The importance of continuity of care Previous research suggests that survival of patients may be associated with hospital organisational culture.1 Organisational factors such as culture, staffing, and retention of staff are crucial to patient safety. In a linked study covering nine years of monthly data from all NHS acute trusts in England, Moscelli and colleagues showed that a high turnover of senior doctors (hospital consultants and specialty associated doctors) and nurses in hospitals is associated with increased mortality for patients admitted for emergencies.2 For the 30 day mortality risk, a 1 standard deviation increase in the monthly turnover rate of nurses was associated with a 0.052 (0.037 to 0.067) percentage point increase and of senior doctors was a 0.019 (0.006 to 0.033) percentage point increase. Extensive robustness checks give credibility to the findings , although such associations cannot be taken as proof of causality. Turnover rates among nurses showed a stronger association with mortality than turnover rates among …
{"title":"Staff retention and mortality","authors":"Hogne Sandvik, Steinar Hunskaar","doi":"10.1136/bmj.q2521","DOIUrl":"https://doi.org/10.1136/bmj.q2521","url":null,"abstract":"The importance of continuity of care Previous research suggests that survival of patients may be associated with hospital organisational culture.1 Organisational factors such as culture, staffing, and retention of staff are crucial to patient safety. In a linked study covering nine years of monthly data from all NHS acute trusts in England, Moscelli and colleagues showed that a high turnover of senior doctors (hospital consultants and specialty associated doctors) and nurses in hospitals is associated with increased mortality for patients admitted for emergencies.2 For the 30 day mortality risk, a 1 standard deviation increase in the monthly turnover rate of nurses was associated with a 0.052 (0.037 to 0.067) percentage point increase and of senior doctors was a 0.019 (0.006 to 0.033) percentage point increase. Extensive robustness checks give credibility to the findings , although such associations cannot be taken as proof of causality. Turnover rates among nurses showed a stronger association with mortality than turnover rates among …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678325","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}
Yi-Xin Wang, Leslie V Farland, Audrey J Gaskins, Siwen Wang, Kathryn L Terry, Kathryn M Rexrode, Janet W Rich-Edwards, Rulla Tamimi, Jorge E Chavarro, Stacey A Missmer
Objective To prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years). Design Prospective cohort study Setting The Nurses’ Health Study II, United States (1989-2019). Participants 110 091 women aged 25-42 years in 1989 without a history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer. Main outcome measures Hazard ratios (estimated by Cox proportional hazards models) for total and cause specific premature mortality according to laparoscopically confirmed endometriosis or ultrasound or hysterectomy confirmed uterine fibroids reported in biennial questionnaires. Results 4356 premature deaths were recorded during 2 994 354 person years of follow-up (27.2 years per person), including 1459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The crude incidence of all cause premature mortality for women with and without laparoscopically confirmed endometriosis was 2.01 and 1.40 per 1000 person years, respectively. In age adjusted models, laparoscopically confirmed endometriosis was associated with a hazard ratio of 1.19 (95% confidence interval 1.09 to 1.30) for premature death; these models were strengthened after also adjusting for potential confounders including behavioral factors (1.31, 1.20 to 1.44). Cause specific mortality analyses showed that the association was largely driven by mortality from senility and ill-defined diseases (1.80, 1.19 to 2.73), non-malignant respiratory diseases (1.95, 1.11 to 3.41), diseases of the nervous system and sense organs (2.50, 1.40 to 4.44), and malignant neoplasm of gynecological organs (2.76, 1.79 to 4.26). Ultrasound or hysterectomy confirmed uterine fibroids were not associated with all cause premature mortality (1.03, 0.95 to 1.11), but were associated with a greater risk of mortality from malignant neoplasm of gynecological organs (2.32, 1.59 to 3.40) in cause specific mortality analyses. The risk of mortality caused by cardiovascular and respiratory diseases varied according to joint categories of endometriosis and uterine fibroids, with an increased risk of all cause premature mortality among women reporting both endometriosis and uterine fibroids. Conclusion Women with a history of endometriosis and uterine fibroids might have an increased long term risk of premature mortality extending beyond their reproductive lifespan. These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women's health. The data used in the present study will not be made publicly available, but they are accessible by contacting the research staff from NHSII at <https://www.nurseshealthstudy.org/researchers>. The analytic SAS codes
{"title":"Endometriosis and uterine fibroids and risk of premature mortality: prospective cohort study","authors":"Yi-Xin Wang, Leslie V Farland, Audrey J Gaskins, Siwen Wang, Kathryn L Terry, Kathryn M Rexrode, Janet W Rich-Edwards, Rulla Tamimi, Jorge E Chavarro, Stacey A Missmer","doi":"10.1136/bmj-2023-078797","DOIUrl":"https://doi.org/10.1136/bmj-2023-078797","url":null,"abstract":"Objective To prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years). Design Prospective cohort study Setting The Nurses’ Health Study II, United States (1989-2019). Participants 110 091 women aged 25-42 years in 1989 without a history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer. Main outcome measures Hazard ratios (estimated by Cox proportional hazards models) for total and cause specific premature mortality according to laparoscopically confirmed endometriosis or ultrasound or hysterectomy confirmed uterine fibroids reported in biennial questionnaires. Results 4356 premature deaths were recorded during 2 994 354 person years of follow-up (27.2 years per person), including 1459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The crude incidence of all cause premature mortality for women with and without laparoscopically confirmed endometriosis was 2.01 and 1.40 per 1000 person years, respectively. In age adjusted models, laparoscopically confirmed endometriosis was associated with a hazard ratio of 1.19 (95% confidence interval 1.09 to 1.30) for premature death; these models were strengthened after also adjusting for potential confounders including behavioral factors (1.31, 1.20 to 1.44). Cause specific mortality analyses showed that the association was largely driven by mortality from senility and ill-defined diseases (1.80, 1.19 to 2.73), non-malignant respiratory diseases (1.95, 1.11 to 3.41), diseases of the nervous system and sense organs (2.50, 1.40 to 4.44), and malignant neoplasm of gynecological organs (2.76, 1.79 to 4.26). Ultrasound or hysterectomy confirmed uterine fibroids were not associated with all cause premature mortality (1.03, 0.95 to 1.11), but were associated with a greater risk of mortality from malignant neoplasm of gynecological organs (2.32, 1.59 to 3.40) in cause specific mortality analyses. The risk of mortality caused by cardiovascular and respiratory diseases varied according to joint categories of endometriosis and uterine fibroids, with an increased risk of all cause premature mortality among women reporting both endometriosis and uterine fibroids. Conclusion Women with a history of endometriosis and uterine fibroids might have an increased long term risk of premature mortality extending beyond their reproductive lifespan. These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women's health. The data used in the present study will not be made publicly available, but they are accessible by contacting the research staff from NHSII at <https://www.nurseshealthstudy.org/researchers>. The analytic SAS codes ","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"179 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678951","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}
Hoyle and Yassaie discuss whether doctors should be suspended for breaking the law.1 We are, of course, currently on track to face catastrophic warming caused by fossil fuels. Globally, the scientific community is sounding the alarm. The cost to public …
{"title":"Defending our colleagues who take direct action on climate change","authors":"Milo J A Simpson","doi":"10.1136/bmj.q2533","DOIUrl":"https://doi.org/10.1136/bmj.q2533","url":null,"abstract":"Hoyle and Yassaie discuss whether doctors should be suspended for breaking the law.1 We are, of course, currently on track to face catastrophic warming caused by fossil fuels. Globally, the scientific community is sounding the alarm. The cost to public …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670827","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}
Health, economic, and social progress will stall without urgent global collaborative action Road traffic injuries are the leading killer of children and adults aged 5-29 years globally.1 Low and middle income countries are disproportionately represented in this statistic; Africa has the highest road crash mortality of all global regions. Increasing urbanisation and motorisation in many African countries are not yet matched by safer road infrastructure, safer vehicles, and public education on safer road use. Road traffic injuries rob these nations of their workforce and their future. The World Health Organization status report on road safety in the African region for 2023 highlights the urgent need for concerted global action.1 Whereas recorded road deaths have decreased by 5% globally in the past decade, in Africa they have increased by 17%. The demographics of deaths also differ. In high income countries road deaths are mostly among vehicle drivers and passengers; in Africa, half of the deaths are among vulnerable road users—pedestrians, cyclists, and motorcyclists—with pedestrians accounting for a third of all deaths. The inequality probably runs deeper since the burden of injuries, which are harder to measure, is likely to be much higher. Injuries affect ability to work, …
{"title":"Road safety in Africa: a preventable public health crisis","authors":"H I Geduld, P Kinyanjui","doi":"10.1136/bmj.q2498","DOIUrl":"https://doi.org/10.1136/bmj.q2498","url":null,"abstract":"Health, economic, and social progress will stall without urgent global collaborative action Road traffic injuries are the leading killer of children and adults aged 5-29 years globally.1 Low and middle income countries are disproportionately represented in this statistic; Africa has the highest road crash mortality of all global regions. Increasing urbanisation and motorisation in many African countries are not yet matched by safer road infrastructure, safer vehicles, and public education on safer road use. Road traffic injuries rob these nations of their workforce and their future. The World Health Organization status report on road safety in the African region for 2023 highlights the urgent need for concerted global action.1 Whereas recorded road deaths have decreased by 5% globally in the past decade, in Africa they have increased by 17%. The demographics of deaths also differ. In high income countries road deaths are mostly among vehicle drivers and passengers; in Africa, half of the deaths are among vulnerable road users—pedestrians, cyclists, and motorcyclists—with pedestrians accounting for a third of all deaths. The inequality probably runs deeper since the burden of injuries, which are harder to measure, is likely to be much higher. Injuries affect ability to work, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673249","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}
Mulcahy and Smith clearly detail the failure of the United Nations climate change conference (COP) process.1 As they point out, despite all the meetings, emissions still rise. If you plot the rise in CO2 emissions since COP meetings began, you might be forgiven for wondering if they have caused the rise in emissions, or at …
{"title":"There is no point waiting for COP29","authors":"David McKelvey","doi":"10.1136/bmj.q2516","DOIUrl":"https://doi.org/10.1136/bmj.q2516","url":null,"abstract":"Mulcahy and Smith clearly detail the failure of the United Nations climate change conference (COP) process.1 As they point out, despite all the meetings, emissions still rise. If you plot the rise in CO2 emissions since COP meetings began, you might be forgiven for wondering if they have caused the rise in emissions, or at …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670826","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 aim of an integrated neighbourhood team (INT) is to bring medical, nursing, and social care services to the patient’s home (or nearby) in a timely fashion, which should prevent unnecessary hospital admissions and enable earlier discharge, thus saving the NHS money and minimising disruption for patients. These ideas seem so obvious that it’s hard to work out why they haven’t been tried before. They have, of course—but because such programmes identify unmet health needs, they usually result in more spending rather than less.1 In trying to understand the latest neighbourhood team iteration, one stumbling block is the definitions: what do we mean by a neighbourhood? It can’t be based on the area of a GP …
{"title":"Helen Salisbury: Neighbourhood teams are disintegrating—to make them work, we need more staff","authors":"Helen Salisbury","doi":"10.1136/bmj.q2556","DOIUrl":"https://doi.org/10.1136/bmj.q2556","url":null,"abstract":"The aim of an integrated neighbourhood team (INT) is to bring medical, nursing, and social care services to the patient’s home (or nearby) in a timely fashion, which should prevent unnecessary hospital admissions and enable earlier discharge, thus saving the NHS money and minimising disruption for patients. These ideas seem so obvious that it’s hard to work out why they haven’t been tried before. They have, of course—but because such programmes identify unmet health needs, they usually result in more spending rather than less.1 In trying to understand the latest neighbourhood team iteration, one stumbling block is the definitions: what do we mean by a neighbourhood? It can’t be based on the area of a GP …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673243","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}
Like many people, I can no longer find effective dental treatment locally on the NHS. Against my personal preference and political views, I’ve been to a private dentist for some years now. He’s a decent man, charges relatively modest prices, and is conservative (in the best sense) in his interventions. We banter nicely about my need for elephantine quantities of local analgesia, as well as other matters. Recently, I developed some root canal issues. Having done x rays, my dentist sent me for a CT scan costing over £200. I bit the bullet, if you’ll excuse the pun. …
和许多人一样，我再也无法在当地的国民保健服务系统中找到有效的牙科治疗。与我的个人偏好和政治观点相反，我去看私人牙医已经有些年头了。他是个体面的人，收费相对适中，而且在干预方面很保守（从最好的意义上来说）。我们就我需要大量局部镇痛剂以及其他问题进行了友好的交谈。最近，我出现了一些根管问题。做完 X 光检查后，牙医让我去做 CT 扫描，费用超过 200 英镑。我咬了咬牙，请原谅我的双关语。...
{"title":"John Launer: The dilemma of private care","authors":"John Launer","doi":"10.1136/bmj.q2549","DOIUrl":"https://doi.org/10.1136/bmj.q2549","url":null,"abstract":"Like many people, I can no longer find effective dental treatment locally on the NHS. Against my personal preference and political views, I’ve been to a private dentist for some years now. He’s a decent man, charges relatively modest prices, and is conservative (in the best sense) in his interventions. We banter nicely about my need for elephantine quantities of local analgesia, as well as other matters. Recently, I developed some root canal issues. Having done x rays, my dentist sent me for a CT scan costing over £200. I bit the bullet, if you’ll excuse the pun. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670825","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}
Elie A Akl, Joanne Khabsa, Claire Iannizzi, Vanessa Piechotta, Lara A Kahale, James M Barker, Joanne E McKenzie, Matthew J Page, Nicole Skoetz
Publications of living systematic reviews (LSRs) are increasing rapidly. Guidance facilitating transparent, complete, and accurate reporting of LSRs is needed. This paper reports the development of an extension of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement for LSRs (PRISMA-LSR). The PRISMA-LSR extension includes the PRISMA-LSR checklist, the PRISMA-LSR flow diagram, reporting recommendations for the LSR status, and an explanation and elaboration document. This extension has been developed as an “add-on” to the PRISMA 2020 statement, meaning it should be used in addition to the PRISMA 2020 statement. The PRISMA-LSR extension is expected to benefit authors, editors, peer reviewers, and users of LSRs through transparent, complete, and accurate reporting of LSRs. Living systematic reviews (LSRs) are attracting attention from researchers and medical journals.12 Between 2014 (when the LSR approach first emerged3) and 2019, the rate of publication of these systematic reviews was low; however, since 2019, there has been a rapid increase. Indeed, the total number of LSRs published in 2020 and 2021 exceeded the total number published before 2020.4 LSRs are characterised by a continual search of the literature so that new evidence can be incorporated soon after it becomes available.35 These reviews are particularly important when research is published rapidly and where concomitant policy decisions are required, such as during the covid-19 pandemic.678 The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement is intended to facilitate transparent, complete, and accurate reporting of systematic reviews.9101112 The PRISMA 2020 statement was designed primarily to provide guidance for systematic reviews of studies that evaluate the effects of interventions. While the statement was intended for original, updated, or living systematic reviews, the developers noted that there might be additional reporting considerations that …
{"title":"Extension of the PRISMA 2020 statement for living systematic reviews (PRISMA-LSR): checklist and explanation","authors":"Elie A Akl, Joanne Khabsa, Claire Iannizzi, Vanessa Piechotta, Lara A Kahale, James M Barker, Joanne E McKenzie, Matthew J Page, Nicole Skoetz","doi":"10.1136/bmj-2024-079183","DOIUrl":"https://doi.org/10.1136/bmj-2024-079183","url":null,"abstract":"Publications of living systematic reviews (LSRs) are increasing rapidly. Guidance facilitating transparent, complete, and accurate reporting of LSRs is needed. This paper reports the development of an extension of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement for LSRs (PRISMA-LSR). The PRISMA-LSR extension includes the PRISMA-LSR checklist, the PRISMA-LSR flow diagram, reporting recommendations for the LSR status, and an explanation and elaboration document. This extension has been developed as an “add-on” to the PRISMA 2020 statement, meaning it should be used in addition to the PRISMA 2020 statement. The PRISMA-LSR extension is expected to benefit authors, editors, peer reviewers, and users of LSRs through transparent, complete, and accurate reporting of LSRs. Living systematic reviews (LSRs) are attracting attention from researchers and medical journals.12 Between 2014 (when the LSR approach first emerged3) and 2019, the rate of publication of these systematic reviews was low; however, since 2019, there has been a rapid increase. Indeed, the total number of LSRs published in 2020 and 2021 exceeded the total number published before 2020.4 LSRs are characterised by a continual search of the literature so that new evidence can be incorporated soon after it becomes available.35 These reviews are particularly important when research is published rapidly and where concomitant policy decisions are required, such as during the covid-19 pandemic.678 The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement is intended to facilitate transparent, complete, and accurate reporting of systematic reviews.9101112 The PRISMA 2020 statement was designed primarily to provide guidance for systematic reviews of studies that evaluate the effects of interventions. While the statement was intended for original, updated, or living systematic reviews, the developers noted that there might be additional reporting considerations that …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673242","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}
Cédric Lemarchand, Raphaël Chopin, Morgane Paul, Alain Braillon, Lisa Cosgrove, Ioana Cristea, Eiko I Fried, Erick H Turner, Florian Naudet
Cédric Lemarchand and colleagues highlight weaknesses in the evidence on efficacy and safety of hallucinogens and question the use of expedited regulatory pathways The US clinical market for ketamine, estimated at $3.1bn in 2022 and expected to expand at 10.6% a year until 2030,1 is just one of many signs of renewed interest in the use of psychedelics to treat psychiatric conditions.2 Various mind altering drugs have already entered the market, including esketamine nasal spray, which the US Food and Drug Administration approved in 2019. And in 2022 the Australian Therapeutic Goods Administration (TGA) allowed psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) to be prescribed by authorised physicians for psychiatric conditions such as depression and post-traumatic stress disorder. The decision was taken despite an independent scientific report commissioned by the TGA advising against authorisation because the certainty of evidence for benefits was low or very low.3 Psychedelics, the lay term for substances classified as hallucinogens, have various targets and distinct purported mechanisms of action. For instance, psilocybin is a serotoninergic agonist, whereas esketamine is a N-methyl-D-aspartate (NMDA) glutamate receptor antagonist, although its effect is also attributed to synaptic plasticity. Mystical experiences have also been reported as a mechanism of action. Nevertheless, hallucinogens as a group are often understood as “a new paradigm of care for mental health.”4 While many countries, including the UK, Japan, Indonesia, Saudi Arabia, Singapore, Russia, and China, have maintained relatively strict regulatory standards for hallucinogens, more relaxed approaches in the US, Australia, and Europe are hindering repeated calls for a critical evaluation of the evidence.24 The clinical use of hallucinogens began after Alfred Hofmann accidentally discovered the psychotropic effects of LSD while working at Sandoz in 1943.5 The drug was initially hailed as a cure for mental health problems, but enthusiasm waned …
{"title":"Fragile promise of psychedelics in psychiatry","authors":"Cédric Lemarchand, Raphaël Chopin, Morgane Paul, Alain Braillon, Lisa Cosgrove, Ioana Cristea, Eiko I Fried, Erick H Turner, Florian Naudet","doi":"10.1136/bmj-2024-080391","DOIUrl":"https://doi.org/10.1136/bmj-2024-080391","url":null,"abstract":"Cédric Lemarchand and colleagues highlight weaknesses in the evidence on efficacy and safety of hallucinogens and question the use of expedited regulatory pathways The US clinical market for ketamine, estimated at $3.1bn in 2022 and expected to expand at 10.6% a year until 2030,1 is just one of many signs of renewed interest in the use of psychedelics to treat psychiatric conditions.2 Various mind altering drugs have already entered the market, including esketamine nasal spray, which the US Food and Drug Administration approved in 2019. And in 2022 the Australian Therapeutic Goods Administration (TGA) allowed psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) to be prescribed by authorised physicians for psychiatric conditions such as depression and post-traumatic stress disorder. The decision was taken despite an independent scientific report commissioned by the TGA advising against authorisation because the certainty of evidence for benefits was low or very low.3 Psychedelics, the lay term for substances classified as hallucinogens, have various targets and distinct purported mechanisms of action. For instance, psilocybin is a serotoninergic agonist, whereas esketamine is a N-methyl-D-aspartate (NMDA) glutamate receptor antagonist, although its effect is also attributed to synaptic plasticity. Mystical experiences have also been reported as a mechanism of action. Nevertheless, hallucinogens as a group are often understood as “a new paradigm of care for mental health.”4 While many countries, including the UK, Japan, Indonesia, Saudi Arabia, Singapore, Russia, and China, have maintained relatively strict regulatory standards for hallucinogens, more relaxed approaches in the US, Australia, and Europe are hindering repeated calls for a critical evaluation of the evidence.24 The clinical use of hallucinogens began after Alfred Hofmann accidentally discovered the psychotropic effects of LSD while working at Sandoz in 1943.5 The drug was initially hailed as a cure for mental health problems, but enthusiasm waned …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673248","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}
Alexander J K Wilkinson, Laura-Jane Smith, Frances Mortimer
The General Medical Council emphasises the relevant policies and laws it must follow,1 but tremendous injustices can be committed by unthinkingly “following procedure.” Extraordinary circumstances provide important opportunities to reflect on whether policies remain fit for purpose. The GMC shouldn’t judge the fairness of a law, but it must decide if public trust is damaged when laws are broken. If a law—pushed by powerful fossil fuel interests—is widely seen as unjust, breaking it might not undermine trust. In 2023, government officials …
{"title":"Climate crisis imperils the fabric of life: GMC must review its policies","authors":"Alexander J K Wilkinson, Laura-Jane Smith, Frances Mortimer","doi":"10.1136/bmj.q2522","DOIUrl":"https://doi.org/10.1136/bmj.q2522","url":null,"abstract":"The General Medical Council emphasises the relevant policies and laws it must follow,1 but tremendous injustices can be committed by unthinkingly “following procedure.” Extraordinary circumstances provide important opportunities to reflect on whether policies remain fit for purpose. The GMC shouldn’t judge the fairness of a law, but it must decide if public trust is damaged when laws are broken. If a law—pushed by powerful fossil fuel interests—is widely seen as unjust, breaking it might not undermine trust. In 2023, government officials …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673246","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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