BMJ - British Medical Journal

Doctors in Gaza have been “abandoned by the world” as they continue to struggle to provide basic healthcare amid renewed Israeli airstrikes, a lack of staff and supplies, and under threat of violence and death, a US doctor working at the recently bombed Nasser Hospital has said.Feroze Sidhwa, US trauma surgeon who is volunteering in Gaza with MedGlobal, told a press conference on 26 March that the horrors he has witnessed since entering Gaza on 6 March far exceed anything he has seen during his humanitarian career, including during his three stints in Ukraine since the Russian invasion.“Doctors feel alone. They feel abandoned by the world, and I think rightly so. When Russia bombs a children’s hospital in Kiev, everybody loses their mind, and rightly so,” Sidhwa said. “But what’s going on here is far more severe and they see that the world, and especially the West, just doesn’t seem...

The treatment of around 800 patients by a now suspended consultant paediatric orthopaedic surgeon at Addenbrooke’s Hospital in Cambridge is to be examined by a panel of expert clinicians, after an initial review of complex hip surgery cases over the past two and a half years found that nine children had received substandard care.The external retrospective review will be chaired by Andrew Kennedy KC, an independent barrister who represented the Countess of Chester Hospital NHS Foundation Trust in the Thirlwall inquiry into the circumstances surrounding the crimes of nurse Lucy Letby.Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s, has also commissioned an independent investigation by the specialist company Verita into “whether there were any missed opportunities to have identified concerns and acted earlier,” given that concerns were raised as early as 2015 and were the subject of an external review in 2016.Verita has been asked to look into whether...

The timeline for the proposed introduction of assisted dying in England and Wales could be pushed back to four years, raising fears among supporters that its introduction may be abandoned altogether.An amendment approved by the Commons committee scrutinising the bill came as the Isle of Man took its final step to legalise assisted dying, the first area of the British Isles to do so. The Isle of Man Assisted Dying Bill 2023 will now be sent for royal assent before an implementation period begins, with assisted dying potentially available to terminally ill residents from 2027.The deferral in England and Wales was proposed by Kim Leadbeater, the Labour MP behind the private member’s bill. She proposed the amendment to change the maximum implementation period from two to four years after consulting with civil servants, who advised that more time would be needed to set up training and systems for the new...

The NHS is relying too much on recruiting doctors and nurses from countries that have their own significant healthcare workforce shortages instead of training and retaining enough domestic staff, a damning report has concluded.By November 2024 around one in eleven NHS doctors in England (9%) held a nationality from a “red list” country—those listed by the World Health Organization (WHO) as having such a shortage of staff that other countries should not actively recruit from them—found the report from the Nuffield Trust think tank and academics from the University of Sheffield, Queen’s University Belfast, and the University of Michigan.1The report, funded by the Health Foundation, found that since Brexit all UK countries had relied heavily on very high migration of healthcare staff from outside the EU.Mark Dayan, Nuffield Trust policy analyst and Brexit programme lead, told The BMJ, “Yet again, British failure to train enough healthcare staff has been bailed...

As paediatricians working in the US, we view the changes being made to our healthcare and education systems, research enterprise, and regulatory agencies1 as truly dystopian.The damage is clear to us. The breakdown of information from the Centers for Disease Control and Prevention; unjustified firing of workers from the National Science Foundation, US Department of Agriculture, Food and Drug Administration, and Environmental Protection Agency; decreasing the funding of university research through the National Institutes of Health; dismantling the US Agency for International Development; and withdrawal from the World Health Organization and the Paris Climate Agreement have disproportionately adverse effects on children. Children will suffer from diseases and disabilities that otherwise could be prevented and treated, a dire consequence of policies adopted by the very federal government entrusted with promoting and protecting their health, development, and functioning.Dictators have historically used health as a target to destroy the core strength of their...

In this episode of Sharp Scratch, the panel got together to discuss the importance of properly listening to patients.The panel was joined by guest Rageshri Dhairyawan to explore how medical students and doctors can work to improve their listening by increasing their awareness of biases that may lead to some groups of patients being dismissed. The episode highlighted the broader implications of not properly hearing patients, including the impact on health equity. The discussion also covered the challenges of dealing with uncertainty and acknowledging the social factors that can affect healthcare outcomes. The episode emphasised the ways in which becoming a better listener as a medical professional can help us to provide more compassionate and holistic care.Rageshri Dhairyawan is a consultant in sexual health and HIV medicine at Barts Health NHS Trust and deputy director of the SHARE Collaborative for Health Equity, Queen Mary University of London. She is author...

Rising cases of tuberculosis (TB) and measles and an intense influenza and respiratory syncytial virus (RSV) season were seen in England in 2024-25, reiterating the fact that “we cannot be complacent,” the outgoing head of the UK Health Security Agency (UKHSA) has said.The agency’s first report on infectious diseases looks at data from 2023 to early 2025 and acknowledges that social mixing, international travel, migration, and vaccine hesitancy following the covid-19 pandemic have contributed to these patterns of infection.1Provisional data for 2024 show that there were 600 new cases of TB in England in 2024, 13% more than in 2023. This followed an 11% increase in cases in 2023, with 4855 notifications of the disease compared with 4380 in 2022.If cases of TB continue to increase on their current trajectory the UK would lose its World Health Organisation low incidence status, warned Jenny Harries, chief executive of the UKHSA, at...

Decades of progress in improving childhood survival are being put at risk because of major cuts to aid funding, the United Nations has warned.In a report1 published on 25 March the UN found that the number of children dying globally before their 5th birthday has more than halved from 10.1m in 2000 to 4.8m in 2023. Stillbirths have declined modestly, from 2.9m in 2000 to 1.9m in 2021.2But it warned that these gains are now under threat as major aid donors such as the US have announced funding cuts. Earlier this month the Trump administration permanently cancelled funding for nearly 10 000 projects supporting global health and development, equating to a cut of nearly $60bn in aid spending.3 US cuts to foreign aid have already closed vital child malnutrition services in war torn Sudan.4World Health Organization director general Tedros Adhanom Ghebreyesus said, “In the face of global funding cuts, there...

The chancellor of the exchequer, Rachel Reeves, will set out the UK government’s spending plans in her spring statement on 26 March.1 The consultative green paper, Pathways to Work,2 has already outlined plans to cut several billion from the welfare budget, with the aim of saving £5bn by 2029-30.3 The plans include stricter criteria for personal independence payments (PIP) for people with disabilities; halving incapacity benefit payments under Universal Credit for new claimants; and restriction of incapacity benefit top-ups to those aged 23 years and older.Ministers have argued there is a “moral case” for these cuts, and that “people that can work [should be] able to work.”3 However, the chancellor’s approach is unlikely to achieve this goal for two key reasons. First, high rates of economic inactivity in the UK reflect its almost unique failure among industrialised countries to recover population health after the pandemic,456 which came on top of...

In the UK more than 3 in every 1000 people are taking glucagon-like peptide-1 (GLP-1) agonist drugs, says Kevin McCarroll, consultant physician and geriatrician at St James Hospital, Dublin.1 Depending on the region, 77-179 in 100 000 people are using the leading GLP-1 drug semaglutide (Ozempic for type 2 diabetes, Wegovy for obesity), he says.1 And these are just the official prescribing figures—anecdotal evidence suggests many are purchasing the drugs from unofficial sources.Growing evidence of the drugs’ efficacy for weight loss2 is fuelling demand worldwide. The number of patients in the US approved for GLP-1 agonist treatment for obesity rose from 190 000 a month in 2021 to 1.8 million in 2024.3 Analysis of the US market shows that 5.2% of women and 4.2% of men with obesity are being prescribed the drugs, although access varies.“The global supply shortage seen in 2024 was at least partly because of a surge...

Medical students from across the UK rallied outside the Department for Education on 19 March to demand adequate financial support.BMA representatives from the Medical Students Committee delivered a letter to Bridget Phillipson, the secretary of state for education, asking the government to “ensure that both undergraduate and graduate students are eligible for the full Student Finance England maintenance loan provision for all years of study,” as well as improving access to funding through the NHS bursary, “including improving the claims process and exploring new sources of funding.”Medical students stop being solely funded by Student Finance England in their fifth year when maintenance loans fall from a maximum of £10 277 to £2670 an academic year. This is then topped up with the NHS bursary of £1020 and a means tested grant of up to £2696 for those outside of London and £3255 for those in London. An additional £86 a...

Lawyers for families whose babies the nurse Lucy Letby was convicted of killing or assaulting have cast doubt on the findings by an international panel of experts which appear to exonerate her.1The 14 strong panel revealed its conclusion that the deaths were attributable to natural causes or poor medical care at the Countess of Chester Hospital, where Letby worked, at a press conference organised by her barrister, Mark McDonald, last month.2 Letby is serving 15 life terms after being convicted of murdering seven babies and attempting to murder seven others between June 2015 and June 2016.3 McDonald is asking the Criminal Cases Review Commission to send the case back to the Court of Appeal, after Letby’s previous attempts were turned down.In written submissions to the Thirlwall inquiry, the legal team representing several babies’ families, headed by Richard Baker KC, noted that the panel, assembled by the retired Canadian neonatologist Shoo...

The government has been urged to remove the financial barriers to doctors taking on additional work after a BMA survey showed that many consultants and GPs have cut their hours in the past year because of pension tax rules.The BMA’s poll of more than 5000 senior doctors found that many have reduced their work commitments to such a degree that if replicated across the wider workforce it would equate to the loss of around 5400 full time consultants. The BMA highlighted that this is almost 10% of capacity that could be offered to the NHS in England to tackle waiting lists this year. For GP partners, it estimates that the reduction in hours represents a potential loss of around four million appointments.The long standing problem is related to the tapered annual allowance (AA), introduced in 2016, which imposes a limit on how much senior doctors can put into their pension...

The UK has confirmed a case of H5N1 influenza of avian origin in a sheep in Yorkshire, in a world first.The infection in the animal was identified through routine and repeated milk testing, which was enforced after avian influenza was confirmed in captive birds on the same premises. The sheep has now been “humanely culled” and no other cases of avian influenza have been detected in the remaining sheep, the Department for Environment, Food, and Rural Affairs and the Animal and Plant Health Agency have said.“While this is the first time this virus has been reported in a sheep, it is not the first time influenza of avian origin has been detected in livestock in other countries,” the announcement said. “There is no evidence to suggest an increased risk to the nation’s livestock.”In January the UK confirmed a human case of influenza A (H5N1) in a person in the West...

The growing number of medical students put on a “placeholder” list after applying for foundation year training raises serious concerns about the capacity and foresight of the UK Foundation Programme Office (UKFPO). In 2024, more than a thousand medical school graduates were left without allocated foundation year training posts and faced a prolonged period of uncertainty while emergency posts were created.1 This has left graduates unable to plan the next steps of their careers and personal lives. Early reports suggest that this year hundreds of students have again been given a placeholder allocation.2The shortage of foundation training posts is indicative of a growing problem, as the number of students graduating from UK medical schools is expected to continue rising.3 This is the harbinger of an emerging workforce crisis. Unless there is an adequately planned, sustained expansion in the number of foundation training posts available in the UK, the placeholder list...

A growing tendency in official data to ask a person for their gender identity rather than their sex is having serious consequences in some areas of healthcare such as missed cancer screenings and mistakes in blood testing.An independent, government commissioned report1 into the collection of accurate data and statistics on biological sex concluded that public bodies should collect distinct data on both sex and gender identity to ensure that nationally held data are accurate and clear.The report, published by the Department for Science, Innovation, and Technology, sets out a timeline of how survey data have been collected since the 1960s. It shows how the word “gender” started to replace “sex” in some data collection in the 1990s, and in some survey data, gender was defined as “sex” while in others gender was defined as “identity.”The review authors found that from around 2015 the word “gender” started to be understood in...

bmj;388/mar24_9/r574/FAF1faIn 1983 surgeons across East Africa began to compare notes about a new disease, known colloquially as “slim,” which was prevalent across the region. At the time, Anne Bayley was running a clinic at the University Teaching Hospital in Lusaka, Zambia, for patients with endemic Kaposi’s sarcoma, a relatively indolent skin tumour, found mainly in older men.In 1983, however, the number of new cases of Kaposi’s sarcoma doubled to 23—and 13 of these patients (including three women) presented with unusual, more aggressive disease. Eight patients died in less than a year.1 There was also a rise in reports of Kaposi’s sarcoma in the literature, reflecting the emergence of HIV/AIDS among mainly gay men in the West. Bayley realised that HIV was the underlying problem in her patients with aggressive Kaposi’s sarcoma, which she thought implied heterosexual transmission. Not everyone agreed, convinced that it was spread by sex between men.Keeping an...

Researchers have criticised the UK drug industry trade association’s decision to restore Novo Nordisk’s membership despite the company being subject to ongoing regulatory breaches during its two year suspension period.In March 2023 the Danish pharmaceutical company, which manufactures the high profile weight loss drugs Ozempic, Saxenda, and Wegovy, was suspended as a member of the Association of the British Pharmaceutical Industry (ABPI) for two years because of “serious breaches” of the organisation’s code of practice.1 The company failed to disclose clearly its sponsorship of a weight management training course for healthcare professionals which included positive information on its obesity drug liraglutide (Saxenda).The ABPI, announcing its decision to reinstate Novo Nordisk’s membership on 17 March, said it was satisfied that the company had made “clear, significant, and sustained improvements” to ensure it properly adheres to strict industry standards.2But academics from the University of Bath told The BMJ that the available evidence—including...

Near-infrared spectroscopy (NIRS), originally described in 1977, entered clinical practice as a non-invasive method to assess regional tissue oxygenation.1 This monitoring technique was initially used in high risk surgeries to measure cerebral oxygenation in real time. After encouraging results that linked intraoperative NIRS guided, goal directed treatment to improved neurological outcomes in cardiac surgery, NIRS use quickly expanded.234 This increased use has sparked the development of multiple competing clinically approved NIRS monitoring systems, highlighting the substantial market interest in this technology.5Despite the widespread use of NIRS, negative findings from subsequent trials have raised concerns about whether NIRS monitoring truly improves outcomes.678 These concerns have prompted a debate regarding the surgical populations who might benefit from NIRS and the best practices for its use.9 In a linked research paper (doi:10.1136/bmj-2024-082104), Han and colleagues present noteworthy findings from the Bottomline-CS trial, which examined whether perioperative care guided by cerebral and peripheral tissue...

A love of people and their life stories inspired Raja Badrakalimuthu to specialise in old age psychiatry.“Working with older people, you get to have conversations about their lives,” says Badrakalimuthu, a consultant old age liaison psychiatrist at Royal Surrey County Hospital in Guildford. “Their generation built our society, and we’ve inherited the legacy of their hard work. I find it satisfying to be able to do something for them—to thank them, and show my gratitude.”Old age psychiatry is “the perfect blend of medicine and mental health,” he says. “Older people can have multiple physical conditions and you have to take this into account when diagnosing dementia.”With new dementia drugs becoming incorporated into clinical practice, and new cognitive assessments and scans becoming readily available, “it’s an exciting time to be doing old age psychiatry,” Badrakalimuthu says. Old age psychiatrists also have to be aware of what kind of support is available...