Seven days in medicine: 24-30 May 2023
BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1214 (Published 01 June 2023) Cite this as: BMJ 2023;381:p1214
Pay
Welsh health unions accept pay offer
Most health unions in Wales, representing staff on the Agenda for Change contract, have accepted the government’s two year pay offer, which will see average pay rise by 15.7%. However, some unions, including the Royal College of Nursing, have rejected the offer and remain in dispute. Darren Hughes, director of the Welsh NHS Confederation, welcomed the news, which comes after several months of negotiation and disruption. He said, “We must continue to address the underlying issues affecting the NHS that led to this activity being felt as necessary in the first place.”1
US firearms
Chicago sees rise in children’s injuries
The rate of injuries from firearms in children rose over five years from 82 in 2016 to 127 in 2020, showed an audit of the Chicago metropolitan area published in Trauma Surgery & Acute Care Open.2 The researchers reported that more than a fifth of injuries were fatal and that the rise was particularly significant after the stay-at-home order took effect in March 2020 because of the covid pandemic. They wrote, “We have lost ground during the pandemic. We need to double down on multifaceted prevention initiatives.”
Climate emergency
Extreme weather deaths decline as events rise
The damage and cost associated with extreme weather such as storms and droughts increased from around $183bn (£148bn; €172bn) in the 1970s to nearly $1.5tn in the 2010s, said the World Meteorological Organization. However, the number of deaths caused by such events has decreased from over half a million in the 1980s to 184 000 in the 2010s despite a far larger global population. The WMO said that this was due to improvements in early warning systems and disaster management.
Vaccines
Cholera vaccine shortage “could last years”
The global vaccine alliance Gavi has warned that the current shortage of cholera vaccine could persist into 2025 as outbreaks grow around the world. “The outlook is bleak,” a World Health Organization official told Reuters. They said that just eight million of the 18 million requested vaccine doses were available in 2023. Last year 15 countries reported outbreaks, but that has already risen to 24 this year. Over the past two years 48 million vaccine doses have been used—more than 10 million more than in the previous decade.
England announces free flu vaccine eligibility
The UK government and NHS England have released their annual letter announcing who will be eligible for free flu vaccination from 1 September. The groups remain the same as last year and include clinically vulnerable people, over 65s, pregnant women, primary schoolchildren, children aged 2 and 3, close contacts of immunocompromised people, and frontline healthcare staff. The UK Health Security Agency’s head of immunisation, Mary Ramsay, said, “Every year the flu vaccination programme offers direct protection to those at higher risk of serious illness from flu.”3
Alcohol
Ireland will add cancer warning on products
Ireland is set to become the first country to introduce comprehensive health labels on alcohol products, including a warning about the risk of liver disease and fatal cancers from alcohol consumption. The law will apply from 22 May 2026 to give businesses time to prepare. The health minister Hildegarde Naughton said, “This law is designed to ensure all consumers of alcohol have access to clear and concise information about the risks from alcohol. The medical evidence is clear that a cancer risk applies even at lower levels of alcohol consumption.”
Government has failed to tackle harms, say MPs
The UK government is not taking a “proportionate and serious approach” to tackling alcohol related harms in England, with more than eight in 10 dependent drinkers not receiving treatment, a Commons Public Accounts Committee report has said. It noted an “alarming increase” of 89% in alcohol related deaths over the past 20 years, with particularly sharp rises since 2019. The report highlighted that treatment success rates were around 60% and that on average every £1 spent on treatment immediately delivered benefits worth £3. (Full story doi:10.1136/bmj.p1192)
Substance misuse
UK reports first death linked to xylazine
The veterinary tranquilliser xylazine has been linked to a death in the UK, said a report in the Journal of Forensic and Legal Medicine.4 Postmortem toxicology detected a number of drugs in a 43 year old who was found dead in May 2022, including xylazine, heroin, fentanyl, and cocaine. Xylazine, which is most frequently mixed with other drugs such as fentanyl or heroin as a cheap filler, has been increasingly detected in illicit drug supplies and linked to overdoses in the US, but this is the first time it has been linked to a death in the UK.
Mpox
UK warns of rise in cases
The UK Health Security Agency urged people to remain vigilant regarding mpox ahead of the summer months, as 10 new cases were reported from 30 April to 25 May. Twenty cases have been reported in the UK since the start of 2023, all diagnosed in London. People who are eligible for vaccination but have not yet received two doses are being encouraged to book their first dose by 16 June and to be booked for a second dose by the end of July.5
IT
EMIS retains panic button on GP computer systems
The IT supplier EMIS’s “panic button” feature for general practices, which sends an alert to other computers at the practice, will no longer be removed from systems. The software company previously announced that the feature would be removed from June, but GPs said that the button was often the best way to alert other staff in an emergency, such as when a patient becomes violent or threatening. David Wrigley, deputy chair of the BMA’s General Practitioners Committee England, said, “Potentially taking something that is a means of a call for help away, makes many practices extremely vulnerable.”
Social media
Call for research into impact on young people
The US surgeon general, Vivek Murthy, has called for researchers to prioritise studying the effects of social media on young people’s mental health and to develop a shared research agenda to evaluate the impact of social media, age, and personal environment on poor mental health outcomes. In a report on the issue6 Murthy said that another focus should be the benefits and risks of specific social media design, as well as the long term effects on adults of social media use during childhood and adolescence. (Full story doi:10.1136/bmj.p1211)