Seven days in medicine: 5-11 DecemberBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6665 (Published 10 December 2015) Cite this as: BMJ 2015;351:h6665
Screening for early breast cancer may reduce invasive cancer Treating women found to have ductal carcinoma in situ (DCIS) after mammography may prevent subsequent invasive breast cancer, a study of more than five million women in the UK breast screening programme found. For every three women found to have DCIS, invasive interval cancers were one fewer in the next three years, the analysis found. The results showed that a substantial proportion of DCIS would become invasive if untreated, said the lead author, Stephen Duffy. (See The BMJ’s full story at doi:10.1136/bmj.h6576. See also Five minutes with . . . Stephen Duffy at doi:10.1136/bmj.h6637.)
Unacceptable mental healthcare placements Norman Lamb, the former health minister, called it an “outrage” that more than 2000 people a month in England are admitted to hospital for mental illness outside their local mental health trust. A quarter of these are inpatients at least 30 miles from their home area. Lamb told the Observer newspaper, “This would never, ever happen with a physical health problem, such as a stroke or heart failure.”
Fewer GPs think the NHS works well Only 22% of UK general practitioners think that the NHS works well, a substantial drop since 2013 when nearly half thought so, a survey by the Commonwealth Foundation found. Norway had the most doctors (67%) likely to be satisfied with their healthcare system, and the United States had the least (16%). GPs often found it difficult to coordinate care with other providers, and one in three UK GPs expressed dissatisfaction with practising medicine. (Full BMJ story doi:10.1136/bmj.h6639.)
Mental illness link to “later” maternal deaths Maternal deaths in the United Kingdom have continued to fall, but more could be done to prevent suicides during pregnancy or in the first year after birth, the Confidential Enquiry into Maternal Deaths found. Direct deaths, such as those caused by sepsis, eclampsia, thrombosis, or haemorrhage, halved from 132 in 2003-05 to 69 in 2011-13. Over the same period indirect deaths—from causes such as cardiac disease, flu, or pneumonia—fell from 163 to 132. The study also showed 335 “later” deaths, occurring six weeks to a year after birth, a quarter of which were related to mental health problems. (Full BMJ story doi:10.1136/bmj.h6666.)
MPs take evidence on demands in general practice NHS and patient leaders appeared before the UK House of Commons health select committee to give evidence about how to tackle the growing demand for general practice services and improve access for patients, as part of the committee’s inquiry into primary care services. The panel was questioned on a range of issues, including how to successfully implement the government’s policy pledge for seven day access to general practice services.
Combined HRT may reduce risk of endometrial cancer Continuous hormone replacement therapy (HRT) with combined oestrogen plus progestogen significantly reduced the risk of endometrial cancer in postmenopausal women compared with placebo (hazard ratio 0.65), a large randomised US study showed. Reporting in the Journal of the National Cancer Institute the authors said that more research was needed on the substantial reduction in endometrial cancers seen in women with high body mass index, who are at increased risk for this cancer. (Full BMJ story doi:10.1136/bmj.h6627.)
US Senate takes evidence on overcharging for drugs Hearings began at the United States Senate into price spikes for generic drugs, in which the case of Turing Pharmaceuticals is expected to feature. The company bought the rights to the toxoplasmosis drug pyrimethamine (Daraprim) in August for $55m (£37m; €52m) and in September announced a price hike from $13.50 a pill to $750. It recently abandoned its commitment to lowering the drug’s list price and instead reduced the price charged to hospitals, as well as offering more support to patients who lack health insurance or financial resources.
Tobacco companies challenge plain packaging law Claims by four of the world’s biggest tobacco companies that standardised tobacco packaging in England is illegal were due to be heard in the High Court. British American Tobacco, Imperial Tobacco, Philip Morris International, and Japan Tobacco International argue that the consultation on plain packaging was flawed, that it did not include evidence from Australia, and that the law infringes their right to unrestricted use of branding. The hearing is expected to last six days and to reach a verdict in the New Year. MPs voted overwhelmingly to ban branding in March, and the changes are due to take effect in May.
Patient rated quality of care stalls Trusts in England made only a modest improvement in the quality of care over the past nine years as judged by patients, said a new report from the King’s Fund and Picker Institute Europe. The study of patients’ experience of using hospitals from 2005 to 2013 found that scores improved in 14 of 20 questions and fell in six but that these changes were modest. Most improvements, such as ward cleanliness, were driven by national policies. Patients were less happy with the length of time they had to wait for a bed after admission and with timely discharge in 2013 than in 2005.
Cite this as: BMJ 2015;351:h6665