Seven days in medicine: 16-22 November 2016

BMJ 2016; 355 doi: (Published 24 November 2016) Cite this as: BMJ 2016;355:i6291

Footprint areas

Map shows plans for England’s NHS services

All sustainability and transformation plans (STPs) for cutting costs in 44 “footprint” areas in England will be published by Christmas and implementation will begin in the New Year, NHS England said. Health activists and local councillors have widely criticised the plans, concerned that hospital services will be cut to deliver the £22bn (€25.9bn; $27.3bn) in savings by 2020-21 demanded by health chiefs. An interactive map with a summary of the planned changes is at


Scotland may offer procedures to Northern Irish women

Nicola Sturgeon, Scotland’s first minister, told the country’s parliament that the Scottish government would consider giving women from Northern Ireland access to terminations in Scotland’s health service free of charge. The Supreme Court is considering an application from a Northern Irish teenager challenging the refusal by the NHS in England to fund the procedure for women from Northern Ireland. Sturgeon said, “When a woman opts to have an abortion—I stress that that is never, ever an easy decision for any woman—the procedure should be available in a safe and legal way.”

Flu vaccine

High vaccine uptake by healthcare workers

Some 372 339 (40.4%) front line health workers in England had been vaccinated against influenza by 31 October 2016, NHS England figures showed—higher than at the same stage during previous winters, including 312 203 (32.4%) last winter. NHS Employers hopes that the final end-of-winter tally will exceed last year’s 502 033 (50.6%).

Public health

Minimal effects of school sex education

Little evidence shows that school sex and reproductive health classes affect the number of young people infected with HIV in adolescence, the number infected with other STIs, or the number of adolescent pregnancies, a Cochrane review concluded. Giving monthly cash or free school uniforms to encourage students to stay in school also had little effect on infection rates, although better school attendance may reduce adolescent pregnancies, said the researchers.

Foreign patients

ID may be needed to access NHS care

The Department of Health is examining whether patients should show identification to get some elements of NHS care, an idea already being tested at some hospitals. Chris Wormald, permanent secretary at the department, told a Public Accounts Committee hearing that the NHS has a “lot further to go” in reclaiming money from foreign visitors. National Audit Office figures from 2014-15 show that £674m (€794m; $839m) was charged to the UK government for care of British citizens abroad but that just £49m was charged to foreign governments for care of European Economic Area nationals.

Final appeal against minimum alcohol price in Scotland

The Scotch Whisky Association announced that it will make a final legal challenge to Scotland’s introduction of a minimum price on a unit of alcohol. It will appeal to the UK Supreme Court, since the Scottish Court of Session last month rejected its claim that minimum pricing was incompatible with EU law. Scotland’s health secretary, Shona Robison, said that minimum pricing had the overwhelming support of the Scottish parliament, had been tested in Europe, and had been approved twice in the Scottish courts. (doi:10.1136/bmj.i6202)


E-cigarettes raise teens’ risk of cough and wheeze

Teenagers who use electronic cigarettes have twice the risk of respiratory symptoms such as persistent cough, bronchitis, and wheeze, a study in the American Journal of Respiratory and Critical Care Medicine found. The results were based on a survey of 2086 teenagers aged 16-18 about their use of e-cigarettes and chronic cough, phlegm, bronchitis, and wheeze in the previous 12 months. (doi:10.1136/bmj.i6203)

Research news

Steroid eardrum injection cuts dizziness in Meniere’s disease

Injections of the steroid methylprednisolone through the eardrum are as effective as the current standard treatment of gentamicin in reducing dizziness in patients with Meniere’s disease but without the associated risk of hearing loss, showed a double blind trial of 60 patients reported in the Lancet. Patients treated with methylprednisolone showed a 90% reduction in the mean number of attacks from 16.4 to 1.6, and those treated with gentamicin showed an 87% reduction in attacks from 19.9 to 2.5. (doi:10.1136/bmj.i6185)

Thiazide diuretic may protect against fracture

The thiazide diuretic chlorthalidone was associated with a 21% lower risk of hip and pelvic fracture than amlodipine or lisinopril, a randomised trial with over 22 000 participants found. The authors concluded, “The present results of short term and long term fracture protection with thiazide antihypertensive therapy compared with other antihypertensive drugs strongly recommends use of a thiazide for hypertension treatment in addition to its long track record of cardiovascular protection.” (doi:10.1136/bmj.i6263)

Cancer drugs

Discount allows NICE to approve breast cancer drug

The National Institute for Health and Care Excellence (NICE) approved pertuzumab for NHS patients with breast cancer after agreeing a discounted price with the manufacturer Roche, having previously rejected the drug. Draft guidance recommends pertuzumab in combination with trastuzumab and docetaxel to shrink HER2 positive locally advanced tumours before surgery. NICE noted evidence that adding pertuzumab to neoadjuvant treatment helped get rid of breast cancer in the breast and lymph nodes, but it was uncertain whether this cut the risk of cancer returning or improved long term survival. It also recently approved eribulin (by Eisai) and everolimus (Novartis) for breast cancer after agreeing discounts with manufacturers.

NICE approves three quarters of cancer fund drugs

Seven of nine treatments that NICE has looked at in the Cancer Drugs Fund have been approved, and the rest are being reappraised. Andrew Dillon, NICE chief executive, said, “Sensible pricing, and in some cases better data, is helping to secure access to important cancer medicines as they move out of the old Cancer Drugs Fund. As reappraised drugs now move to routine commissioning, funding in the CDF can be freed up and used for newer, innovative cancer treatments. This is good news all round for patients.”


Brexit could prompt science “brain drain”

The government must prevent a “brain drain” of scientists from the United Kingdom by exempting them from any tightening of immigration rules, MPs urged. Evidence submitted to the House of Commons Science and Technology Committee’s inquiry into the effect on science and research of the UK’s decision to leave the European Union said that many researchers were “seriously considering” leaving the UK. Ottoline Leyser, of the Royal Society, said that the 31 000 scientists and researchers from the rest of the EU working in the UK were “feeling very anxious and alone.” (doi:10.1136/bmj.i6193)

Scientific research gets £2bn a year boost

The UK government will invest £2bn (€2.36bn; $2.49bn) a year by 2020 In research and development, the prime minister told business leaders on Monday in her first speech to the Confederation of British Industry’s annual conference. Theresa May also announced a review of current research and development tax incentives to ensure the United Kingdom’s global competitiveness as a home for scientists, innovators, and tech investors, as well as a new Industrial Strategy Challenge Fund to back technologies such as robotics and biotechnology.

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