysis, especially in so-called developed countries—the global North. Climate policy paralysis and hypocrisy are stark given the disturbing evidence of rising global temperatures in the last 18 months. The primary responsibility for climate change lies with the lifestyles and intransigence of the world’s most affluent people, most of whom live in high-income nations including Europe, the US, Canada, and Australia. Although these populations have, to date, been comparatively insulated from the harm caused by climate change, more extreme climate related weather events are becoming increasingly frequent, such as wildfires in...

The 10 winners of the 2024 Shkreli awards, given annually to the worst examples of profiteering and dysfunction in US healthcare, have been announced by the Lown Institute, a non-profit US think tank.1The winners include an oncologist who subjected a healthy patient to cancer treatment for profit, a hospital accused of demanding upfront payments from patients with cancer, and UnitedHealth, the insurance company that has faced a storm of public indignation after one of its executives was murdered in New York.2This is the eighth year in which the awards have been given. Winners are chosen by a panel including doctors, public health experts, journalists, and patient advocates. The awards are named after Martin Shkreli, the “pharma bro” who became infamous when he bought the maker of the anti-parasitic drug Daraprim and increased the price 50-fold.Speaking at the ceremony, Lown Institute president Vikas Saini said, “All these stories paint a picture...

One of England’s largest hospital trusts has ordered an independent review of its international medical training programmes because of concerns, first highlighted in The BMJ, that overseas doctors were paid substantially less than domestic peers working at a comparable level.University Hospitals Birmingham NHS Foundation Trust (UHB) has already carried out an internal review “following concerns raised by staff members” about the international medical training programmes.A message sent to UHB staff on 8 January from Kiran Patel, the trust’s chief medical officer, said that the internal review had “highlighted a number of issues, including pay parity . . . We will therefore undertake an independent review of each of the international training programmes we are involved in.”Foreign doctors come to English hospital trusts as “fellows” as part of the Academy of Medical Royal Colleges’ medical training initiative scheme.1 The scheme provides experience in the NHS for up to two years for...

I agree with Wolf’s concerns about transfusion in sickle cell disease.12 In developed countries, where the blood donor pool is predominantly white and lacking the Ro antigen, transfusion for sickle cell disease is often affected by alloantibody formation, which complicates future transfusions. Iron overload is a potential complication of chronic blood transfusions in patients with sickle cell disease.Notwithstanding, Howard does recommend simple additive transfusion for acute anaemia (haemoglobin concentration 20 g/L below steady state) in patients with sickle cell disease.3 Similarly, British Committee for Standards in Haematology guidelines recommend that transfusion be considered in uncomplicated painful crises if there is a substantial drop in haemoglobin from baseline (a drop greater than 20 g/L or to a concentration lower than 50 g/L.4In many countries where sickle cell disease is prevalent, the blood donor population is Ro similar and the rate of alloantibody formation lower.5 In addition, blood shortage makes chronic transfusion...

The covid-19 pandemic and the recent cost-of-living crisis have substantially exacerbated pre-existing inequalities in health and social care in the UK.1 Marginalised populations are disproportionately affected, for example by experiencing higher rates of childhood obesity, depression, and maternal and neonatal mortality.2 Paradoxically, those who are most in need of medical care—disadvantaged populations—often face the greatest barriers to accessing it. In England, people living in the most deprived areas are twice as likely to wait over a year for non-urgent treatment compared to others.3For the NHS to make a real difference to health equity, local organisations should not be waiting for a solution to emerge nationally. Instead, they should be looking to, and working with, the local populations they serve. For instance, there is a critical need for better data on healthcare access and outcomes, specifically broken down by income and background. The recent independent investigation into the NHS in England...

Charles and colleagues’ overview of management of acute pain crisis in sickle cell disease is welcome,1 especially as patients move away from city centres to areas that typically have a less ethnically diverse demographic. As a consultant haematologist specialising in haemoglobinopathy and transfusion, however, I must challenge the suggestion that transfusion is recommended when haemoglobin drops by 20 g/L.Transfusion is not a benign treatment, particularly in patients with sickle cell disease. Rates of red cell alloimmunisation are high, especially in countries where the donor population is predominantly white, with rates of almost 20% in a recent UK study2 and up to 30% in some North American studies.3 Transfusion can also lead to serious life threatening consequences of delayed haemolytic transfusion reaction or hyperhaemolysis syndrome, in which patients begin to haemolyse their own cells as well as that of transfused cells. Longer term, repeated transfusion can lead to iron overload and...

How bad is it?Latest NHS England figures show that hospitals had an average 5407 patients a day with influenza, including 256 in critical care, in the week to 5 January.1 This was 3.5 times the number in the same week last year (1548 for the week ending 7 January 2024). NHS staff have told the BBC this is one of the worst winters they have seen, comparing it to 2022-23, which was the worst since modern records began.2 The Royal College of Physicians warned of “chaos” in hospitals, with ever more care provided in corridors and other temporary environments. Saffron Cordery, interim chief executive of NHS Providers, said “winter has been brutal so far” and predicted that “things are likely to get worse before they get better.” The BMA’s chair of council, Phil Banfield, warned that “we are in a national emergency,” adding, “A seasonal flu outbreak is something we...

A new year is meant to bring new hope, and perhaps this one does too, but it’s hard to be thrilled by health services overwhelmed by winter pressures (doi:10.1136/bmj.q2871),1 transatlantic rabble rousing, and insoluble global crises and conflicts. What a new year can certainly bring is a fresh start, with new energy and effort to direct ourselves away from a destructive future, to focus on improving people’s health and wellbeing.Yet with each era the task grows more complex. In Samuel Taylor Coleridge’s Rime of the Ancient Mariner, sailors marooned on a ship drifting near the equator are tortured by “water, water, every where, nor any drop to drink.” Medicine at that time, the end of the 18th century, was replete with untested hypotheses on illness and disease, reliable information was scarce, and therapies were few.That changed—first gradually, then rapidly—with advances in medical science, printing and distribution, and the internet. More...

The BMJ’s articles on helping healthcare providers identify abuse, neglect, and exploitation of children123 are particularly useful in the acute setting, such as the emergency department.On behalf of the adolescent special interest group of the British Association of Sexual Health and HIV (BASHH) I would like to bring to your attention to two further resources offering standardisation of best practice in this field that are used across the United Kingdom and internationally.The Spotting the Signs toolkit was originally developed by Brook, a sexual health charity, and BASHH, aiding the identification of young people at risk of child sexual exploitation.4 This tool has been used in sexual health services since 2014 and has recently been updated to widen its scope to include assessment of child criminal exploitation and online risks using trauma informed and conversational approaches. It will be used by a broader range of professionals, including schools, youth services, and...