Seven days in medicine: 17-23 May 2017
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2508 (Published 25 May 2017) Cite this as: BMJ 2017;357:j2508
NHS deficits
Trusts overspend by £770m despite bailout
NHS trusts are set to record a combined deficit of £770m (€893m; $1bn) in 2016-17, an analysis by the Health Service Journal showed.1 This is substantially less than the record £2.45bn overspend incurred in 2015-16 but £190m more than the maximum £580m target set by NHS Improvement. NHS leaders acknowledged that the £770m figure would have been higher without £1.8bn of bailout funding in 2016-17. NHS Improvement was blocked from publishing the official year end figures earlier this month under election purdah rules.
Drug prices
Aspen faces probe over hiking generic prices
The European Commission launched an investigation into increased prices on cancer drugs imposed by Aspen, a South African company, which acquired five drugs from GlaxoSmithKline in 2009 in a deal worth $2.2bn (then about £1.4bn) in cash and shares. Aspen increased the UK price of busulfan, a leukaemia drug, from £5.20 (currently €6.03; $6.75) to £69.02 a pack, and chlorambucil, also used in leukaemia treatments, increased from £8.36 to £42.87. Margrethe Vestager, the EU’s competition commissioner, said that people depended on the drugs “to save or prolong our lives.” (Full story doi:10.1136/bmj.j2417)
Tobacco control
Plain packaging arrives in UK
Standardised cigarette packaging with large graphic warnings came into effect in the UK at the weekend. All packs must contain 20 cigarettes to be big enough to display the health warnings. The EU Tobacco Products Directive extends to e-cigarettes, which are limited in strength and size. Health warnings on the front and back of e-cigarette packaging read: “This product contains nicotine which is a highly addictive substance.”
Smoking and vaping are restricted in Philippines
Smoking or vaping by adults in the Philippines will be restricted to designated areas of 10 m2 located at least 10 m from entrances or exits of buildings, under an executive order signed by President Rodrigo Duterte. All indoor smoking will be banned, and anyone flouting the rules will face four months in jail and a fine of 5000 pesos (£77; €89; $100). About a third of the adult population smoke—some 17 million people.
Health ranking
UK is 30th, behind many European countries
The UK was ranked 30th of 167 countries in terms of healthcare quality and access in 2015, with a score of 84.5/100 in the Global Burden of Disease study published in the Lancet. The score is based on death rates from 32 diseases that effective medical care could have avoided. Andorra maintained its top ranking from 1990 with a score of 94.6, followed by Iceland (93.6), Switzerland (91.8), Sweden (90.5), and Norway (90.5). Martin McKee, study coauthor, from the London School of Hygiene and Tropical Medicine, said that the UK lagged behind other European countries in outcomes of some cancers—“a problem that has many causes but is often attributed to low levels of investment in specialist care.”
World Medical Association
BMA’s request to suspend president is rejected
A request by the BMA that the president of the World Medical Association, Ketan Desai, who took up the two year post in October 2016, should be suspended pending a resolution of corruption charges by a court in Delhi, India, was rejected. Despite the rejected proposal the BMA said that a “proposition has been put forward to do background checking and assess ‘appropriateness’ on future candidates for presidency, chair, deputy chair, and treasurer, but Desai remains in post.” (Full story doi:10.1136/bmj.j2446)
Research news
Thrombocytosis may link to cancer risk
A cancer diagnosis should be considered in patients with thrombocytosis, researchers suggested, after they found that 11.6% of men and 6.2% of women with the condition developed cancer in the next 12 months. If a second raised platelet count was recorded within six months the positive predictive value for thrombocytosis rose to 18.1% in men and 10.1% in women. If only “5% of patients with cancer have thrombocytosis before diagnosis, one third of them have the potential to have their diagnosis expedited by at least 3 months; this equates to 5500 earlier diagnoses annually,” the authors wrote in the British Journal of General Practice. (Full story doi:10.1136/bmj.j2481)
Tailored emails improve smoking cessation
Abstinence from smoking was considerably higher in smokers who received multiple tailored emails (34%) than in those sent just one email (25.8%), a study published in Tobacco Control found. J Lee Westmaas, lead author, said, “It appears that personalisation in the emails and their frequency—initially every day and then tapering off—gave people the assurance that someone cared about them, and wanted them to succeed. They were receiving daily or nearly daily guidance about how to deal with issues that came up in their quit attempt, made possible by a relatively simple computer tailoring algorithm.” (Full story doi:10.1136/bmj.j2459)
Antibiotics
Delayed prescriptions did not harm patients
Offering a delayed rather than an immediate prescription for antibiotics to adults with lower respiratory tract infections was associated with a lower likelihood of a subsequent GP consultation and no increased risk of admission or death, a study published in The BMJ showed. Repeat consultation for new, worsening, or non-resolving symptoms was common, occurring in 19.7% of patients who received no antibiotics, 25.3% who had immediate antibiotics, and 14.1% with a delayed prescription. (Full story doi:10.1136/bmj.j2496)
Surgery
Private sector “needs same safety rigour as NHS”
The Royal College of Surgeons called for a review of safety standards in the private sector after the conviction of Ian Paterson, who was found guilty last month of 20 counts of unlawful wounding after carrying out unnecessary operations. The private sector should be expected to report the same kinds of patient safety data as the NHS, the college said, including unexpected deaths, “never” events, and serious injuries, to reassure the public that rogue surgeons will be identified. It should play a better role in clinical audits, the college added, and this should be a condition of all NHS and private organisations’ registration with the healthcare regulator, the Care Quality Commission. (Full story doi:10.1136/bmj.j2402)
Ebola
WHO is ready to deploy vaccine in outbreak
For the first time during a live outbreak of Ebola a vaccine could be used to stop the disease spreading. As of 17 May, 20 cases of Ebola had been recorded in the Democratic Republic of Congo, including three deaths. Peter Salama of the World Health Organization said on 18 May that WHO had been talking to the country’s government about deploying the vaccine, which proved effective in a 2015 trial in Guinea but is not yet licensed. He said that the vaccine must be kept at –80°C, posing an “enormous challenge” in an area with poor road access and no large scale electrification. (Full story doi:10.1136/bmj.j2454)