British Medical Journal

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Judge rebukes expert witness in injured baby case for series of failings

Lun, 03/10/2022 - 17:26
A leading neuroradiologist who was an expert witness in an injured baby case has been strongly criticised by the judge in the case, who said that Robin Sellar “had not read the relevant documents, not fully read the literature . . . and had misread and misinterpreted the relevant research.”1Sellar, a professor at Edinburgh University, was an expert witness in a case brought by Hertfordshire County Council against a mother and father over their 7 week old baby’s serious brain injuries. The council brought care proceedings against the parents, based on a report it commissioned from a consultant neuroradiologist named only as Dr N, who said he could not “recall ever having seen such an injury as a result of an episode of domestic impact trauma.”However, Dr N’s report was based on incomplete information early in the case, and four consultant paediatric neuroradiologists at Great Ormond Street Hospital later produced...

Labour pains left behind by a united and confident party conference

Lun, 03/10/2022 - 17:06
Labour Party conferences have been factional and unsettled affairs for some years. Health campaigning in the Corbyn era was largely against fictional NHS privatisation. And fights then between the dominant hard left and the centrists made the annual conference atmospheres tense, if not actually unpleasant.This was not so in Liverpool last week. For the first time in many years Labour actually seemed, sounded, and acted like a prospective party of government. This was all helped by the government’s self-immolation over the mini-budget, which hit the bond and sterling markets hard.AnnouncementsLabour’s conference saw big pledges on the NHS.1 Shadow chancellor Rachel Reeves promised that reversing the cut to the 45 p top rate of tax will fund a variety of increases in NHS workforce training. The money would fund a doubling of district nurses qualifying every year, 5000 new health visitors, and additional 10 000 nurse and midwife placements each year.More...

Why it is important to discuss what antidepressants do

Lun, 03/10/2022 - 16:51
Kendrick and Collinson suggest that we overstepped the data in discussion of the relevance of our serotonin paper to antidepressant use.12 The serotonin hypothesis was propagated by drug companies and academics as a rationale for why people should take antidepressants. It is still widely disseminated,3 but the evidence is unconvincing. No other biological hypotheses for depression are proved or accepted.4If there is no conclusive evidence that antidepressants work by reversing an underlying abnormality, we must consider other plausible explanations for how they might work. We know antidepressants, like other psychoactive drugs, produce subtle mental changes,5 including emotional numbing.6 These are likely to affect depressive symptoms and might, along with physical effects, produce amplified placebo effects (which are not refuted by the paper cited, as there is good evidence of unblinding7 and expectation effects in antidepressant studies).8 We suspect that few patients are currently given this information.The antidepressant trials mentioned routinely...

Sixty seconds on . . . the “twindemic”

Lun, 03/10/2022 - 10:36
An epidemic of twins?Although the rate of multiple births in the UK has been rising over the past 20 years, it’s starting to slow down, in line with singleton births.1 But this isn’t about twins. We’re talking about the dual epidemics of flu and covid-19 which will be in circulation this winter.Oh, brother!Indeed. Public health officials are certainly getting worried. Last week the UK Health Security Agency urged parents to vaccinate their 2 and 3 year old children against flu this year, because of fears over a lack of natural immunity caused by reduced exposure during the pandemic.2 All those eligible for a flu vaccine should also book their jab, it said.The deadly twins?Possibly. An analysis by health analytics company Airfinity has estimated that hospitals in England could see more than 7500 people admitted to hospital every week in January 2023 with covid-19 or flu (under different scenarios, such as...

Young women and anal sex: should we consider rectal PAP smear testing?

Vie, 30/09/2022 - 14:46
Thank you for drawing attention to the increase in heterosexual anal intercourse.1 In 1983 while finishing my master’s thesis and building a sexual function questionnaire for my study, I obtained my data for the tool using heterosexual female graduate students. Anal intercourse activity was reported by 10%.If anal intercourse is becoming more common, then perhaps it is time to begin anal Papanicolaou test screening on those women reporting such practices—similar to current screening in men who have sex with men—to screen for human papillomavirus.

Young women and anal sex: healthcare professionals must normalise questions about what is normal for many people

Vie, 30/09/2022 - 14:41
Discussion about sex, particularly the neglected topic of anal sex in women, is uncommon in general medical journals and raising of awareness is a generally positive thing.1 We are concerned, however, that it has been framed in a negative and judgmental way.There may be potential physical trauma from anal sex, and anatomical differences could play a role, but there is a risk of trauma from all sexual intercourse. Evidence that anal sex is more “dangerous” in women is lacking—one quoted study shows the impact of anal sex on faecal incontinence was greater in men,2 another does not describe higher risk in women.3 The editorial lacks advice about minimising risk, such as using lubrication or condoms, a missed opportunity to offer practical advice.There is excessive emphasis on coercion and pressure. All coercive sexual activity, anal or otherwise, is highly concerning and questions about non-consensual sex are routine in sexual health services....