Analogies and analoguesThe words “analogy” and “analogue” come from the Greek word ????????, which had several different meanings, including mathematical proportion, proportion in general, correspondence, and resemblance. The meanings that dominate English today are reasoning on the basis of parallel cases (analogy) and forms of technology other than digital (analogue).Although “analogy” entered English in the 15th century, via the Latin analogia and the French analogie, with the now obsolete meaning of proportion or mathematical agreement of ratios, most of its other meanings did not emerge until the 16th century or slightly later, including “a thing which (or occasionally person who) corresponds to or resembles another; a parallel, an equivalent ….”1Here, for example, is the Elizabethan physician Philip Barrough in The Methode of Physicke in 1583: “Therefore by the example and analogie of one difference of tumours, which are caused thorough defluxion (for here we mind to intreate only of them)...

Bodies of Palestinians returned by Israel as part of a ceasefire deal show signs of torture, execution, and being run over by tanks, hospital workers have said.Sources at Nasser Hospital in Khan Younis, which received the remains, told Middle East Eye (MEE) that several bodies bore strangulation marks, broken bones, and mutilation, while others were missing limbs.1The news comes as UN leaders called for a “massive surge” in aid as doctors in Gaza report that “nothing has changed on the ground” and there is still a huge shortage of aid and medical supplies.Speaking to MEE, the source said that some 45 bodies returned on 14 October were recently killed, while others arrived in a decomposed state or as partial remains.The ceasefire agreement between Israel and Hamas, brokered by the US, included an exchange deal that has seen Hamas release all 20 living hostages taken during the 7 October 2023 attack...

How far will you go to promote your medical invention? This is a question for clinical innovators. How far will you go to market the invention? This is a question for corporations whose primary purpose is to keep pleasing their shareholders. The limits of promotion, of course, should be reached when the balance of benefits and harms is no longer favourable. That balance is a judgment, made by people capable of deciphering the evidence and seeking to protect the public—drug and device regulators, for example.What happens when an intervention seems innocuous, the data are equivocal, and the benefits are more theoretical than demonstrable? Again, it depends. There is no free good; every intervention is a vector of harm—trivial, minor, major, or yet to be determined. It is in these grey areas, where judgment is required, that the peddlers of a new product show their true colours and the vigilance of...

American pharmaceutical giant Eli Lilly has said it will crack down on suppliers who are selling fake versions of its unapproved weight loss drug retatrutide.Social media companies TikTok and Meta have also intervened against black market sellers operating on their platforms.The decision comes after a Channel 4 investigation found that patients have been able to buy fake versions of retatrutide on social media.1 The triple glucagon hormone receptor agonist drug is currently in phase 3 clinical trials, set to conclude in May 2026.2As a glucagon-like peptide-1 receptor agonist, it is similar to other weight loss drugs such as tirzepatide (Mounjaro) and semaglutide (Ozempic, Wegovy). It is also an agonist for glucagon receptors and gastric inhibitory polypeptide.Undercover journalists from Channel 4 were able to buy a fake version of the unapproved weight loss injection online, and find members of the public who had bought the drug from TikTok.A spokesperson for Eli...

The prime minister, Keir Starmer, has ordered a rapid review of how healthcare regulators such as the General Medical Council deal with allegations of racist or antisemitic behaviour in the NHS. The government will also roll out mandatory antisemitism and antiracism training for all 1.5 million NHS staff and has promised a “zero tolerance” approach to discrimination in healthcare.The move follows a case in which a British-Palestinian trainee doctor, Rahmeh Aladwan, was allowed to continue practising pending a full Medical Practitioners Tribunal Service hearing into allegations that she made antisemitic remarks.1Aladwan, who has continued to comment on social media, has been referred for a new interim orders tribunal hearing, set for 23 October.In another recent case, a former consultant surgeon, Manoj Sen, was struck off the UK medical register for antisemitic comments in social media, including calling a Jewish man “vermin” and “rodent.”2The rapid review will be led by John...

A long acting injection given every two months to reduce the risk of contracting HIV is to be made available in England for people who are unable to have a daily prophylaxis tablet.The National Institute for Health and Care Excellence (NICE) said its approval1 of the “groundbreaking” preventative therapy would support the government’s target of eliminating HIV transmissions by 2030.Latest data from the UK Health and Security Agency show that new HIV diagnoses fell by 2% in England from 2838 in 2023 to 2773 in 2024.2“This breakthrough preventative therapy is another powerful tool in our arsenal to reach that crucial goal,” said health secretary Wes Streeting.NICE’s final draft guidance recommends cabotegravir (Apretude, made by ViiV Healthcare) as an option for pre-exposure prophylaxis (PrEP) alongside safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults and young people who weigh at least 35 kg.It is only recommended...

bmj;391/oct16_10/r2181/FAF1faUntil her untimely death aged 44, Scottish born Vicky Johnson, associate professor of neurosurgery at Perelman School of Medicine, University of Pennsylvania, led landmark international research exploring the biology and pathology of traumatic brain injury (TBI), with projects spanning complex pre-clinical models to human pathology studies. She established herself as one of the leaders in TBI research, directing multiple programmes and mentoring many students and postdoctoral researchers.“Traumatic brain injury is a common and often devastating health problem,” she said on the Johnson Laboratory website, highlighting how it affected 2.5 million people a year in the US.1 Johnson’s research focused largely on links between TBI and neurodegenerative diseases such as Alzheimer’s and chronic traumatic encephalopathy, including the short and long term outcomes of sports concussions. Her work advanced understanding of the mechanisms by which acute brain trauma leads to long term neurological decline. She contributed to more than 120 published research...

Healthcare in low and middle income countries in Africa and elsewhere is being “hijacked” by commercial surrogacy companies, experts have warned.At a session at the European women’s rights conference FiLia in Brighton on 12 October, former surrogates and women’s rights campaigners from France, the US, and Germany argued that pregnancy complications such as sepsis, postpartum haemorrhage, and pre-eclampsia are higher in surrogate pregnancies and that the industry is distorting healthcare provision in commercial surrogacy destinations.Marie Josephe Devilliers, president of the feminist organisation International Coalition Against Surrogate Motherhood, presented evidence of such practice in Uganda, where a medical sector has been developed for in vitro fertilisatoin (IVF) and reproductive surrogacy but where local women cannot access obstetric care. The situation is similar in South Africa, where “ordinary citizens have little access to medical care for their own pregnancies, but the most sophisticated clinics are available for surrogate pregnancies,” Devilliers said.Lexi Ellingsworth,...

Almost a quarter of children needing community care services in England are waiting over a year for treatment, with 1 in 15 waiting two years, an analysis by two healthcare think tanks has found.1The Nuffield Trust and the Health Foundation said the “unacceptable” figures were placing children’s health and life chances at risk and should serve as a “wake-up call” for the government. The think tanks said their findings, published on 16 October, showed that many young people with disabilities and developmental problems faced potentially damaging delays to treatment.Failing to tackle the problem could derail ambitions laid out in the NHS’s 10 year plan to move more care out of hospitals into the community, they warned.2Community health services see and treat more than two million patients each month in England, with more than eight million care contacts, accounting for around 13% of all daily activity in the NHS.In July 2025...

The report on surrogacy presented to the United Nations General Assembly in October by special rapporteur Reem Alsalem concludes that “The practice of surrogacy is characterized by exploitation and violence against women and children, including girls”.1 Its key recommendation is to eradicate all forms of surrogacy around the world. Alsalem’s report has, predictably, prompted highly polarised responses, with some commentators welcoming its conclusions, and others responding with outrage.234Two things need to be said here. Firstly, Alsalem is the UN special rapporteur on violence against women and girls, and the report is entitled “The different manifestations of violence against women and girls in the context of surrogacy.” The report therefore takes a particular viewpoint and is not intended as an objective survey of the global surrogacy landscape. Secondly, although the special rapporteur can make recommendations, the UN is under no obligation to accept them. This report is therefore a prompt for...

The World Health Organization has been forced to cut dozens of staff in Europe over the past few weeks, as the US withdrawal continues to hit the agency hard.Speaking at the World Vaccine Congress Europe in Amsterdam on 15 October, Robb Butler, WHO Europe’s director of the division of communicable diseases, environment, and health, said 32 staff had been cut from his division in the past three weeks. “We’ve taken a very heavy hit. The politicisation of health is a very raw and real thing in the WHO European region at the moment,” he said.The Trump administration withdrew from WHO in January,1 saying that the UN agency had mishandled major international health crises. The US had previously contributed around 18% of WHO’s funding.Between January and July this year WHO reduced its staff by 221, according to Health Policy Watch, from 9452 to 9231.2 In March WHO said it would have...

The BMJ editorial on declining childhood vaccine uptake in England is both sobering and timely.1 The authors rightly highlight fragmentation, austerity, and service delivery barriers, but they linger within the boundaries of traditional paradigms. I urge a more radical, systemic response—one that dares to reframe the entire vaccine ecosystem in the UK.First, it is time to recognise that our current model—a patchwork of institutional silos, short term funding, and legacy outreach—is not simply strained but obsolete. Instead of incremental tweaks, let’s pilot “vaccine broker” hubs: hyperlocal, interdisciplinary teams embedded in schools, community centres, and pharmacies. These hubs would not just deliver immunisations but also build authentic relationships with families—leveraging data science to predict hesitancy, tailor outreach, and triage barriers in real time.2Second, digital transformation remains underused. Although reminders and portals exist, the future lies in intelligent scheduling and artificial intelligence (AI) driven nudges embedded into the everyday digital footprint of...

Advances in cancer treatment have affected patients worldwide. However, these advancements have also introduced new risks that must be balanced against the benefits of treatment. One potential complication is cancer therapy related cardiac dysfunction, when certain anticancer agents unintentionally damage healthy heart tissue.1 This leads to impaired cardiac function and occurs through mechanisms such as oxidative stress, mitochondrial dysfunction, disruption of cardiomyocyte signalling, and inflammation.1 For example, anthracyclines generate reactive oxygen species that impair mitochondrial function, leading to toxicity in cardiomyocytes and other cardiac cells. Six out of 100 patients undergoing cancer treatment each year will experience this cardiac dysfunction.2 The incidence increases to 10 out of 100 for adults aged 50 years or older, and it is highest in patients with breast cancer. Treatment interruptions or even discontinuation may result, leading to additional burdens to patients and a lower quality of life.3Risk prediction refers to the likelihood of a...

AbstractObjectivesTo systematically review all prediction models developed or validated for cancer therapy related cardiac dysfunction (CTRCD) and to quantitatively analyse their performance.DesignSystematic review and meta-analysis.Data sourcesEmbase, Medline, and the Cochrane Central Register of Controlled Trials, from inception to 23 August 2024.Eligibility criteria for selecting studiesStudies that developed or externally validated multivariable models to predict CTRCD risk in young people (children, adolescents, and young adults (?39 years)) or older adults (?40 years) with cancer or cancer survivors treated with systemic antineoplastic agents. Studies on radiation induced cardiotoxicity were excluded.MethodsTwo reviewers independently screened studies, extracted data, and assessed risk of bias using the Prediction model Risk Of Bias ASsessment Tool. Performance measures were pooled using random effects meta-analyses.Results56 studies were included, reporting 51 developed models and 12 externally validated models. Most models were developed in adults (n=34/51, 67%), primarily for breast cancer (n=20/34, 59%) or haematological malignancies (n=6/34, 18%) to determine pretreatment risk (n=33/34, 97%). In young people, most developed models (n=16/17, 94%) focused on long term risk assessment, mostly in survivors of haematological malignancies. Discrimination and calibration metrics were reported for 13/51 (25%) developed models and 6/44 (14%) external validations. Nearly all models were at high risk of bias. 12/51 (24%) developed models underwent external validation, four of 17 (24%) in young people and eight of 34 (24%) in adult populations. The Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) tool was the most frequently validated (11 times), mainly in patients with breast cancer receiving HER2 (human epidermal growth factor receptor 2) targeted therapies (5/11, 45%). Across all external validations, this tool consistently underestimated risk, with observed event rates exceeding predicted risks, especially in studies where mild CTRCD was the most frequently reported outcome. Among patients with breast cancer treated with anti-HER2 agents, the pooled C statistic was 0.60 (95% confidence interval 0.52 to 0.68). In this population, observed pooled event rates were 12% in the low risk group (<2% predicted), 15% in the medium risk group (2-9%), 25% in the high risk group (10-19%), and 41% in the very high risk group (?20%).ConclusionsExisting prediction models for CTRCD need additional evidence before widespread clinical adoption. Poor reporting of key performance metrics and limited external validation studies currently restrict their thorough evaluation. The HFA-ICOS tool shows suboptimal performance, especially when mild forms of CTRCD are included as events. Future research should prioritise validating and updating existing models using large, clustered datasets across various malignancies to enhance the assessment of their performance, generalisability, and clinical utility in routine practice.Systematic review registrationPROSPERO CRD42023475469.

There was standing room only in my hospital’s big lecture theatre for a recent seminar about retirement from the NHS. I recognised many staff, now in their 50s and 60s, who I’ve worked alongside for a quarter of a century. It was palpably sad to see the NHS potentially losing so many experienced, wise people who know how things work and hold the collective memory of an organisation. The event felt like a surreal group lifestyle clinic with colleagues,1 and I sensed a cohort limping through their workload, hoping to reduce some heavy financial burdens and get a chance to breathe.Many doctors assume that perfectionism and presenteeism are the only acceptable ways of working until they suddenly stop for retirement. It’s precisely this approach to work that can lead to burnout, poor retention, and staff retiring earlier than they might. But the NHS now offers more flexible ways of working,...

bmj;390/sep23_12/r1979/FAF1faHugh was born in Rugby on 10 August 1941. He attended Lawrence Sheriff School before going to Bristol University, where he obtained his medical degree followed by a diploma in obstetrics and gynaecology. He worked in general practice for a short period before changing to pathology, working first at the Bristol Royal Infirmary and Frenchay Hospital before going to the John Radcliffe Hospital in Oxford. Here, he mainly worked in pathology of the heart and the breast.He was appointed consultant histopathologist at the Leicester General Hospital in 1978, where he stayed until his retirement in 2003. Much of his work during this period was in renal pathology, where he supported the hospital’s kidney transplant programme, but he was also involved in histopathology for all other departments. For much of his time there he was the hospital’s senior pathologist; he also served a term as head of department, overseeing other specialties...

GPs in England are being advised to make it standard practice to rethink if a patient has had three appointments and not been offered a substantiated diagnosis or has had worsening symptoms.A new initiative—known as Jess’s rule—is being rolled out across England to speed up diagnosis of serious illnesses such as cancer, particularly in young people.It is named after Jessica Brady, who died of cancer aged 27 after 20 appointments at her GP surgery failed to diagnose her condition in 2020. She eventually sought private healthcare and was diagnosed with stage 4 adenocarcinoma later that year. Brady was then admitted to hospital where she died three weeks later.The scheme—overseen by NHS England and the Department of Health and Social Care (DHSC)—advises GPs that if they have not been able to make a substantiated diagnosis, or the patient’s symptoms have escalated, then they should consider taking further steps.These include arranging a...

The UK government was dealt a major blow earlier this month when the US pharmaceutical giant Merck announced that it has halted construction on its £1bn London research centre.This was the latest in a series of setbacks that have thrown the UK’s life science sector—described by the government as “one of the crown jewels” of the country’s economy—into disarray.Merck, known as MSD in Europe, has also cancelled ongoing projects at the Francis Crick Institute in London and will move its life science research to the US. The company accused successive UK governments of not investing enough in the sector and of paying too little for innovative drugs and vaccines.Days after Merck’s announcement, AstraZeneca said it was putting a new £200m laboratory in Cambridge on hold, having in January already cancelled a £450m investment in its vaccine site at Speke, Liverpool.Eli Lilly also recently paused a planned investment in a biotech...

F. Gordo Vidal
Med Intensiva. 2023;47:191-2

Texto completo - PDF

Francisco Álvarez-Lerma, Mercedes Catalán-González, Joaquín Álvarez, Miguel Sánchez-García, Mercedes Palomar-Martínez, Inmaculada Fernández-Moreno, José Garnacho-Montero, Fernando Barcenilla-Gaite, Rosa García, Jesús Aranaz-Andrés, Francisco J. Lozano-García, Paula Ramírez-Galleymore, Montserrat Martínez-Alonso
Med Intensiva. 2023;47:193-202

Resumen - Texto completo - PDF