Seven days in medicine: 23-29 June 2021BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1650 (Published 01 July 2021) Cite this as: BMJ 2021;374:n1650
Trial assesses ivermectin for non-hospital treatment
The broad spectrum antiparasitic drug ivermectin is being investigated as part of the Principle trial, which will evaluate whether it can help speed up recovery, reduce symptom severity, or prevent hospital admission in people at risk of serious covid-19 illness. Stephen Griffin, associate professor at the University of Leeds, UK. said that there was some evidence to support the use of ivermectin for covid-19 but no randomised controlled trials (RCTs), while other small studies showed no benefit. “A well conducted RCT would be welcome to resolve ongoing controversy, although one must question whether such resource is justified by available supporting data,” he said.
Vaccinated people should still wear face masks—WHO
People who have been vaccinated against covid-19 should continue to wear face coverings, the World Health Organization said on 25 June. It said that this was particularly important in protecting against the delta variant, which was now the dominant strain in the UK. “Vaccine alone won’t stop community transmission,” said Mariangela Simao, WHO’s assistant director general for access to medicines and health products. “People need to continue to use masks consistently, be in ventilated spaces, [ensure] hand hygiene, physical distance, and avoid crowding.”
Junk food ads will be banned from 2023
Advertisements for unhealthy food and drink will be banned before the 9 pm watershed by the end of 2022 in television and on-demand programmes, the UK government announced after a public consultation. However, Chris Thomas, research fellow at the Institute for Public Policy Research think tank, said that the government should be bolder and tax junk food to pay for nutritious diets. He said, “There is strong evidence that funding free nutritious food for those that need it has a positive impact on health and the economy.”
GMC appeals tribunal’s racism decision
The General Medical Council (GMC) plans to appeal against a “flawed” employment tribunal decision that the regulator had discriminated against a consultant urologist, Omer Karim, on the grounds of his race. The employment tribunal held that Karim was treated differently from a white doctor who was also under investigation and that there was no credible explanation for this. But the GMC said that the facts of the white doctor’s case differed in key respects from those of Karim’s case and that the tribunal had wrongly concluded that disproportionate referrals of ethnic minority doctors to the regulator by employers constituted evidence of direct discrimination. (Full story doi:10.1136/bmj.n1619)
Trust pays out for patient who died from starvation
The family of Linda Doherty, 69, a patient who starved to death in hospital, are expected to receive a six figure sum in an out-of-court settlement from Surrey and Sussex Healthcare NHS Trust, after a catalogue of errors when she was admitted with abdominal pain and a small bowel obstruction. Anna Crawford, assistant coroner for Surrey, found that Doherty died in 2017 from sepsis and acute kidney injury, malnutrition, intestinal failure secondary to Crohn’s disease and ileal resection, and inadequate nutritional intake. The trust said that it had put in place a range of measures to ensure that this could never happen again. (Full story doi:10.1136/bmj.n1642)
Conflicts of interest
MPs receive “hidden” funding from pharma
The pharmaceutical industry has a “hidden web of policy influence” over MPs on all-party parliamentary groups (APPGs), a paper published in Plos One found.1 Researchers from the University of Bath examined how APPGs—informal cross party groups dealing with a particular topic—were funded. They found that from 2012 to 2018, 58 health related APPGs received 468 payments totalling just under £2.2m (€2.6m; $3m) in direct and indirect funding from drug companies. The authors said that the payments “represent institutional conflicts of interest,” calling for greater transparency over how these groups are funded.
NICE backs e-cigarettes as quitting aid
E-cigarettes should be offered alongside other aids to stop people smoking, said a new draft guideline from the National Institute for Health and Care Excellence. Evidence shows that they are similarly effective to other cessation options such as a combination of short and long acting nicotine replacement therapy. The guidance says that people should be advised on where to find information on e-cigarettes containing nicotine, that the devices are substantially less harmful than smoking, but that the long term health effects are still uncertain. People should also be advised to stop smoking completely if they decide to start using e-cigarettes containing nicotine.
Champix products are temporarily unavailable
Pfizer stopped distribution of all varenicline (Champix) products under its control with immediate effect after it observed nitrosamines above the acceptable level of daily intake in several lots. It was responding to requests from various regulatory authorities worldwide to check for the presence or formation of nitrosamine impurities in medicines. In England about 20 000 prescriptions a month are given for varenicline. Pfizer anticipates that supply problems will last several weeks.
Low dose misoprostol works best for labour induction
Induction of labour with low dose oral misoprostol results in fewer caesarean sections than standard induction methods, found a Cochrane review of 61 trials involving 20 026 women.2 Misoprostol was also associated with lower rates of hyperstimulation with fetal heart rate changes. Oral misoprostol outperformed vaginal dinoprostone, which is often thought of as the gold standard but is much more expensive and is used in preference in many countries. Misoprostol in some countries will be more than 150 times cheaper than alternative drugs, said the authors.
“Serious concerns” over pension and payment system
The BMA’s General Practitioners Committee wrote to NHS England to highlight serious concerns with the recently launched GP payments and pensions system PCSE (run by Capita) after reports from practices of pension data not showing up, lacking detail, and being incorrect. GPs have also reported incorrect, missing, and even double payments. The BMA said, “There is a lack of detail in statements, which is making it needlessly difficult for practices to check whether they are correct, and it seems there is even confusion as to what some payments are for.”
Racism in medicine
BMJ wins award for diversity work
The BMJ won the Professional Publishers Association award for diversity and inclusion. The judges were especially impressed with The BMJ’s work experience programme for school leavers from under-represented backgrounds, which the team hopes will result in long term change. They also applauded the special themed issue “Racism in Medicine,” published in February 2020, which led to the establishment of the Race and Health Observatory and the BMA’s charter to prevent and effectively deal with racial harassment at medical schools.