BMJ - British Medical Journal

bmj;388/feb28_1/r405/FAF1faAndrew studied medicine at Clare College, Cambridge, and St Thomas’ Hospital, London. After house jobs he did national service in Malta and then moved to Edenbridge, Kent, in 1957. Here he worked as a GP and trained as an anaesthetist at Queen Victoria Hospital.The three general practices in Edenbridge merged and Andrew enjoyed a long period in a stable and harmonious practice, while giving 25 years of service as an anaesthetist at Edenbridge War Memorial Hospital. He was awarded an MBE for services to the community, which continued long after retirement.As well as epitomising the era of personal care in general practice, he was an early GP trainer. A particular delight was his leadership of the longstanding Edenbridge Clinical Society, which met at 9 pm on Friday evenings, a tradition started at its inception to allow neighbouring doctors time to finish their evening surgeries before travelling.Outside work Andrew was happiest...

Last summer an estimated 29 Islamophobic and xenophobic riots occurred in towns and cities in the UK.1 Several of these targeted mosques and hotels housing asylum seekers and were attended by far right activist groups.2 Healthcare workers were also targeted by threatening posts on social media, verbal abuse, and intimidation from patients and the public.The violence followed false news about the perpetrator of a July 2024 knife attack on a dance class in Southport, in which three girls died. Posts on social media claimed that the man, who was later jailed for 52 years for the murders, had recently arrived in the UK by boat and was a Muslim, when in fact he was born in Cardiff to Christian parents.One of the first reported incidents involving healthcare workers was an attack in Sunderland on two Filipino nurses, who were making their way to work in a taxi when it was...

The government’s efforts to tackle antimicrobial resistance (AMR) have had limited impact, the National Audit Office (NAO) has warned. Despite taking the threat seriously, resistant infections have risen and the UK remains “a long way” from tackling the problem, the parliamentary watchdog found.1Only one of five targets set in 2019—cutting the use of antibiotics in food producing animals—has been met, the NAO investigation found. Another goal to reduce the number of drug resistant infections in humans in England by 10% between 2018 and 2025 has been missed with rates instead increasing by 13% since 2018. In 2018 there were 59 064 drug resistant infections and this rose to 66 824 by 2023.Use of antibiotics in humans has fallen slightly in England but the target to reduce doses by 15% by 2024 was missed. It was proving hard to change the behaviour of both people and institutions to meet other goals...

I work inside the US federal research system and The BMJ allowed me to publish an anonymous account of how science and certain populations are under attack from our own government.1 Last week continued to be bad. We were overwhelmed with distractions and threats to productivity.First, our residents, fellows, interns, and post-docs were fired for being new government employees on their probationary period. The preparation to sit with them was heartbreaking. We had to discuss the details of how to prepare to be fired at a random time and consider what would happen to them. In addition to being unemployed, they will lose their health insurance that is linked to their employment. This fills them with fear. Someone I know is on an expensive medication for a chronic condition, and without insurance cannot get the medication.These fired colleagues have been betrayed. They came to us to learn, and they trust...

It’s hard to ignore Donald Trump and the deep harm he’s inflicting on health, both in the US and worldwide (doi:10.1136/bmj.r370 doi:10.1136/bmj.r357 doi:10.1136/bmj.r356 doi:10.1136/bmj.r279 doi:10.1136/bmj.r395 doi:10.1136/bmj.r288 doi:10.1136/bmj.r289).1234567 The assault is so multipronged that it’s mindboggling to fully identify, gauge, and respond to it. The US’s power and reach are such that science, medicine, and health are in unprecedented jeopardy. What we hear less of is that Trump has already earned negative opinion poll ratings in the US for his performance and for his much publicised policies.8 Yet, in its rush to meet Trump’s agenda, the UK government is damaging health too.We know that the impact of policies that harm science and medicine extends beyond national borders and spreads quickly around the world. Trump cares for none of this in his manic pursuit of striking deals and cutting costs. One of his first acts in his second presidential term was to...

Health authorities have yet to identify the cause of outbreaks of a disease in the Democratic Republic of Congo that the World Health Organization has called “a significant public health threat.”Last week WHO reported 53 deaths and 431 cases.1 Its latest update, published 27 February, noted 60 deaths and 1096 cases from the three villages involved.2The outbreak began in Boloko village, Équateur province, in the country’s north west. Three children, who reportedly had eaten a bat they found dead, fell sick and died between 10 and 13 January. Four more children, aged 5 to 18, died over the following two weeks.The disease also appeared in the neighbouring village of Danda. There have been 10 cases and seven deaths in Boloko, and two cases with one death in Danda.Nearly two weeks after the Boloko outbreak the disease appeared in the village of Bomate, also in Équateur province but 190 km away....

Aid organisations have expressed horror at the UK government’s decision to slash spending on overseas development in order to fund an increase in the defence budget.On 25 February UK prime minister Keir Starmer announced that defence spending would increase to 2.5% of gross national income (GNI) by 2027, compared with 2.3% currently. To pay for this, spending on overseas aid will drop from 0.5% of GNI to 0.3%—a cut of about £6bn. In 2023 the UK aid budget stood at £15.3bn.Speaking in the House of Commons, Starmer said he was not happy to be making the announcement “but the realities of our dangerous new era mean that the defence and national security of our country must come first.”He added, “I am proud of Britain’s pioneering record on overseas development and we will continue to play a key humanitarian role in war torn countries like Sudan, Ukraine, and Gaza; in tackling...

AbstractThe covid-19 pandemic saw frequent changes and conflicts in mask policies and politicization of masks. On reviewing the evidence, including studies published after the pandemic, the data suggest respirators are more effective than masks in healthcare, but must be continuously worn to be protective. Healthcare and aged care settings amplify outbreaks, so protection of patients and staff is paramount. Most guidelines assume risk is only present during close contact or aerosol generating procedures, but studies show intermittent use of respirators is not protective. New research in aerosol science confirms the risk of infection is widespread in health facilities. In community settings, any mask use is protective during epidemics, especially if used early, when combined with hand hygiene, and if wearers are compliant. Community use of N95 respirators is more protective than surgical masks, which are more protective than cloth masks, but even cloth masks provide some protection. Mask guidelines should be adaptable to the specific context and should account for rising epidemic activity, and whether a pathogen has asymptomatic transmission. The main rationale for universal masking during pandemics is asymptomatic transmission, which means risk of transmission cannot be self-identified. The precautionary principle should be applied during serious emerging infections or pandemics when transmission mode is not fully understood, or vaccines and drugs are not available. If respirators are not available, medical or cloth masks could be used as a last resort. Data exist to support extended use and reuse of masks and respirators during short supply. In summary, extensive evidence generated during the covid-19 pandemic confirms the superiority of respirators and supports the use of masks and respirators in the community during periods of high epidemic activity. Some gaps in research remain, including economic analyses, research in special population groups for whom masking is challenging, and research on countering disinformation.

A conflict arises when healthcare institutions’ public commitment to equity collides with their internal practices. Although research teams routinely compensate their academic members and clinicians for research work, a puzzling contradiction exists: patient partners in research (that is, not research participants), whose lived experience has become increasingly central to meaningful research, face a labyrinth of institutional barriers to fair payment—if payment is offered at all.1The current system automatically values academic expertise, while lived expertise is diminished. The rationales offered by institutions to explain unfair compensation for patient partners reveal a deeper story about power imbalances, devaluing patient experience, and institutional dynamics in modern healthcare research.2 The barriers cited by institutions include concerns about benefits, administrative complexities, and payment thresholds, which represent organisational inertia rather than genuine limitations. When institutions argue that they can’t pay patient partners because those partners might lose disability benefits, institutions make unilateral decisions that strip patient...

Health misinformation and harmful online narratives are a major threat to public health and security. Driving low confidence in vaccines and medicines, denial of pandemic risk, or use of unproven health treatments, inaccurate information can create confusion, sow mistrust, harm health, and undermine public health efforts. In 2020, the wave of accurate and inaccurate information on covid-19 was declared an infodemic by the World Health Organization (WHO).12 Additionally, misinformation and disinformation was recently named as one of the greatest threats to global security at the World Economic Forum.3 Our current approach to health misinformation is limited and we need to progress our understanding of the information ecosystems4 and drivers of online health narratives.The challenges of health misinformation go beyond countering false claims. People increasingly go online to answer questions and explore concerns they may have about their health, treatments, or healthcare. Digital access, commercial internet platforms, and artificial intelligence are...

Launer recalls a patient vignette in a government pamphlet about a patient called Sarah with sinus pain and hearing loss who is referred by a nurse practitioner for a CT scan. She uses the NHS app to arrange the scan in her local shopping centre and later to check reviews to find the best local consultant, who arranges multiple further investigations and leaves her happy with her care.1 As Launer points out, Sarah’s story is completely ludicrous to anyone with a modicum of knowledge about medical matters. It is consistent with Keir Starmer’s suggestions that people with internal bleeding should not consult a general practitioner2 and that an “AI enhanced stethoscope” could save a patient’s life “in an instant.”3 Industry lobbyists seem to have access to the Labour front bench4; do experts in healthcare have the same privilege?Of course, Sarah’s story is entirely in keeping with a future healthcare system...

What is Bluesky?In a nutshell, it’s a social network that tries to recreate the “good old days” of Twitter before it was bought by billionaire Elon Musk and became X (Bluesky actually began as a research project at Twitter in 2019 but became an independent company in 2021).To the user, it works, looks, and feels like Twitter as it used to be, with short posts published to a timeline and displayed chronologically, rather than arranged by an algorithm to show the most popular posts. Users can follow other users—and topics—that align with their interests.Each post has a character limit of 300 (compared with the default 280 characters on X). Pictures, videos, gifs, and links can be included, and hashtags can be used to mark topics. Users can also set up and follow “topic groups,” which are similar to “lists” or hashtags that could be followed on X/Twitter. #MedSky has been...

bmj;388/feb27_1/r400/FAF1faGeoff was born in Manchester and after attending Manchester Grammar School went to Manchester Medical School. He completed house jobs at Manchester Royal Infirmary and Crumpsall Hospital, before choosing a career in anaesthesia.During his training his major interest was cardiothoracic anaesthesia, but at the time there was a shortage of consultant posts and this led him to the new specialty of intensive care medicine.In 1975 he took up a consultant position at the Royal Shrewsbury Hospital, his brief being to set up and direct a new intensive care unit. He dedicated all his hours to the management of the unit, his omnipresence leading him to be affectionately referred to as “God” by the intensive care staff.Outside medicine Geoff had a strong interest in other means of supporting health. He was an early adopter of vegetarianism, practised tai chi and the Alexander technique, and, after a trip to China, he trained...

A London hospital is to investigate why over half of its patients with multiple sclerosis (MS) who switched from disease modifying therapy Tysabri (natalizumab) to biosimilar Tyruko have had to be switched back because of “significant and continuing side effects.”Imperial College Healthcare NHS Trust said it was asked by NHS England in January 2024 “to be the first service in London to switch to Tyruko” and after a period of “preparation and planning” it started switching patients in May 2024. It noticed, however, that patients were reporting side effects “over and above the relatively mild, short term side effects we expected to see.” Following a clinical review the trust returned just over half of the patients to Tysabri.“We have raised our experience and concerns with NHS England and the Medicines and Healthcare Products Regulatory Agency (MHRA), and at a local level we are continuing to work closely with our patient...

The Isle of Man is set to become the first place in the British Isles to legalise assisted dying, after a bill to allow terminally ill residents to end their life passed its final hurdle in the island’s lower elected house.Members of the island’s House of Keys voted in favour of final amendments to the bill in line with recommendations from its proposer, Alex Allinson, a GP and member of the house. It is now expected to pass, subject to final approval in the Isle of Man’s Legislative Council.The bill proposes to introduce the choice of assisted dying to residents who are mentally competent and have less than 12 months to live. Its proponents hope that the service will be available from 2027, after royal assent and an implementation period.The option of an assisted death will be limited to self-administration and will not involve a doctor ending a person’s life....

NHS England’s chief executive, Amanda Pritchard, has announced that she is to step down at the end of next month after three and a half years in the post.The surprise announcement on 25 February followed recent strong criticism by two high profile parliamentary committees that questioned the ability and “dynamism” of NHS leaders to implement the changes to the health service desired by the government.Pritchard, who has also been chief operating officer at NHS England since 2019 and previously served as chief executive of Guy’s and St Thomas’ NHS Foundation Trust in London, said she believed that now was the time for her to leave, with the NHS continuing to make progress in its recovery from the covid-19 pandemic.“It has been an enormous privilege to lead the NHS in England through what has undoubtedly been the most difficult period in its history,” said Pritchard, the first woman to hold the...

The doctor who took over as medical director of the NHS trust that employed Lucy Letby has told a public inquiry that her predecessor told her she should report the paediatricians who raised concerns that the nurse might be killing babies to the General Medical Council, as he hadn’t done.Susan Gilby, who soon after became acting chief executive of the Countess of Chester Hospital NHS Foundation Trust and took on the substantive role in August 2018, told appeal court judge Kathryn Thirlwall’s inquiry into the circumstances surrounding Letby’s activities that the outgoing medical director, Ian Harvey, told her as they were leaving their handover meeting, “You need to refer those paediatricians to the GMC.”Harvey had earlier denied in evidence to the inquiry that he had made the comment. But Gilby said that, when asked why he had not referred the paediatricians to the regulator himself, “He jokingly said, ‘I don’t...

Two people in the US have been admitted to hospital with H5N1 avian flu, adding to concerns over the growing number of infections in cattle, poultry, wildlife, and humans worldwide.As of 24 February, a woman in Wyoming remains in hospital while a man in Ohio has been discharged. Both patients had severe “respiratory and non-respiratory symptoms,” the CDC said in its weekly flu report.1“This shows that H5N1 can be very severe, and we should not assume that it will always be mild,” Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organisation at the University of Saskatchewan, told the Guardian.2The hospital admissions bring the total number of patients with severe cases of H5N1 in the US to four since the first was reported in December 2024. The first death was recorded in Louisiana in February this year.3Concerns about avian flu have been growing since early 2022, when a surge...

The World Health Organization has warned that urgent action is needed to reduce the number of children dying from preventable causes in its European region.In its latest report summarising health trends in the region,1 which covers 53 countries across Europe and Asia, WHO said that protecting the health of children required specific attention, with 75 647 children dying before their 5th birthday in 2022.The report, which is produced every three years, highlights the need to improve population health and access to essential healthcare services to improve outcomes. “Too many infants still die unnecessarily before the age of 5 years,” it says. “Closing the gap between the member states with the highest and lowest mortality rates remains a challenge, especially since some have recorded relatively higher rates over the past 5 years.”Across the region, neonatal mortality ranges between 0.7 and 23 deaths per 1000 live births, and under 5 mortality ranges...

Data submitted to the UK drugs regulator show a total of 82 deaths related to glucagon-like peptide-1 receptor agonists, the class of drugs used for weight loss and type 2 diabetes.Data from the yellow card scheme for reporting adverse events to the Medicines and Healthcare Products Regulatory Agency (MHRA) show that up to 31 January 2025 there were 22 deaths from adverse reactions associated with use of GLP-1 agonists for weight loss and 60 linked to use for treating type 2 diabetes.Commenting on the figures, Alison Cave, MHRA chief safety officer, said, “The decision to start, continue, or stop treatments should be made jointly by patients and their doctor, based on full consideration of benefits and risks.”The data show 18 deaths linked to tirzepatide (Mounjaro), of which 10 were linked to its use relating to weight loss and eight to its indication for type 2 diabetes. A total of 29...