BMJ Summary – 6/1/18

And we’re back! Here at medicine.co.uk we wish you all a happy new year, despite the champagne and fireworks being inevitably accompanied by newspaper headlines regarding the NHS winter crisis. One of my personal New Year’s Resolutions is to have a less bleak outlook, so no more bellyaching about the state of our health system, Brexit or the fact that my Christmas Toblerone seems to have shrunk yet further. No, I’m just going to coolly, calmly tell you about what is in the BMJ. On that note… Here’s corruption and undeclared deals between CCGs and Big Pharma!

The BMJ does Spotlight… I can picture it so clearly. With sweaty brows, chewed pencils and rolled shirtsleeves (we’re in the realms of healthcare here, bare below the elbows must extend as far as the BMJ offices) intrepid journalists at the BMJ, as well as big cheeses like lecturer, Piotr Ozieranski, at the University of Bath and sociologist, Shai Mullinari, at Lund University in Sweden, have been doing some serious investigative work. Cross-referencing between online declarations of payments to Care Commissioning Groups and Freedom of Information accounts of the actual assets received by the CCGs from external parties, Ozieranski et al., have discovered quite a mismatch in some areas. They found as many as a third of payments, were undeclared by various CCGs in public registers. Oops.

As with any potential John Grisham bestseller, big, ole Pharma was often caught up in the dodge. Drug companies were often found to sponsor teaching and education events, as well as projects, some of which had an associated Pharma-flavour to them. For instance, undisclosed funding by AF-drug manufactures Bayer, Boehringer Ingelheim and Pfizer, paid for an AF-related service in the NHS Southwark CCG.

While potential corruption is always a sad thing, I commend the BMJ’s creativity in using the revelatory piece to sneak a picture of Beyonce into the issue. Apparently NHS Sunderland CCG received tickets to a Beyonce concert in 2016, and of course, that necessitates a picture of the superstar. Nice to see the BMJ doesn’t need to rely on tabloid tricks to get people to read their articles. I didn’t fall for that one at all…

Sugar. Public Enemy No. 1:  As if we needed any more shaming for our Christmas excesses, the BMJ has chosen this particular week to publish an article stating that sugar might be even more culpable in causing diabetes. The standard thinking is that excess sugar is excess calories and that is the main culprit in provoking the metabolic changes of Type 2 Diabetes. However, this article suggests that sugar might have a direct effect in promoting diabetes by inducing toxic fatty changes in the liver. Growing evidence from animal models supports this. Beginning to feel slightly better about my shrinking Toblerone now.

Tying in with this, NHS England is considering enforcing a ban on the sale of sugary foods and drinks in hospitals. But what will night shift staff survive on?!

Lung cancer screening – the US leads the way

Despite the best efforts of the current US Presidential Administration to take US healthcare back a step, medical research efforts continue. The US National Lung Screening trial has published evidence showing that annual low-dose CT screening for high risk lung cancer individuals (smokers etc) over a three year period, reduces lung cancer mortality by 20%. There are problems, such as a high false positive rate, but this can be reduced by rescanning and better predictive modelling of suitable candidates.

Best of the Rest:

The case of the itchy rash… The Lancet Journal of Public Health states that despite 17000 fewer cases of shingles between 2013 and 2016, and less consultations over post-herpetic neuralgia, figures show less uptake of the shingles vaccination in the target group of 70 -79 year olds.

GPs do Black Mirror: Ok, I exaggerate. There are no dystopias in this article, other than the one we seem to be living in, but GPs are now offering a telehealth consultation service, where patients can have video-link appointments with their GP from their phone. The Hammersmith GP practice associated with Babylon, a digital health company that ran an impressive advertising regime on London transport, has seen a 7,000 person rise in its patient list. The catch in the system being that patients need to delist from any other GP practice to join the virtual surgery. This raises the question – what happens if 7,000 new virtual patients need to physically see a GP at some point?

Priorities and Human Rights: The Royal College of Anaesthetists is not the first organisation I necessarily think of when I think of defence of human rights, but this week’s BMJ showed me. The RCA are calling on NHS Trusts to provide food and rooms for their trainees whilst on shift. Whilst this adherence to the Universal Declaration of Human Rights is commendable, it remains to be seen how they address the main outcome of the annual survey of their trainees. 2/3s of the 3,977 polled said their health had been affected by the intense College exams. So although the RCA will fight for your right to a bed on a night shift, as an anaesthetic trainee you’re unlikely to be getting any sleep with all the crippling revision.

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