The philosopher Derek Parfit, introducing his 1984 book Reasons and Persons, sets out a few basic concepts—that we have reasons for acting, that some ways of acting are morally wrong, and that some outcomes are good or bad in a sense that has moral relevance.1 Reaching for what he presumably judged to be an uncontroversial example of a poor outcome, he notes that “it is bad, for example, if people become paralysed.” Whatever hopes one might have about the arc of the moral universe bending towards justice, the US elections have placed enormous power in the hands of a Republican Party intent on sabotaging vaccination programmes and medical research, while withdrawing support from international programmes funded by USAID.2 This threatens the health and wellbeing of millions of people risking the resurgence of polio (and thus paralysis) as well as other existing and novel infectious diseases. While basic human decency calls for action to try to ensure that such policies, which will shorten the lives of many of the most vulnerable people, can be stopped, mitigated, and ultimately reversed, it is easy to feel right now that this is too hard or perhaps impossible. Bobbie Jacobson’s …
{"title":"Effective public health requires “deep prevention”","authors":"Nick Hopkinson","doi":"10.1136/bmj.r646","DOIUrl":"https://doi.org/10.1136/bmj.r646","url":null,"abstract":"The philosopher Derek Parfit, introducing his 1984 book Reasons and Persons, sets out a few basic concepts—that we have reasons for acting, that some ways of acting are morally wrong, and that some outcomes are good or bad in a sense that has moral relevance.1 Reaching for what he presumably judged to be an uncontroversial example of a poor outcome, he notes that “it is bad, for example, if people become paralysed.” Whatever hopes one might have about the arc of the moral universe bending towards justice, the US elections have placed enormous power in the hands of a Republican Party intent on sabotaging vaccination programmes and medical research, while withdrawing support from international programmes funded by USAID.2 This threatens the health and wellbeing of millions of people risking the resurgence of polio (and thus paralysis) as well as other existing and novel infectious diseases. While basic human decency calls for action to try to ensure that such policies, which will shorten the lives of many of the most vulnerable people, can be stopped, mitigated, and ultimately reversed, it is easy to feel right now that this is too hard or perhaps impossible. Bobbie Jacobson’s …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wilkinson brings the challenges of burnout and mental ill health faced by doctors into sharp focus.1 In Northern Ireland, we look with envy at the provision of NHS Practitioner Health in England, and the corresponding services in Wales, Scotland, and the Republic of Ireland. We are the only nation on these islands without a commissioned, confidential mental health service for clinicians. In the 2024 Royal …
{"title":"Northern Ireland needs a practitioner health service","authors":"Emma Murtagh, Ursula Mason","doi":"10.1136/bmj.r599","DOIUrl":"https://doi.org/10.1136/bmj.r599","url":null,"abstract":"Wilkinson brings the challenges of burnout and mental ill health faced by doctors into sharp focus.1 In Northern Ireland, we look with envy at the provision of NHS Practitioner Health in England, and the corresponding services in Wales, Scotland, and the Republic of Ireland. We are the only nation on these islands without a commissioned, confidential mental health service for clinicians. In the 2024 Royal …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Singh and colleagues answer questions on managing HIV in primary care.1 Several other aspects are relevant to primary care clinicians caring for people with HIV. Many people with HIV, such as men who have sex with men, are at higher risk of mpox infection and are therefore recommended to receive mpox vaccination by the …
{"title":"HIV in primary care: further considerations","authors":"Daniel Bradshaw","doi":"10.1136/bmj.r639","DOIUrl":"https://doi.org/10.1136/bmj.r639","url":null,"abstract":"Singh and colleagues answer questions on managing HIV in primary care.1 Several other aspects are relevant to primary care clinicians caring for people with HIV. Many people with HIV, such as men who have sex with men, are at higher risk of mpox infection and are therefore recommended to receive mpox vaccination by the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steve was born in Preston, only two miles from where he would later practice as a consultant physician for 28 years. The maternity ward was hit by an outbreak of neonatal diarrhoea and there were several tragic deaths. Steve teetered on the brink but survived, according to his mother’s account, as a result of copious amounts of Lourdes holy water sprinkled daily on his forehead. Some 60 years later, by complete coincidence, he attended a domiciliary consultation with a lady with a similar birth date—and discovered that she also was one of the Preston outbreak survivors. Steve was the middle of three boys. His father was an engineer, his mother a teacher. Secondary education was at the …
{"title":"Stephen Andrew Cairns","authors":"Bill Stephens, Alastair Campbell","doi":"10.1136/bmj.r614","DOIUrl":"https://doi.org/10.1136/bmj.r614","url":null,"abstract":"Steve was born in Preston, only two miles from where he would later practice as a consultant physician for 28 years. The maternity ward was hit by an outbreak of neonatal diarrhoea and there were several tragic deaths. Steve teetered on the brink but survived, according to his mother’s account, as a result of copious amounts of Lourdes holy water sprinkled daily on his forehead. Some 60 years later, by complete coincidence, he attended a domiciliary consultation with a lady with a similar birth date—and discovered that she also was one of the Preston outbreak survivors. Steve was the middle of three boys. His father was an engineer, his mother a teacher. Secondary education was at the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"216 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chris Howard studied medicine at Liverpool University, qualifying in 1968. He completed his houseman, senior house officer, and registrar training in medicine and paediatrics at Leeds General Infirmary and in hospitals across Liverpool, obtaining his membership of the Royal College of Physicians in 1973. In 1974 he saw a “positions vacant” …
{"title":"John Christopher Howard","authors":"Diane Howard","doi":"10.1136/bmj.r621","DOIUrl":"https://doi.org/10.1136/bmj.r621","url":null,"abstract":"Chris Howard studied medicine at Liverpool University, qualifying in 1968. He completed his houseman, senior house officer, and registrar training in medicine and paediatrics at Leeds General Infirmary and in hospitals across Liverpool, obtaining his membership of the Royal College of Physicians in 1973. In 1974 he saw a “positions vacant” …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this feature by Sally Howard ( BMJ 2025;388:r305, doi:10.1136/bmj.r305, published 6 March 2025) …
{"title":"Trump 2.0 sends “a ripple of fear” through the reproductive health community fighting for safe abortions worldwide","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.r627","DOIUrl":"https://doi.org/10.1136/bmj.r627","url":null,"abstract":"In this feature by Sally Howard ( BMJ 2025;388:r305, doi:10.1136/bmj.r305, published 6 March 2025) …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caring for migrants in immigration removal centres can present GPs with complex practical and ethical difficulties, Sally Howard reports Several cases haunt Alan Mitchell from his 14 years as a general practitioner at Dungavel House immigration removal centre in Scotland (box). One man was deported to East Asia with a large bowel tumour that a prison GP had failed to find under examination, despite a textbook anal protrusion. The discovery of the tumour did not prevent the man’s deportation. Then there was the detainee with advanced multiple sclerosis whose symptoms had gone untreated for years owing to fear that GPs would report him to the Home Office. There were also avoidable deaths, Mitchell says, from cancers and communicable diseases—the result of late presentation. These losses, he says, “are all part of providing care to this highly vulnerable population.” Mitchell retired from his role at Dungavel House last June but remains the immigration removal centres lead for the Royal College of General Practitioners’ secure environments group. It’s a year and a half since the publication of the Brook House Inquiry report,2 which was commissioned to investigate the mistreatment of detainees at Brook House immigration removal centre near Gatwick Airport in Sussex between 1 April and 31 August 2017. And there are concerns that guidance set out by the report on a range of matters, including the use of force, has not been implemented across centres. Immigration removal centres are one of the most challenging settings for GPs to practise in, presenting ethical quandaries for clinicians navigating between vulnerable patients’ best interests and Home Office pressures that can conflict with clinical independence. The health of people in immigration removal centres is often poor. A 2021 review of the clinical literature found that three quarters of people in immigration detention in the …
{"title":"Migrants in limbo and the doctors struggling to provide care","authors":"Sally Howard","doi":"10.1136/bmj.q2438","DOIUrl":"https://doi.org/10.1136/bmj.q2438","url":null,"abstract":"Caring for migrants in immigration removal centres can present GPs with complex practical and ethical difficulties, Sally Howard reports Several cases haunt Alan Mitchell from his 14 years as a general practitioner at Dungavel House immigration removal centre in Scotland (box). One man was deported to East Asia with a large bowel tumour that a prison GP had failed to find under examination, despite a textbook anal protrusion. The discovery of the tumour did not prevent the man’s deportation. Then there was the detainee with advanced multiple sclerosis whose symptoms had gone untreated for years owing to fear that GPs would report him to the Home Office. There were also avoidable deaths, Mitchell says, from cancers and communicable diseases—the result of late presentation. These losses, he says, “are all part of providing care to this highly vulnerable population.” Mitchell retired from his role at Dungavel House last June but remains the immigration removal centres lead for the Royal College of General Practitioners’ secure environments group. It’s a year and a half since the publication of the Brook House Inquiry report,2 which was commissioned to investigate the mistreatment of detainees at Brook House immigration removal centre near Gatwick Airport in Sussex between 1 April and 31 August 2017. And there are concerns that guidance set out by the report on a range of matters, including the use of force, has not been implemented across centres. Immigration removal centres are one of the most challenging settings for GPs to practise in, presenting ethical quandaries for clinicians navigating between vulnerable patients’ best interests and Home Office pressures that can conflict with clinical independence. The health of people in immigration removal centres is often poor. A 2021 review of the clinical literature found that three quarters of people in immigration detention in the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The supply chains that deliver drugs to patients around the world are surprisingly brittle. Donald Trump’s trade war—with both allies and rivals—could break them. Flynn Murphy reports When hurricane Helene flooded a North Carolina plant that made 60% of the US’s intravenous fluids in October 20241 it was a grimly familiar situation. The damage worsened a shortage that had lingered since hurricane Maria hit the same company’s production in Puerto Rico in 2017. Medical procedures had to be altered to reduce the use of IV products. Fluids were rationed and surgeries postponed, and some patients had to get by with sports drinks.2 It took three months to bring the crisis under control. A broader, more intractable crisis has replaced it. Trump’s aggressive reconfiguration of US trade relations and a pledge to make all of the country’s essential drugs and their inputs at home is threatening the stability of medical supply chains that have only just recovered from covid. Additionally, tariffs targeting both traditional US allies and rivals are likely to hamper progress already made on relocating some medical sourcing from key exporter China to other countries. ### Trump’s China beef “Our enemy” is what President Donald Trump has called China. Yet China holds an intractable position in global healthcare supply chains—particularly for generic drugs, medical devices and supplies, and even some emerging treatments like antibody drug coagulates. China is also a key source of many of the materials required to manufacture and test drugs, such as those used to make active pharmaceutical ingredients (APIs), APIs themselves, and excipients such as binders, fillers, and lubricants. Years of US efforts to mitigate reliance on China has created room for Canada, Costa Rica, India, Ireland, Mexico, and others to grow their own export industries. But they are now in Trump’s tariff crosshairs too. And most …
{"title":"How Trump’s trade war will break global medicine supply chains","authors":"Flynn Murphy","doi":"10.1136/bmj.r648","DOIUrl":"https://doi.org/10.1136/bmj.r648","url":null,"abstract":"The supply chains that deliver drugs to patients around the world are surprisingly brittle. Donald Trump’s trade war—with both allies and rivals—could break them. Flynn Murphy reports When hurricane Helene flooded a North Carolina plant that made 60% of the US’s intravenous fluids in October 20241 it was a grimly familiar situation. The damage worsened a shortage that had lingered since hurricane Maria hit the same company’s production in Puerto Rico in 2017. Medical procedures had to be altered to reduce the use of IV products. Fluids were rationed and surgeries postponed, and some patients had to get by with sports drinks.2 It took three months to bring the crisis under control. A broader, more intractable crisis has replaced it. Trump’s aggressive reconfiguration of US trade relations and a pledge to make all of the country’s essential drugs and their inputs at home is threatening the stability of medical supply chains that have only just recovered from covid. Additionally, tariffs targeting both traditional US allies and rivals are likely to hamper progress already made on relocating some medical sourcing from key exporter China to other countries. ### Trump’s China beef “Our enemy” is what President Donald Trump has called China. Yet China holds an intractable position in global healthcare supply chains—particularly for generic drugs, medical devices and supplies, and even some emerging treatments like antibody drug coagulates. China is also a key source of many of the materials required to manufacture and test drugs, such as those used to make active pharmaceutical ingredients (APIs), APIs themselves, and excipients such as binders, fillers, and lubricants. Years of US efforts to mitigate reliance on China has created room for Canada, Costa Rica, India, Ireland, Mexico, and others to grow their own export industries. But they are now in Trump’s tariff crosshairs too. And most …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We have a capacity problem in general practice. There are too few GPs, either as partners or employed, for the number of patients who need looking after. This is despite there being GPs unable to find work and practices that would like to employ them but lack the money or space.1 Unsurprisingly, capacity and access are a priority for the government—perhaps because nothing says that the system is broken quite as effectively as an 8 am queue for appointments snaking around the block. Last year’s primary care network contract included extra payments related to this, with a number of boxes that needed to be ticked to earn them.2 Unfortunately, the focus was entirely on ease of access …
{"title":"Helen Salisbury: Improved access is meaningless without increased capacity","authors":"Helen Salisbury","doi":"10.1136/bmj.r641","DOIUrl":"https://doi.org/10.1136/bmj.r641","url":null,"abstract":"We have a capacity problem in general practice. There are too few GPs, either as partners or employed, for the number of patients who need looking after. This is despite there being GPs unable to find work and practices that would like to employ them but lack the money or space.1 Unsurprisingly, capacity and access are a priority for the government—perhaps because nothing says that the system is broken quite as effectively as an 8 am queue for appointments snaking around the block. Last year’s primary care network contract included extra payments related to this, with a number of boxes that needed to be ticked to earn them.2 Unfortunately, the focus was entirely on ease of access …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valdo Calocane case shows the importance of continuity of care An NHS review into the clinical care of Valdo Calocane, who killed three people during a psychotic episode, found serious failings that contributed to his relapse and the tragic events that unfolded.12 Nottinghamshire Healthcare NHS Foundation Trust reported that Calocane, who had been admitted to psychiatric hospitals four times because of psychotic episodes linked to schizophrenia,2 was under the care of the early intervention psychosis (EIP) service, which provides standalone community support for people after their first psychotic episodes, including for those unwilling to engage with services. Patients with schizophrenia require treatment owing to the risk of serious adverse events, including violence. In a Cochrane review, patients with schizophrenia treated with antipsychotics had more than 50% fewer violent outcomes compared with the placebo groups.3 Assessing and managing the risks of perpetrating violence are complicated in this patient group. One complication, almost unique in healthcare, is that the illness itself is associated with loss of insight into the need for treatment. This was the case for …
{"title":"Clinical care for patients at risk of psychosis related violence","authors":"Seena Fazel, Belinda Lennox","doi":"10.1136/bmj.r603","DOIUrl":"https://doi.org/10.1136/bmj.r603","url":null,"abstract":"Valdo Calocane case shows the importance of continuity of care An NHS review into the clinical care of Valdo Calocane, who killed three people during a psychotic episode, found serious failings that contributed to his relapse and the tragic events that unfolded.12 Nottinghamshire Healthcare NHS Foundation Trust reported that Calocane, who had been admitted to psychiatric hospitals four times because of psychotic episodes linked to schizophrenia,2 was under the care of the early intervention psychosis (EIP) service, which provides standalone community support for people after their first psychotic episodes, including for those unwilling to engage with services. Patients with schizophrenia require treatment owing to the risk of serious adverse events, including violence. In a Cochrane review, patients with schizophrenia treated with antipsychotics had more than 50% fewer violent outcomes compared with the placebo groups.3 Assessing and managing the risks of perpetrating violence are complicated in this patient group. One complication, almost unique in healthcare, is that the illness itself is associated with loss of insight into the need for treatment. This was the case for …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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