World Health Day this year marks the 75th birthday of the World Health Organization (WHO).1 Founded alongside the United Nations, it was accompanied by a family of global organisations, including UNICEF, UNESCO, the World Bank, and the Food and Agriculture Organisation of the United Nations. Global policy governance was borne out of post war political optimism and a universal desire to address William Beveridge’s five giant evils—want, idleness, ignorance, squalor, and disease. There was a vision to rebuild a fairer, cleaner, healthier, wiser, and productive global community. It was a time for the old colonial powers to retreat and for new independence to come to the Global South.Previous attempts to bring together international efforts on health had had limited success, hindered by the two world wars and other conflicts around the world. The Pan American Health Organisation (PAHO) —the first international health grouping—became one of the regions of WHO. The...

Before covid-19, Reshma Jagsi had a thriving clinical and research career. As a full time physician and deputy department chair of radiation oncology at the University of Michigan, USA, she was ascending the leadership ladder before the world around her went into lockdown.“Everything was an emergency, and [all my colleagues were] working around the clock out of a sense of need, because the house was on fire,” she says. It felt as though “I was drowning.”On top of the acute emergency of helping sick patients, Jagsi was developing rapid treatment guidelines for covid-19 and reorganising research efforts for colleagues—while caring for her elderly mother and tutoring two schoolchildren. Other colleagues with younger children experienced high levels of anxiety, their careers completely sidelined by the pandemic.She says, “During an emergency, it didn’t matter how urgent the need was and how great your expertise was: if you’ve got a toddler who needs...

A recent report by TUC and Long Covid Support highlights the challenges facing people with long covid who want to remain in the workforce.1 The survey of around 3000 people with long covid in the UK found that one in seven (14%) had lost their job because of reasons related to their condition. Two thirds of respondents (66%) reported experiencing unfair treatment at work because of their illness, including bullying or harassment, the threat of disciplinary action, or being questioned about whether they have long covid.That so many people with long covid have had such poor experiences reflects wider societal problems in how we treat people with a disability or ill health—particularly people who have an invisible illness. Many people living through long covid have had their symptoms trivialised and the adaptations they need as an employee dismissed. As the report states, “Previous research on energy limiting impairments demonstrates that...

Every year, it has been estimated, up to around 500 suicides in England are linked to gambling (doi:10.1136/bmj.p766).1 That would mean more than one person dying every day on average as a result of a preventable harm. Gambling related harms are pervasive, affecting not only people with gambling addictions but their family, friends, and wider society. More harmful, high risk gambling is associated with deprivation and unemployment, exacerbating existing health inequalities.This month, after many delays, a white paper updating the 2005 Gambling Act is expected. But will it be far reaching enough, and will it put forward legislation to tackle this growing public health concern and to control the vested interests of the gambling industry?Some campaigners have called for the white paper to introduce a statutory levy, but this is a divisive option. Supporters argue that a levy could raise funds for specialist treatment, clinics, and research—shifting away from reliance...

Paediatric mental health admissions in the USThe rise of mental health problems in children and young people in the UK in recent years is as alarming as the lack of provision of mental health services for them, which is a national scandal. Are things any better in the US? National hospital admission data, published in JAMA, show an increase in admissions with attempted suicide and self injury in children aged between 3 and 17 years from 49 285 in 2009 to 129 699 in 2019. The proportion of mental health admissions due to attempted suicide, suicidal ideation, or self injury increased from 31% to 64% over the same period. The authors’ rather reserved conclusion is that these findings “underscore the growing effect of mental health diagnoses on the wellbeing of children in the US.”JAMA doi:10.1001/jama.2023.1992Driving after a critical illnessThe outcomes that seem to matter most to patients after a critical...

The US Food and Drug Administration (FDA) has approved the sale of naloxone, a nasal spray known as Narcan, without a prescription as an emergency treatment to reverse drug overdoses.Announcing the decision on 29 March, the FDA said in a statement, “Today’s action paves the way for the life saving medication to be sold directly to consumers in places like drug stores, convenience stores, grocery stores, and gas stations, as well as online.”1In the 12 months to October 2022, more than 101 750 people died of a drug overdose in the US, primarily because of synthetic opioids such as illegal fentanyl, the FDA said. Emergent BioSolutions, Narcan’s manufacturer, said in a press release, “The decision comes at a time when approximately every eight minutes a person dies from an opioid overdose and research shows the epidemic is escalating in the US with the rise in synthetic opioids.” The company said...

Polypills for hypertensionA systematic review gives a thumbs up to fixed dose combinations of antihypertensive drugs. Trials of low dose triple and quadruple combinations show that they are effective and safe as first line therapy for stage 2 hypertension (blood pressure >140/90 mm Hg). A strong advantage of combination treatment is that adherence to medication is high (Heart doi:10.1136/heartjnl-2022-321496).Antibiotics and inflammatory bowel diseaseA registry study from Denmark finds a weak but consistent link between antibiotic prescription and a subsequent diagnosis of both ulcerative colitis and Crohn’s disease. The strongest association was seen one to two years after antibiotic exposure in people over 40. However, the investigators couldn’t rule out reverse causality, so it’s possible that the inflammatory bowel disease led to the prescription of antibiotics rather than the other way around (Gut doi:10.1136/gutjnl-2022-327845).Pandemic planningThe World Health Organization declared covid-19 a pandemic more than three years ago. The effectiveness of population...

Much of the focus on the state of health services since the height of the pandemic has been on healthcare financing, workforce shortages,12 and physician burnout.345 Less attention has been given to the physical, psychological, and moral distress healthcare workers experienced because of increased and changed work demands,6 personal protection requirements,7 and isolation from peers and workplace supports.4 Moral loss, for example, occurred when staff had to say no to grandparents visiting their dying grandchild, when a nurse rather than a family member held a dying patient’s hand while holding a tablet computer to the family, or from the everyday awareness of how masks prevented patients from hearing and understanding.Rallying cries to learn from the covid crisis call for regeneration, transformation, and systems change.8 Such language is ambitious and aspirational, and is largely directed at policy makers, institutions, and health systems.8 Although structural changes to ease the burden on healthcare...

Much of Europe is struggling with a weak economy. Annual inflation across the European Union (EU) reached 10.4% in December 2022, compared with just 5.3% a year earlier,1 as the economy went into freefall in the wake of the covid-19 pandemic and the Russia-Ukraine war. Consumers are facing a growing energy crisis and soaring food prices. Policy makers and healthcare professionals should bear in mind that the widespread fall in people’s disposable incomes in real terms will not only affect people’s daily living expenses, but also the affordability of lifesaving medications.Evidence shows that economic crises adversely affect medication adherence in patients with non-communicable and communicable diseases.234 During the 2010-14 Portuguese financial crisis, almost 15% of older patients started saving money by increasing the inter-dose interval of their medication, and around 13% stopped taking their medication entirely.2 Similarly, during the Greek debt crisis between 2009 and 2017, patients with financial difficulties...

It has long been known that “those who discriminate on the grounds of race or gender do not generally advertise their prejudices: indeed, they may not even be aware of them.”1 So there are no surprises in the judgments23 in the two cases to which Kar refers.4Evidence from the Akinmeji case2 illustrates the extent to which NHS trusts will go to protect perpetrators of racial discrimination. The tribunal found “the claimant was given a false explanation of what the respondent had done in consequence of the complaint.” The trust had stated that the accused had undergone unconscious bias training and recognised the inappropriateness of her actions, even though she hadn’t completed the training.2In the case of Cox,3 in the course of giving evidence, the respondent illustrated a point about the contents of meeting notes by referring to the claimant eating bananas. The tribunal considered this to be a shockingly poor...

We want to let you know of the cautious optimism experienced in communities of colour as a result of the recent front page of The BMJ that featured Shubulade (Lade) Smith.1 We have been asking people who subscribe to receive a paper copy of the journal to donate print copies of the issue for curation in our communities. This is because representation matters. Young black girls need to be inspired to be their best selves. Smith’s feature represents an intersection of issues that are important to us.Several factors made Smith’s election possible. She has not taken the same route as other recent presidents, which is usually through previous elected college offices such as being dean. The Royal College of Psychiatrists has made a deliberate push to enhance issues of diversity, equality, and inclusion. Smith is one of two appointed equality leads. In this role, she has been so active and...

I thank Sundar for their response to my article.12 I agree that the NHS needs better demand management so that patients can be prioritised for care based on their health needs and the urgency of their referral. The effect of charges on access to medical care in the NHS is not known as the NHS has never charged for consultations with doctors (although there are charges for some services such as prescriptions, dentistry, and optical services). Ideally, funding for primary care services would come from taxation. But the current situation can’t continue, and future governments need to make decisions on what healthcare the NHS should provide and how the NHS should be funded.

There’s a showdown brewing in Tennessee. Beth Ann Malow, professor of neurology at Vanderbilt University Medical Center, is one of many health experts campaigning for an end to daylight saving time. She wants her state, and six neighbouring southern states, to secede on this matter together and enshrine permanent standard time into law.“Once they agree to go to standard time as a region we wouldn’t need the federal government to tell us what to do,” she explains. Among the neighbouring states she hopes would join such a movement are Alabama, Arkansas, and Mississippi. If all seven states moved together, people travelling around this region wouldn’t have to adjust to different times, she adds.Malow and other health experts argue that permanent standard time increases people’s exposure to morning sunlight, which is associated with improved sleep.1A string of studies published in recent years suggests that a twice yearly time shift is bad...

At the Nuffield Trust’s 2023 summit in early March, The BMJ hosted a roundtable discussion examining the NHS’s institutional intolerance towards flexible working. Participants discussed the damaging effect this is having on retention and what the service needs to do to become a truly flexible employer.The panellistsRachel Hutchings: fellow at the Nuffield Trust, and co-author of the report Future Proof, which explored the impact of parental and caring responsibilities on surgical careersFarzana Hussain: GP in Newham, east LondonThea Stein: chief executive of Leeds Community Healthcare Trust and trustee of the Nuffield TrustSarah Sweeney: interim chief executive of National Voices, a coalition of health and care charitiesWhere is the NHS going wrong on flexible working?CulturePanellist Rachel Hutchings, a fellow at the Nuffield Trust and co-author of a report on the challenges of combining a career in surgery with parenting,12 kicked off the discussion. She said that although surgery had a particular...

A 15 month old child presented with 12 days of right sided, purulent nasal discharge and six days of progressively worsening bulging, excess fluid/tearing, and eyelid redness of the right eye. Examination revealed pronounced proptosis, chemosis, eyelid erythema, and yellow crusting in the corner of the right eye (fig 1), with no signs on the left. Pupil diameter and pupillary light reflexes were normal in both eyes. The patient was unable to cooperate with further visual examination, so it was not possible to assess visual acuity or eye movements. Three days earlier, intravenous infusion of ceftriaxone sodium had been started, as we suspected acute rhinosinusitis causing orbital inflammation, but this had no effect. The child’s temperature was 40°C, white blood cell count 18.65×109/L (nomal range 4-10×109/L), and a culture of the nasal discharge grew Streptococcus viridans and coagulase-negative Staphylococcus aureus. Orbital infection caused by acute rhinosinusitis was suspected.bmj;380/mar23_6/e068579/F1F1f1Fig 1Clinical photograph...

This Viewpoint discusses policies the Biden administration can enact to reduce costs, including benchmarking Medicare Part B drug payments to the lowest price paid in similar countries, preventing Part D plans from negotiating confidential rebates with manufacturers, and patent reform to promote generic drug use.

This Viewpoint reviews evidence that higher hospital prices reflect greater market power more than higher-quality services and proposes that backstop price caps can mitigate harms from the most excessive prices without constraining or distorting competitive health care markets.

This narrative review summarizes the epidemiology, pathophysiology, diagnosis, management, and prognosis of irritable bowel syndrome.

In this narrative medicine essay an infectious diseases physician shares the sense of forgiveness she brings to anyone possibly involved in COVID-19 transmission, having learned as a child the healing power of family absolution after she witnessed the death of a cousin.