The UK’s medicines regulator has approved the first immunotherapy to be licensed to delay the progression of type 1 diabetes in patients who are in the early stages of the disease.The Medicines and Healthcare Products Regulatory Agency (MHRA) said teplizumab (Tzield), manufactured by Sanofi, can be given to adults and children aged 8 years and older who have stage 2 of the condition1 and are at high risk of progressing to stage 3.Patients who have reached stage 3 have usually started to have blood sugar problems and are then diagnosed with type 1 diabetes, which requires lifelong insulin treatment.A 14 day course of daily infusions of teplizumab has been shown to delay patients at high risk of developing the condition from reaching stage 3 by an average of three years, the MHRA said. It works by binding to certain immune cells, and may deactivate the immune cells that attack insulin...

Doctors will be able to prescribe a new treatment for people with inflammatory bowel disease (IBD), after the UK medicines watchdog approved guselkumab (Tremfya) for use on the NHS.The National Institute for Health and Care Excellence (NICE) has recommended the biological treatment as an option for patients with moderate to severe ulcerative colitis or moderately to severely active Crohn’s disease who have not responded well to other treatments or have experienced unacceptable side effects.Ulcerative colitis and Crohn’s disease—two types of IBD that cause inflammation and ulcers in the large bowel or gut—together affect an estimated 500 000 people in the UK, said the charity UK Crohn’s and Colitis UK. Inflammatory bowel diseases can develop at any age but are most often diagnosed in people under 30.Guselkumab is currently approved to treat plaque psoriasis and psoriatic arthritis, but clinical studies have shown that it is also effective in treating adults with...

Recent publication of the NHS’s 10 Year Health Plan for England, with its renewed emphasis on pay for performance, presents an important moment to reflect on past models like the Quality and Outcomes Framework (QOF) and to learn from international experience.QOF, launched in 2004, was a pioneering effort to improve primary healthcare through a pay for performance model. The framework financially rewards providers for high performance or quality. Two decades later, however, the limitations of this approach have become evident. The initial gains in quality have plateaued, a trend that has been interpreted as “incentive fatigue.”1 General practitioners are increasingly demoralised with their work as the administrative burdens and job complexity continue to rise,12 emphasising that financial incentives are only effective when they reinforce professional purpose and promote cohesive teams, autonomy, and good working conditions.If pay for performance models are to help overcome the current challenges in primary care, they...

Doctors working with Médecins Sans Frontières (MSF) in Sudan have treated more than 2300 cholera patients in the past week and have seen 40 people die from the infection.Sudan, which has been engulfed by civil war since April 2023,1 has been experiencing a cholera outbreak for over a year, with around 100 000 suspected cases and more than 2470 related deaths reported.Tawila, North Darfur State, has seen the worst impact, as 380 000 people have fled fighting in the nearby city of El Fasher. People in the town are currently surviving with just three litres of water a day—less than half the emergency minimum of 7.5 L needed for drinking, cooking, and hygiene.Sylvain Penicaud, MSF project coordinator in Tawila, said, “In displacement and refugee camps, families often have no choice but to drink from contaminated sources and many contract cholera. Just two weeks ago, a body was found in a...

bmj;390/aug15_6/r1745/FAF1faKen was born in Pontefract, West Yorkshire, as a second son. His elder brother Roger had died at birth two years earlier, but his existence was acknowledged right throughout Ken’s life and influenced his upbringing. Ken’s birth involved an emergency caesarean section and post-natal infection, and a recommendation of no further pregnancies for his parents.After being unsuccessful in his preferred choice of study as a vet, Ken decided to focus on patients of the two legged variety, graduating from Manchester medical school in 1963. House and junior doctor jobs followed around the north west of England, before he became a respected consultant surgeon at Bury General Hospital and latterly at Fairfield, before retiring in 2001.He was one of the last of the truly general surgeons, where his skills ranged from stripping veins and removing lumps and bumps, to complex colorectal and hepatobiliary procedures. Many of the consultants and GPs who...

The recent drop in the NHS waiting list hailed by ministers as a sign of progress in tackling the treatment backlog has given a “misleading” impression of the service’s ability to meet demand, a report from two healthcare think tanks has concluded.Last month NHS England and the government reported the waiting list had dropped to a 26 month low, with health secretary Wes Streeting saying that the drop was “not a coincidence—it is because this government has delivered on the Plan for Change.”1But an analysis from the Nuffield Trust and the Health Foundation concluded that the statistics “do not necessarily mean that more need is being met.”2 Instead, the drop was driven by “unreported removals” rather than the number of patients being treated exceeding new additions to the list.“Unreported removals” refers to patients who are removed from the waiting list without being treated. This can occur, for example, if a...

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