BMJ - British Medical Journal

bmj;388/jan08_2/r17/FAF1faMeena was born in Mantuvi, a tiny island off the east coast of Sri Lanka, in 1930, the youngest of four children. She was delivered by her father, a doctor, whom she revered and adored.In 1946 she met Shelly, the second man after her father to have a pivotal role in her life. In 1950 they entered medical school together at the University of Colombo. He was her strength and support and, for the next 78 years, they formed a happy and loving relationship.Meena began her training in pathology in 1962 at the General Hospital in Colombo, before moving to the UK. In 1965 she continued her training in pathology and microbiology at the West Middlesex, West London, and Charing Cross hospitals. Here she met Henry Winner, professor of microbiology at Charing Cross, who became her mentor. She loved, enjoyed, and embraced her career as a consultant medical microbiologist until...

bmj;388/jan08_1/r16/FAF1faGeorge Delfas was born in Athens and qualified at the top of his class in medicine at the University of Athens. After two years of national service, largely with the Greek delegation to NATO in Izmir, Turkey, he trained in general medicine and cardiology at the Evangelismos Hospital in Athens. He married Magda in 1966 and left for the UK after the colonels’ coup in 1967.George found the UK immediately congenial and started work at Orpington Hospital, moving to positions in cardiology at Glasgow’s Western Infirmary and then Walsgrave Hospital in Coventry. He became a GP in Earlsdon, Coventry, with specialist clinics in rheumatology at Coventry and Warwickshire Hospital. He was a caring and hard working family doctor, seeing the out-of-hours call outs of those days as a natural part of the job. On top of his general practice work he enjoyed working as a medical expert for the Tribunal...

2025 is here and medicine has continued to move away from the utopian vision of our admission essays for medical school. We are spending countless hours on electronic health records scrolling through layers of data to find the information we need, receiving vital information through fax machines, and listening to on-hold music as we try to help patients progress through labyrinthine treatment pathways so that they can get the care that they need. The administrative burden of modern medicine has become overwhelming.Healthcare providers face relentless obstacles in their workflows and inefficient technologies that impede patient care and contribute to suboptimal patient outcomes and physician burnout.1 Clearly, the labour of clinical practice is ripe for disruption and transformation. In response, the purveyors of artificial intelligence (AI) have promised solutions to overcome these seemingly intractable obstacles and inefficiencies. Given past experiences with the introduction of technology, such ambitious promises may understandably elicit...

The US has reported its first human death from avian influenza H5N1 in a person who had been admitted to hospital in Louisiana after being exposed to a non-commercial backyard flock and wild birds.1The patient was over 65 and reported to have underlying medical conditions. “The department expresses its deepest condolences to the patient’s family and friends. Due to patient confidentiality and respect for the family, this will be the final update about the patient,” the Louisiana Department of Health said in a statement on 6 January.The department added that its “extensive public health investigation” identified no additional H5N1 cases or evidence of person-to-person transmission. The US has reported around 66 human cases of H5N1 since the start of 2024.2“This patient remains the only human case of H5N1 in Louisiana,” it said. “While the current public health risk for the general public remains low, people who work with birds, poultry,...

bmj;388/jan07_8/r18/FAF1faCharles was born in London and was evacuated to Biggin Hill during the second world war. He studied medicine at University College London, then worked on the house staff at University College Hospital (UCH) before joining the Royal Air Force Institute of Aviation Medicine in 1955 with the rank of flight lieutenant.He had stints working in clinical practice at Hammersmith Hospital and UCH, and research roles in Sheffield and at Harvard Medical School, where he worked in the Biophysical Laboratory under Arthur K Solomon.Having met his future wife Gillian in the US, he returned to the UK in 1963 and the couple married and raised a family. Charles rejoined UCH as a consultant physician and senior clinical scientist with the Medical Research Council (MRC).While remaining with the MRC and in charge of the thyroid clinic at UCH, he was appointed consultant endocrinologist at Northwick Park Hospital and Clinical Research Centre...

The 1990s are firmly back in style. From bucket hats to Britpop playlists, the last decade of the 20th century is being celebrated across social media and pop culture. But alongside the harmless nostalgia, a far more unwelcome trend has been revived: the glamorisation of smoking.Recent headlines have highlighted how smoking is creeping back into the spotlight, particularly through influencers and celebrities with massive youth followings. Charli XCX, for example, whose music and aesthetic shaped the “brat summer” trend, described the vibe as “a pack of cigs, a Bic lighter, and a strappy white top with no bra.” At New York Fashion week last year, models strutted down the catwalk smoking cigarettes. There’s even an Instagram account dedicated to showing pictures of high profile, attractive celebrities smoking. This normalisation of smoking risks re-igniting a harmful cultural association between cigarettes and coolness, to which young people are particularly vulnerable.History repeating itself?The...

It was a familiar scene in the lead-up to Christmas: husbands looking lost in highly perfumed, dazzlingly lit shops. An expensive lipstick or cashmere scarf, seldom actually wanted, was bought as a surrogate object to represent “I love you.” Parents strained to understand the latest craze in overpriced plastic toys that promised more quality time with their children, away from digital distractions, but which often led to less. I too stood in those shops and bought those scarves and toys for my wife and children. But I’d already bought the perfect present for my friends—a gift that no one wants. For Christmas last year I bought my friends a funeral.This may seem a strange gift, and in many ways it is. Over the past 20 years, while caring for patients who are in the thick fog between life and death, I’ve met hundreds of people who have died, were resuscitated,...

The prime minister, Keir Starmer, has unveiled new plans to radically transform the NHS in a bid to cut waiting lists.1 One new element is the promise that GPs will be able to order more tests directly, including MRI and CT scans.2 This may speed up the process of reaching a diagnosis, as the relevant investigation will have already been performed by the time the patient sees a specialist, and if no abnormality is found it may be possible to reassure the patient without a hospital appointment.Discussions among GPs on social media reveal huge variations around the country in the kinds of tests they currently can and can’t order. GPs’ appetites for increased access also vary, with some keen to just get on and request the tests they know their patients will need, while others are wary of yet another transfer of work to GPs from hospitals, coupled with the...

The UK government has committed to leading the world in clinical trials and to “transforming treatment for dementia.”1 This commitment continues implementation of O’Shaughnessy’s recommendations on commercial clinical trials in the UK.2 It includes establishing “clinical trial delivery accelerators”—multidisciplinary teams working to widen access to research, hasten recruitment, and embed trials in the UK medical research infrastructure. The first of these to be announced was the dementia trial accelerator.3 A core component of the dementia accelerator is the trial ready cohort, a pool of pre-screened potential trial participants. We argue that the potential of trial ready cohorts is unproven and suggest that their ability to contribute to dementia research relies on tackling the distinctive ethical challenges that they present.Accelerating dementia trialsThe dementia field has been the “graveyard of drug discovery.”4 Clinical trials in the field have had an almost 100% lack of success, involving nearly 200 000 participants and costing...

After six months in power, the UK government has finally set out how it intends to tackle the longstanding and well documented challenges of adult social care. This should be welcomed. The centrepiece proposal is to establish an independent commission “to build a national consensus around a new National Care Service able to meet the needs of older and disabled people into the 21st century.”1We have been here before—the past 27 years have seen two government commissions, one shorter government commissioned review, three independent commissions, five white papers, and 14 parliamentary committee inquiries on social care reform. They have had little impact.2 Many have questioned whether yet another review is needed. But the choice of Louise Casey, a skilled Whitehall operator and cross bench peer, as chair of the commission creates an opportunity to bring a fresh perspective that avoids retreading old ground, helps build public support for a poorly...

The government has announced several measures to cut waiting times for NHS elective treatment in England, including expanding community diagnostic centres, creating 14 new surgical hubs, and increasing the use of remote monitoring technology.The aim is for 92% of people waiting for non-urgent elective treatment to be seen within 18 weeks of referral by the end of this parliament (March 2029).1 In the shorter term, the plans should mean that 65% of patients are treated within 18 weeks by the end of 2026—equivalent to around 450 000 people, on the basis of the current waiting list.However, healthcare leaders have expressed doubt about whether these goals can be met. They warned the government against focusing on just one target and forgetting about the importance of supporting and growing the NHS workforce. Currently in England 7.5 million people are waiting for elective care, of whom nearly 235 000 have been waiting more...

Some of the crucial matters raised in Dobson’s article about disinformation1 emphasise the urgency of making progress with The BMJ’s Commission on the Future of Academic Medicine.2One, perhaps extreme, example comes from the covid-19 pandemic, when disinformation was rampant. The rapid production of scientifically valid evidence was necessary, though sadly not always sufficient. The earlier embedding of research networks across all hospital trusts in the UK was widely acknowledged to be a key factor in the Recovery trial’s speedy progress in producing the evidence to show which potential therapies were effective.3More broadly, we don’t know exactly what pressures might be exerted on clinicians by the new US regime, but it is a context in which any measures that strengthen the capacity to speak up for science should be encouraged. A recently updated systematic review examined evidence about the widely held assumption that patients treated in research active healthcare organisations, or...

Prolonged debate on the terms of the pandemic treaty has highlighted the differences in how to tackle our global health challenges. Despite the growing calls for a One Health approach, which integrates, optimises, and balances the health of people, animals, and the environment and aims to protect their collective health holistically, the global community continues to separate discussions about climate change, pandemic preparedness, and other health campaigns.The world is facing innumerable health challenges, including accelerating disease burdens, increased pandemic risk, and growing health inequities amid slowed progress towards universal health coverage. Climate change is driving poor health, eroding hard won progress, and creating new challenges. Our future pandemic risk is not exempt. These issues are deeply interrelated.Experts predict there is at least a 50% chance of another covid-like pandemic occurring in the next 25 years, and this risk is exacerbated by climate change.12 Critically, there are four concerns.Climate related risksFirst,...

With a sense of inevitability and clear predictability, urgent and emergency care in the UK is rapidly heading into another winter of discontent. We are seeing signs that we will experience another winter of patients facing prolonged waits to access emergency care. The result will be patient harm, corridor care in emergency departments and acute medical units, and delays in ambulance response times.1 Each of these metrics have deteriorated over the past decade, with politicians failing to understand and deliver on the priorities that could reverse this decline.Hospital occupancy levels remain dangerously high.2 This leaves no room in the system to cope with a surge in demand. The “quad-demic” of influenza, respiratory syncytial virus, covid-19, and norovirus will simply be overwhelming. Disturbingly, a measurable increase in any of these conditions would cause hospitals to struggle—with the impact most noticeable in urgent and emergency care.3The discontent is felt and experienced by...

Health officials overseeing the city of Wuhan in China have been forced to stop HIV clinics from uploading results to a new digital system for test sharing after two HIV positive patients were refused hospital treatment.One man was turned away from a dental hospital in the city on 30 November, and another with cold symptoms was rejected from a general hospital on 1 December. In both instances staff told the men that they had seen their positive HIV status in an interhospital test system and were unable to treat people with HIV, said local reports verified by The BMJ.1These incidents highlight the ongoing problem of medical discrimination in China and show how this is complicating a major government effort to curb costs and overtreatment by making hospitals share information such as x ray imaging and blood test results.The orders to HIV clinics to stop uploading results were issued on 4...

I welcome the Medical Protection Society’s report calling for all NHS trust staff who deal with disciplinary procedures to have specialised training.12 As one of the people involved in setting up new guidelines for NHS trusts to follow in respect of human resources disciplinary procedures (outlined on page 3 of the report), I consider that three key things must happen.Firstly, as noted in the report, managers and healthcare staff in management roles need to be properly trained and properly accountable when they are involved in NHS disciplinary procedures. Managers should therefore be regulated just like doctors and nurses. Secondly, there should be a requirement that principles of fairness are imprinted into NHS disciplinary procedures. These are what I have termed PIE principles—plurality, independence, and expertise in panels. Thirdly, there should be an independent body—a “Staff Care Quality Commission”—that has the power to prosecute and fine trusts that abuse NHS disciplinary...

The government has announced the launch of an independent commission into adult social care in England, which will inform the creation of its proposed National Care Service.1The commission, led by the cross bench peer Louise Casey, will be split into two phases and will make “clear recommendations for how to rebuild the adult social care system to meet the current and future needs of the population.”The first phase, expected to report in mid-2026, will identify the main problems with the current care system and set out recommendations for “effective reform and improvement in the medium term.” These recommendations will be aligned with the government’s spring spending review. The second phase, set to report in 2028, will then make longer term recommendations for the transformation of adult social care.The health and social care secretary, Wes Streeting, said, “I have written to opposition parties to invite them to take part in the...

The UK is not a good place to be poor. It is not even a very good place if you are middle income or below. Over the past 14 years, life expectancy has not improved, health inequalities have increased, and reported health has not improved for the poorer half of the population.1 Housing has played an important role in this crisis.A new report from the UCL Institute of Health Equity, Building Health Equity: the Role of the Property Sector in Improving Health, outlines the consequences of housing problems for health equity and details what needs to be done to tackle these.2The report draws attention to three aspects of housing that are important for health: affordability, quality, and supply. Affordability implies some relation between price and ability to pay the price. In the past 15 years income growth in the UK has fallen behind that of other European countries, and income...

Crider and colleagues discuss the availability of personal and private medical records held by the NHS.1 Cybercrime is another area of concern.I recently researched occurrences of cybercrime against medical records.2 It occurs worldwide and is often attached to ransom demands. Intel Security McAfee Laboratories says that cybercriminals are investing more time and resources into exploiting and selling healthcare data.3 On 3 June 2024 the UK firm Synnovis, an NHS pathology testing provider, was hacked, causing massive disruption to multiple London hospitals. The hack disrupted more than 3000 hospital and primary care appointments and operations. Synnovis resisted paying a ransom, and on 24 June 2024, the cybercrime group Qilin shared almost 400 GB of private information on their darknet site. A sample of the data seen by the BBC includes patient names, dates of birth, NHS numbers, and blood test descriptions. It is not known whether test results are also in...

In December 2024, negotiations led by the United Nations to finalise a treaty to end plastic pollution concluded without agreement, pushing discussions into 2025.1 Plastic pollution is now recognised as not only an environmental crisis but also a critical human health crisis. The need for decisive international action to tackle plastic pollution has never been more urgent.The health focus is reflected in the objective of the current treaty draft “to protect human health and the environment from plastic pollution.”2 With the world’s annual plastic production at 400 million tonnes and projected to double by 2040, the scale of plastic pollution is staggering.3 Without intervention on a global scale, this trajectory will worsen.The treaty negotiations have highlighted divisions among countries on critical issues, including the treaty’s scope, limits on plastic production, controls on toxic chemical additives in plastics, and financing for treaty implementation in the regions most affected. These unresolved disagreements...