Launer recalls a patient vignette in a government pamphlet about a patient called Sarah with sinus pain and hearing loss who is referred by a nurse practitioner for a CT scan. She uses the NHS app to arrange the scan in her local shopping centre and later to check reviews to find the best local consultant, who arranges multiple further investigations and leaves her happy with her care.1 As Launer points out, Sarah’s story is completely …
{"title":"Losing touch with NHS reality: government on trajectory to two tier service","authors":"John Puntis","doi":"10.1136/bmj.r345","DOIUrl":"https://doi.org/10.1136/bmj.r345","url":null,"abstract":"Launer recalls a patient vignette in a government pamphlet about a patient called Sarah with sinus pain and hearing loss who is referred by a nurse practitioner for a CT scan. She uses the NHS app to arrange the scan in her local shopping centre and later to check reviews to find the best local consultant, who arranges multiple further investigations and leaves her happy with her care.1 As Launer points out, Sarah’s story is completely …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506968","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 World Health Organization is facing threats from countries wishing to pull out from funding it. But who has actually served notice, and why? Argentina and the US are the two countries that have so far announced their intention to leave WHO. At the moment, 194 nations are members. Donald Trump, in one of his first executive orders on starting his second term as president in January, withdrew the US from supporting WHO.1 The order states that this is “due to the organisation’s mishandling of the covid-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states.” It added that WHO “continues to demand unfairly onerous payments from the US, far out of proportion with other countries’ assessed payments.” On 23 January, Italy’s deputy prime minister Matteo Salvini said he had proposed a law to follow Donald Trump’s withdrawal from WHO. A spokesperson at the time said that Prime Minister Georgina Melloni did not yet have a position on it, and no further developments have been reported. Salvani had written on X that, “Italy must no longer have to deal with a supranational power centre—handsomely financed by Italian taxpayers—which goes hand-in-hand with the multinational pharmaceutical companies. Let’s use those 100 million to support the sick in Italy and finance our hospitals and doctors!” President of …
{"title":"Who wants to leave WHO?","authors":"Mun-Keat Looi","doi":"10.1136/bmj.r309","DOIUrl":"https://doi.org/10.1136/bmj.r309","url":null,"abstract":"The World Health Organization is facing threats from countries wishing to pull out from funding it. But who has actually served notice, and why? Argentina and the US are the two countries that have so far announced their intention to leave WHO. At the moment, 194 nations are members. Donald Trump, in one of his first executive orders on starting his second term as president in January, withdrew the US from supporting WHO.1 The order states that this is “due to the organisation’s mishandling of the covid-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states.” It added that WHO “continues to demand unfairly onerous payments from the US, far out of proportion with other countries’ assessed payments.” On 23 January, Italy’s deputy prime minister Matteo Salvini said he had proposed a law to follow Donald Trump’s withdrawal from WHO. A spokesperson at the time said that Prime Minister Georgina Melloni did not yet have a position on it, and no further developments have been reported. Salvani had written on X that, “Italy must no longer have to deal with a supranational power centre—handsomely financed by Italian taxpayers—which goes hand-in-hand with the multinational pharmaceutical companies. Let’s use those 100 million to support the sick in Italy and finance our hospitals and doctors!” President of …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495386","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}
Evidence suggests no increased risk The use of glucagon-like peptide-1 (GLP-1) receptor agonists has surged in recent years, driven by their benefits in glucose control in type 2 diabetes, weight reduction, and cardiovascular and renal outcomes. Given the increasing number of patients being treated with these drugs, timely assessment of potential safety signals is important. In July 2023 the European Medicines Agency launched an investigation into thoughts of suicide and self-harm potentially linked to GLP-1 receptor agonists.1 Although meta-analyses of randomised controlled trials have not indicated that GLP-1 receptor agonists increase suicidality, depression, anxiety, and other adverse mental health outcomes, the clinical trials were not designed to assess those outcomes, and the statistical power of the analyses have been limited by the low number of events.23 In addition, most clinical trials have excluded patients at high risk of suicidality. In this situation, adequately designed observational …
{"title":"GLP-1 receptor agonists and suicidality","authors":"Peter Ueda, Björn Pasternak","doi":"10.1136/bmj.r351","DOIUrl":"https://doi.org/10.1136/bmj.r351","url":null,"abstract":"Evidence suggests no increased risk The use of glucagon-like peptide-1 (GLP-1) receptor agonists has surged in recent years, driven by their benefits in glucose control in type 2 diabetes, weight reduction, and cardiovascular and renal outcomes. Given the increasing number of patients being treated with these drugs, timely assessment of potential safety signals is important. In July 2023 the European Medicines Agency launched an investigation into thoughts of suicide and self-harm potentially linked to GLP-1 receptor agonists.1 Although meta-analyses of randomised controlled trials have not indicated that GLP-1 receptor agonists increase suicidality, depression, anxiety, and other adverse mental health outcomes, the clinical trials were not designed to assess those outcomes, and the statistical power of the analyses have been limited by the low number of events.23 In addition, most clinical trials have excluded patients at high risk of suicidality. In this situation, adequately designed observational …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506794","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}
Objective To determine whether the use of glucagon-like peptide-1 (GLP-1) receptor agonists is associated with an increased risk of suicidal ideation, self-harm, and suicide among patients with type 2 diabetes compared with the use of dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Design Active comparator, new user cohort study. Setting Primary care practices contributing data to the UK Clinical Practice Research Datalink linked to the Hospital Episodes Statistics Admitted Patient Care and Office for National Statistics Death Registration databases. Participants Patients with type 2 diabetes. Exposures Two cohorts were assembled, with the first composed of patients who started and continued on GLP-1 receptor agonists or DPP-4 inhibitors between 1 January 2007 and 31 December 2020 and the second composed of patients who started and continued on GLP-1 receptor agonists or SGLT-2 inhibitors between 1 January 1 2013 and 31 December 2020. Both cohorts were followed until 29 March 2021. Main outcome measures The primary outcome was suicidality, defined as a composite of suicidal ideation, self-harm, and suicide. Secondary outcomes were each of these events considered separately. Propensity score fine stratification weighted Cox proportional hazards models were fitted to estimate hazard ratios and 95% confidence intervals (CIs) to estimate the average treatment effect among the treated patients. Results The first cohort included 36 082 GLP-1 receptor agonist users (median follow-up 1.3 years) and 234 028 DPP-4 inhibitor users (median follow-up 1.7 years). In crude analyses, GLP-1 receptor agonist use was associated with an increased incidence of suicidality compared with DPP-4 inhibitors (crude incidence rates 3.9 v 1.8 per 1000 person years, respectively; hazard ratio 2.08, 95% CI 1.83 to 2.36). This estimate decreased to a null value after confounding factors were accounted for (hazard ratio 1.02, 95% CI 0.85 to 1.23). The second cohort included 32 336 GLP-1 receptor agonist users (median follow-up 1.2 years) and 96 212 SGLT-2 inhibitor users (median follow-up 1.2 years). Similarly, GLP-1 receptor agonist use was associated with an increased risk of suicidality compared with SGLT-2 inhibitors in crude analyses (crude incidence rates 4.3 v 2.7 per 1000 person years; hazard ratio 1.60, 95% CI 1.37 to 1.87) but not after confounding factors were accounted for (0.91, 0.73 to 1.12). Similar findings were observed when suicidal ideation, self-harm, and suicide were analysed separately in both cohorts. Conclusions In this large cohort study, the use of GLP-1 receptor agonists was not associated with an increased risk of suicidality compared with the use of DPP-4 inhibitors or SGLT-2 inhibitors in patients with type 2 diabetes. ICD-10 codes to identify the outcome are included in supplementary table S1. Example code lists used to identify covariates are included in supplementary table S2. Codes used to used to
{"title":"Glucagon-like peptide-1 receptor agonists and risk of suicidality among patients with type 2 diabetes: active comparator, new user cohort study","authors":"Samantha B Shapiro, Hui Yin, Oriana Hoi Yun Yu, Soham Rej, Samy Suissa, Laurent Azoulay","doi":"10.1136/bmj-2024-080679","DOIUrl":"https://doi.org/10.1136/bmj-2024-080679","url":null,"abstract":"Objective To determine whether the use of glucagon-like peptide-1 (GLP-1) receptor agonists is associated with an increased risk of suicidal ideation, self-harm, and suicide among patients with type 2 diabetes compared with the use of dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Design Active comparator, new user cohort study. Setting Primary care practices contributing data to the UK Clinical Practice Research Datalink linked to the Hospital Episodes Statistics Admitted Patient Care and Office for National Statistics Death Registration databases. Participants Patients with type 2 diabetes. Exposures Two cohorts were assembled, with the first composed of patients who started and continued on GLP-1 receptor agonists or DPP-4 inhibitors between 1 January 2007 and 31 December 2020 and the second composed of patients who started and continued on GLP-1 receptor agonists or SGLT-2 inhibitors between 1 January 1 2013 and 31 December 2020. Both cohorts were followed until 29 March 2021. Main outcome measures The primary outcome was suicidality, defined as a composite of suicidal ideation, self-harm, and suicide. Secondary outcomes were each of these events considered separately. Propensity score fine stratification weighted Cox proportional hazards models were fitted to estimate hazard ratios and 95% confidence intervals (CIs) to estimate the average treatment effect among the treated patients. Results The first cohort included 36 082 GLP-1 receptor agonist users (median follow-up 1.3 years) and 234 028 DPP-4 inhibitor users (median follow-up 1.7 years). In crude analyses, GLP-1 receptor agonist use was associated with an increased incidence of suicidality compared with DPP-4 inhibitors (crude incidence rates 3.9 v 1.8 per 1000 person years, respectively; hazard ratio 2.08, 95% CI 1.83 to 2.36). This estimate decreased to a null value after confounding factors were accounted for (hazard ratio 1.02, 95% CI 0.85 to 1.23). The second cohort included 32 336 GLP-1 receptor agonist users (median follow-up 1.2 years) and 96 212 SGLT-2 inhibitor users (median follow-up 1.2 years). Similarly, GLP-1 receptor agonist use was associated with an increased risk of suicidality compared with SGLT-2 inhibitors in crude analyses (crude incidence rates 4.3 v 2.7 per 1000 person years; hazard ratio 1.60, 95% CI 1.37 to 1.87) but not after confounding factors were accounted for (0.91, 0.73 to 1.12). Similar findings were observed when suicidal ideation, self-harm, and suicide were analysed separately in both cohorts. Conclusions In this large cohort study, the use of GLP-1 receptor agonists was not associated with an increased risk of suicidality compared with the use of DPP-4 inhibitors or SGLT-2 inhibitors in patients with type 2 diabetes. ICD-10 codes to identify the outcome are included in supplementary table S1. Example code lists used to identify covariates are included in supplementary table S2. Codes used to used to","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506866","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 editorial emphasising that “adult social care reform cannot wait” covers the finance and policy issues clearly but fails to mention that it is essential—and possible—to reduce the need for social care by preventing problems such as falls, isolation, frailty, stroke, and dementia, which create the need.1 The science is now clear that the normal biological process of ageing is not …
{"title":"Adult social care reform must include prevention","authors":"Muir Gray, Yvalia Febrer","doi":"10.1136/bmj.r338","DOIUrl":"https://doi.org/10.1136/bmj.r338","url":null,"abstract":"The editorial emphasising that “adult social care reform cannot wait” covers the finance and policy issues clearly but fails to mention that it is essential—and possible—to reduce the need for social care by preventing problems such as falls, isolation, frailty, stroke, and dementia, which create the need.1 The science is now clear that the normal biological process of ageing is not …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485511","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}
Thomas Callender, Katherine Payne, Nora Pashayan, Anne Mackie
Tom Callender and colleagues argue that outcomes for individual cancers will need to be assessed to inform decisions about the use of multicancer tests for screening Tests using blood based biomarkers for the concurrent detection of multiple types of cancer in asymptomatic people are currently being trialled in the UK and elsewhere.1 This has raised the possibility of their adoption in population screening programmes. Multicancer testing has the potential to improve cancer survival, particularly for rarer cancers, through early detection. But this benefit has to be balanced against possible harms from false positive results; overdiagnosis; inaccurate predictions of, or indeed inability to, predict the cancer site; and cases where a cancer detected by testing is too small to be seen on imaging.23 Most discussion has considered the overall—aggregate—benefits and harms of screening programmes using multicancer tests. However, cancers behave remarkably differently between both individuals and cancer types. Differences in the natural history of disease have an important influence on the potential for one potential harm—overdiagnosis—when screening for multiple cancers simultaneously. The example of overdiagnosis illustrates why differences in cancer specific outcomes are relevant to both clinical practice and policy but risk being obscured by a focus on aggregate metrics to evaluate multicancer tests. Stage of cancer at diagnosis affects survival, making early detection through screening a research and policy priority. Cancer causes 28% of all deaths in England and 42% of premature deaths among people aged 40-70 years.4 Around two thirds of deaths from cancer in men and half of those in women are from cancers for which there are no screening programmes.4 Developing cost effective screening programmes for single rarer cancers is challenging. As the number of screening programmes and ensuing tests expands, the burden these programmes place on individuals increases, as does the …
{"title":"Screening for multiple cancers: evaluation must go beyond aggregate measures","authors":"Thomas Callender, Katherine Payne, Nora Pashayan, Anne Mackie","doi":"10.1136/bmj-2024-081098","DOIUrl":"https://doi.org/10.1136/bmj-2024-081098","url":null,"abstract":"Tom Callender and colleagues argue that outcomes for individual cancers will need to be assessed to inform decisions about the use of multicancer tests for screening Tests using blood based biomarkers for the concurrent detection of multiple types of cancer in asymptomatic people are currently being trialled in the UK and elsewhere.1 This has raised the possibility of their adoption in population screening programmes. Multicancer testing has the potential to improve cancer survival, particularly for rarer cancers, through early detection. But this benefit has to be balanced against possible harms from false positive results; overdiagnosis; inaccurate predictions of, or indeed inability to, predict the cancer site; and cases where a cancer detected by testing is too small to be seen on imaging.23 Most discussion has considered the overall—aggregate—benefits and harms of screening programmes using multicancer tests. However, cancers behave remarkably differently between both individuals and cancer types. Differences in the natural history of disease have an important influence on the potential for one potential harm—overdiagnosis—when screening for multiple cancers simultaneously. The example of overdiagnosis illustrates why differences in cancer specific outcomes are relevant to both clinical practice and policy but risk being obscured by a focus on aggregate metrics to evaluate multicancer tests. Stage of cancer at diagnosis affects survival, making early detection through screening a research and policy priority. Cancer causes 28% of all deaths in England and 42% of premature deaths among people aged 40-70 years.4 Around two thirds of deaths from cancer in men and half of those in women are from cancers for which there are no screening programmes.4 Developing cost effective screening programmes for single rarer cancers is challenging. As the number of screening programmes and ensuing tests expands, the burden these programmes place on individuals increases, as does the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485854","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}
Sixteen months of bombings and attacks have decimated Gaza’s health system and workforce. Palestinian doctors tell Elisabeth Mahase about the effects on mental health, what needs to happen next, and how UK doctors can help Israel’s attacks on the Gaza Strip since October 2023 have left its healthcare system in ruins, with nearly all hospitals partly or completely destroyed, along with much of their medical equipment.1 More than 1000 healthcare workers have been killed.2 A temporary ceasefire agreement between Hamas and Israel came into effect on 19 January, 470 days after Hamas’s 7 October 2023 attack on Israel, which resulted in around 1200 people being killed and more than 200, including children, being taken hostage. Over the next 16 months Israel has bombarded Gaza, raided hospitals, and carried out ground offensives across the strip. An estimated 47 000 Palestinians have been killed and 111 000 injured, and around 10 000 people are believed to be beneath rubble.3 The effects of the war go far beyond these numbers, says Mohammed Abu Mughaiseeb, deputy medical coordinator for Gaza for the charity Médecins Sans Frontières (MSF). “We don’t count the people who have died as a result of the lack of medical services. A lot of people who had cardiac problems died. A lot of people with renal failure died. A lot of people with cancer—children and adults—died because of a lack of treatment and services,” Mughaiseeb tells The BMJ from southern Gaza. The British Palestinian consultant surgeon Ghassan Abu-Sittah, who was working in Gaza in October and November 2023, says the healthcare system has been “completely eviscerated” and the “magnitude of injury and illness has not been seen before.” He says, “Hospitals have been destroyed. So have numerous health clinics. There are no microbiology labs in a place where almost 90% of …
{"title":"Gaza’s health system is “completely eviscerated”—what happens now?","authors":"Elisabeth Mahase","doi":"10.1136/bmj.r361","DOIUrl":"https://doi.org/10.1136/bmj.r361","url":null,"abstract":"Sixteen months of bombings and attacks have decimated Gaza’s health system and workforce. Palestinian doctors tell Elisabeth Mahase about the effects on mental health, what needs to happen next, and how UK doctors can help Israel’s attacks on the Gaza Strip since October 2023 have left its healthcare system in ruins, with nearly all hospitals partly or completely destroyed, along with much of their medical equipment.1 More than 1000 healthcare workers have been killed.2 A temporary ceasefire agreement between Hamas and Israel came into effect on 19 January, 470 days after Hamas’s 7 October 2023 attack on Israel, which resulted in around 1200 people being killed and more than 200, including children, being taken hostage. Over the next 16 months Israel has bombarded Gaza, raided hospitals, and carried out ground offensives across the strip. An estimated 47 000 Palestinians have been killed and 111 000 injured, and around 10 000 people are believed to be beneath rubble.3 The effects of the war go far beyond these numbers, says Mohammed Abu Mughaiseeb, deputy medical coordinator for Gaza for the charity Médecins Sans Frontières (MSF). “We don’t count the people who have died as a result of the lack of medical services. A lot of people who had cardiac problems died. A lot of people with renal failure died. A lot of people with cancer—children and adults—died because of a lack of treatment and services,” Mughaiseeb tells The BMJ from southern Gaza. The British Palestinian consultant surgeon Ghassan Abu-Sittah, who was working in Gaza in October and November 2023, says the healthcare system has been “completely eviscerated” and the “magnitude of injury and illness has not been seen before.” He says, “Hospitals have been destroyed. So have numerous health clinics. There are no microbiology labs in a place where almost 90% of …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"128 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485515","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}
Consultant psychiatrist John Mulinga talks to Erin Dean about how the kindness of a senior colleague inspired him to support doctors in training throughout his career John Mulinga started working in mental health after meeting the first consultant in his career who was truly welcoming. “This consultant wanted to know a bit about me before we started the training, which was quite different to the other roles I’d had,” says Mulinga, who works as a consultant psychiatrist for Lancashire and South Cumbria NHS Foundation Trust. “I’d never had a time before that when the consultant said, ‘Sit here and let’s just have a chat about who you are, what you want, or how we can best help you.’ But that’s exactly what happened when I started with that psychiatric consultant. At the end of my three month placement my mind was made up to stay.” Mulinga had wanted to be a doctor ever since being rushed to hospital as a child after drinking from a bottle of what he …
{"title":"Paying it forward: the consultant psychiatrist","authors":"Erin Dean","doi":"10.1136/bmj.r62","DOIUrl":"https://doi.org/10.1136/bmj.r62","url":null,"abstract":"Consultant psychiatrist John Mulinga talks to Erin Dean about how the kindness of a senior colleague inspired him to support doctors in training throughout his career John Mulinga started working in mental health after meeting the first consultant in his career who was truly welcoming. “This consultant wanted to know a bit about me before we started the training, which was quite different to the other roles I’d had,” says Mulinga, who works as a consultant psychiatrist for Lancashire and South Cumbria NHS Foundation Trust. “I’d never had a time before that when the consultant said, ‘Sit here and let’s just have a chat about who you are, what you want, or how we can best help you.’ But that’s exactly what happened when I started with that psychiatric consultant. At the end of my three month placement my mind was made up to stay.” Mulinga had wanted to be a doctor ever since being rushed to hospital as a child after drinking from a bottle of what he …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477595","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}
Fetal personhood laws open the door for further surveillance and punishment during pregnancy, write Terry McGovern and colleagues Since the US Supreme Court issued the Dobbs decision, which rolled back the constitutional right to abortion, public health experts have focused mainly on the harm to health caused by abortion bans, as more states moved to restrict when abortion was legal.12 While this is a legitimate focus, there has been another, stealthier legal trend that threatens reproductive healthcare and bodily autonomy more broadly. The rise of laws and state high court opinions granting fertilized eggs, embryos, or fetuses separate legal rights from the person carrying the pregnancy are equally nefarious. At first glance, it may seem that the movement to recognise a fetus as a legal person has only recently gained momentum, as evidenced by lawmakers in Idaho, Indiana, North Dakota, Oklahoma, South Carolina, and Texas introducing or working to introduce bills to allow homicide charges to be brought against people suspected of having an abortion.345 Or in Montana where after voters approved by 58% a state constitutional amendment in 2024 that secured abortion rights, lawmakers are now moving to place a “personhood upon conception” amendment on the ballot in 2026.6 These moves are not new; they are …
{"title":"Fetal personhood: What happens when the rights of the “fertilized egg” supersede the rights of the mother","authors":"Terry McGovern, Ira Memaj, Lourdes Rivera","doi":"10.1136/bmj.r372","DOIUrl":"https://doi.org/10.1136/bmj.r372","url":null,"abstract":"Fetal personhood laws open the door for further surveillance and punishment during pregnancy, write Terry McGovern and colleagues Since the US Supreme Court issued the Dobbs decision, which rolled back the constitutional right to abortion, public health experts have focused mainly on the harm to health caused by abortion bans, as more states moved to restrict when abortion was legal.12 While this is a legitimate focus, there has been another, stealthier legal trend that threatens reproductive healthcare and bodily autonomy more broadly. The rise of laws and state high court opinions granting fertilized eggs, embryos, or fetuses separate legal rights from the person carrying the pregnancy are equally nefarious. At first glance, it may seem that the movement to recognise a fetus as a legal person has only recently gained momentum, as evidenced by lawmakers in Idaho, Indiana, North Dakota, Oklahoma, South Carolina, and Texas introducing or working to introduce bills to allow homicide charges to be brought against people suspected of having an abortion.345 Or in Montana where after voters approved by 58% a state constitutional amendment in 2024 that secured abortion rights, lawmakers are now moving to place a “personhood upon conception” amendment on the ballot in 2026.6 These moves are not new; they are …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477544","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 24 February 2025 marks the third anniversary of Russia’s full scale invasion of Ukraine. This grim milestone coincides with a radical shift in American policy towards Ukraine and the rest of Europe that challenges the country’s sovereignty and capacity to recover. It is an appropriate time to reflect on the impact the invasion has had on Ukrainians and the resilience they have demonstrated in their response. In the last three years, while international attention to the crisis waned, the attempted destruction of Ukraine’s health and healthcare system intensified. Between February 2022 and January 2025, 12 605 Ukrainian civilians have been killed by the war and 29 178 have been injured.1 The World Health Organization (WHO) has verified 2,236 attacks on healthcare facilities in Ukraine since 24 February 2022, the most ever recorded by WHO in a conflict.2 The agency reports that these attacks have increased in the past year, and now occur on an almost daily basis.3 One of the most brazen attacks on Ukrainian healthcare occurred on 8 July 2024, when Okhmatdyt Children’s Hospital, the country’s largest, …
{"title":"Three years into Russia’s full-scale invasion, Ukraine offers a model of health system resilience","authors":"Adrianna Murphy, Pavlo Kovtoniuk","doi":"10.1136/bmj.r377","DOIUrl":"https://doi.org/10.1136/bmj.r377","url":null,"abstract":"The 24 February 2025 marks the third anniversary of Russia’s full scale invasion of Ukraine. This grim milestone coincides with a radical shift in American policy towards Ukraine and the rest of Europe that challenges the country’s sovereignty and capacity to recover. It is an appropriate time to reflect on the impact the invasion has had on Ukrainians and the resilience they have demonstrated in their response. In the last three years, while international attention to the crisis waned, the attempted destruction of Ukraine’s health and healthcare system intensified. Between February 2022 and January 2025, 12 605 Ukrainian civilians have been killed by the war and 29 178 have been injured.1 The World Health Organization (WHO) has verified 2,236 attacks on healthcare facilities in Ukraine since 24 February 2022, the most ever recorded by WHO in a conflict.2 The agency reports that these attacks have increased in the past year, and now occur on an almost daily basis.3 One of the most brazen attacks on Ukrainian healthcare occurred on 8 July 2024, when Okhmatdyt Children’s Hospital, the country’s largest, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477590","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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