BMJ – 13/5/17

We’re feeling ripples from the tumultuous outside world in this week’s BMJ. From the rare/raw steak on its cover, which must surely be a homage to the recent French elections, to the preponderance of “NHS-and-the-Election” articles, it’s nice to see the BMJ being topical. However, one can’t help but feel a touch of gloom when reading this week’s edition, seeing as the outside world seems a little bleak at the moment. Or it could just be the p251 picture of Jeremy Hunt looking particularly Lemony Snicketty that brings the tone down…

Cover Story – The steaks are high: To leave you in no doubt, the BMJ has four different headlines emphasising the findings that red meat is hazardous to health. Not only is it the cover story but it is also the focus of the Editor’s Choice, the Research and Commentary pages, as well as being the subject of one more article for good measure. The BMJ really doesn’t want you to eat that cottage pie.

A major NIH-AARP study (a US National Cancer Institute research project) involving 536,969 people (which impressively works out to more than 7.5 million patient years), shows that red meat intake leads to higher all-cause mortality when compared to those eating white meat. There was a particular association between nitrate consumption in red meat and mortality.

BMJ authors then go on to list all sorts of reasons why one shouldn’t eat meat and paint a justified apocalyptic vision of a world being taken over and destroyed by the meat industry. Forget this year’s “American Carnage,” inauguration speech, the BMJ is trying to trump Trump with its rhetoric. This includes the ending paragraph of article 4 of 4:

“We need to decide whether to act now to reduce human meat consumption or wait until the decay of sufficient parts of the global system tip us into the much poorer planetary, societal and human health.”

Yeesh.

A quick round up of the science:

– Quinine is out. Long term quinine used for cramps or restless legs seems to be associated with higher mortality (in JAMA, n=44,699)

– DASH diet is in. No, DASH is not the latest food regime from the Kardashians, rather it stands for the Dietary Approaches to Stop Hypertension (DASH). Men who had a DASH-rich diet (i.e. those who ate lots of “fruit, veg, legumes and nuts”) were less likely to develop gout than those on the Western diet (“red and processed meats, French Fries, refined grains, sweets and desserts”).

– Fasting doesn’t necessarily make you lose weight faster. In a year-long study those who fasted on alternate days in an effort to lose weight, had the same weight loss as those who followed a general calorie restricted diet (JAMA Intern Med, n=100).

Forerunner of the Cyber Attack: This edition of the BMJ came out the day before the cyber-attack laid much of the NHS low but despite this, it has an eerily prescient article. Krishna Chinthapalli details a cyber-attack on the Hollywood Presbyterian Medical Centre in February 2016 and unsurprisingly advocates for better “digital health” in the NHS. Unfortunately it came a little too late for the crippling attack last week but it tells a salient lesson nonetheless. Expect more in next week’s edition.

The State of the NHS:

In the run-up to the June election the BMJ is getting in on the act with a number of articles. Here’s a quick summary:

The Fairytale of General Practice: Despite a distinct lack of evidence to support demand for it, the Conservatives have been pledging 7 day access to GP services by 2020. The fly in the ointment is that there are a lack of resources to deliver this. With full time GP numbers dropping like said flies, such an aspiration seem unrealistic. This seems to be a common occurrence with our Government – idealistic projections but with no workforce planning to back it up. Running with the BMJ’s bovine theme of the week, it’s all hat, no cattle.

The results are in for the NHS Staff Survey: The results of the 2016 NHS Staff Survey paint an interesting, colourful picture (there are lots of multi-coloured graphs in the article). 423,000 staff (out of the 982,000 petitioned) replied and the results show some variation depending on region and Trust. With a focus on consultants the BMJ lists that 92% work more than their allocated hours, with mental health specialists having a particularly hard time of things, being exposed to more violent incidents than other consultants. On a happier note though, 95% of consultants feel they have a positive impact in their patients’ lives.

Understaffing is the new status quo: Tucked in a small paragraph, we see a shocking statistic from a survey by the Society for Acute Medicine. 94% of survey respondents says that their units regularly face understaffing issues. The number interviewed isn’t listed, however, with 91% respondents reporting locum trainees being used to fill rota gaps, this is just another indicator of the staffing crisis in acute medicine.

“Sexing up” Gen Med: Jane Dacre, President of the Royal College of Physicians, is calling for more standing to be given for General Medicine. In this era of super-specialisation she is calling for a higher profile for the geriatrician and general medic, as well as fewer rota gaps, better collaborative working and more funding. Yep, pretty much what every doctor has wanted for the last few years. 

Oh Jeremy!: He’s at it again. With his dubious talent for fluffing the numbers, Jeremy’s been on the Andrew Marr show misquoting this and that. It’s probably not worth trying to make sense of his words, we should stick to the truth instead. Over the last year 100,000 more patients are waiting to see a specialist within 18 months and after taking inflation into account, there has been a 1.1% fall in healthcare spending since 2011.

Chuckle of the week: The resemblance between Count Olaf, the dastardly uncle from Lemony Snicket’s Series of Unfortunate Events, and Jeremy Hunt is striking, but there is no doubt which is one is the greater villain…

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