Dear Sajid Javid: open letter to a new minister of health
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1662 (Published 01 July 2021) Cite this as: BMJ 2021;374:n1662Linked Editorial
Priorities for the new health secretary
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Dear Editor,
For the past 15-odd months, we have been watching with incredulity the present UK government claiming that they are acting on advice based on pure science, and then applying updates and retracting them every few weeks based on shifting opinions. While the vacillations are partly understandable, as this is a pandemic the likes of which no living human being has witnessed in their lifetimes, certain decisions must clearly come across as being motivated by economics (such as opening up businesses where safe covid protocols are impossible to follow), politics (such as allowing the G9 meetings in person, with heads of state extremely close to each other) and oneupmanships (such as problems related to Brexit and the sometimes acrimonious exchanges between the UK leadership and the mouthpieces of the European Union).
I am an immigrant from India. I understand why India and many other South Asian countries were moved to the Red List at the time when this was done; now, though, when India is seeing less than 50K cases/day (for a population of nearly 1.4 billion), as against 28K in the UK (for a 20 times less population of under 70 million), why does the UK government insist on keeping these countries in the Red List?
Competing interests: No competing interests
Dear Editor,
I endorse Fiona Godlee’s open letter but would add one more “urgent action”.
The government should commit at least 10% of the health and social care research budget for studies on nutrition and dysbiosis in order to identify the dietary factors that will reduce dysbiosis induced mucosal inflammation.
We will not be able to provide a first-class health and social care service for all without reducing the total burden of disease. Thus, there must be a renewed focus on prevention. Fortunately, there is now a clear way forward which the pandemic has under-scored. Dysbiosis induced mucosal inflammation is a contributing factor to ageing and the metabolic syndrome (type 2 diabetes mellitus, atherosclerosis, obesity, and depression) [1]. This inflammation is amplified by SARS-CoV-2 leading to severe Covid-19 and widespread systemic disease [2]. Even when the virus has been eliminated, dysbiosis induced inflammation can persist and lead to the myriad features of long Covid. Periodontitis, a specific form of dysbiosis, is a causative factor in a wide range of systemic disease. We have known about this connection for over 100 years but it is only in the last decade that modern techniques of DNA analysis have revealed the mechanisms by which disease arises. Specific pathogenic bacteria grow within the tissues of the gum, cause inflammation and damage the cementum that holds the tooth in place. The same bacteria then spread by the blood stream to other sites in the body and cause local inflammation in the brain (Alzheimer’s disease), the lining cells of arteries (heart disease and strokes), and the mucosal cells of the breast, pancreas and colon (breast carcinoma, pancreatic carcinoma, colonic carcinoma) [3.4].
The research challenge is to discover the dietary factors that will reduce the carriage of these bacterial pathogens so as to reduce mucosal inflammation. The lactose fermenting bacteria found in milk and yoghurt, suppress bacterial pathogens, reduce inflammation and improve mood. This is an obvious place to start [1].
1. Morris JA. Optimise the microbial flora with milk and yoghurt to prevent disease. Medical Hypotheses 2018; 114: 13 – 17. https://doi.org/10.1016/j.mehy.2018.02.031
2. Marouf N, Cai W, Said KN, Daas H, Diab H, Chinta VR et al. Association between periodontitis and severity of Covid-19 infection: a case-control study. Clinical Periodontology, 2021 https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.13435
3. Marwaha AK, Morris JA, Rigby RJ. Hypothesis: bacterial induced inflammation disrupts the orderly progression of the stem cell hierarchy and has a role in the pathogenesis of breast cancer. Medical Hypotheses 2020; 136: 109530 https://doi.org/10.1016/j.mehy.2019.109530
4. Shah AF, Morris JA, Wray M. Pathogenesis of Alzheimer’s disease: multiple interacting causes against which amyloid precursor protein protects. Medical Hypotheses 2020; 110035 https://doi.org/10.1016/j.mehy.2020.110035
Competing interests: No competing interests
Dear Editor , I would only add that international borders must be shut at the first hint of a pandemic. We can well open open them in 2 weeks and get laughed at and avoid the terrible mortality. Does the government decide on closing borders or do doctors decide ? Who pays for the ineffective decisions ? and in what way ? There has to be culpability. Everything is back to status quo simply because we haven't seen a pandemic in a hundred years. Is that all ? Who takes the fall ? Only the dead ?
Competing interests: No competing interests
Dear Editor
Spot on with the action points.
It’s difficult to believe that advice on ventilation of public spaces and proper PPE needs to be given so far down the line of the pandemic .
However, as a marker of comparison, these items serve to demonstrate the poor state of the old NHS of underinvestment in professional staff and facilities.
With the opportunity of the new order now presented, perhaps the fog will dissipate and locality control of NHS resources into the clinical domains can be promoted above Westminster dogma.
This is a vital time to take stock and invest in the front line of care, with simplified administration.
Good luck with that,
John Hyslop FRCR
Competing interests: No competing interests
Re: Dear Sajid Javid: open letter to a new minister of health
Dear Editor
To support your Urgent Action number 6 (Sharing Vaccines), may I highlight the new initiative by Oxfam:
https://actions.oxfam.org/great-britain/peoples-vaccine-v3/petition/?cid...
Competing interests: No competing interests