Public health experts have warned that inadequate policies on conflicts of interest in government commissioned research into gambling “will only lead to more harm” for members of the public.Last year the government announced that gambling operators would have to pay up to 1.1% of their profits as part of a new levy, to generate £100mn for the “research, prevention, and treatment of gambling harms.”1A fifth of the cash has been set aside for research, led by UK Research and Innovation (UKRI) and its arts and humanities arm, the Arts and Humanities Research Council. The move came after decades in which gambling researchers had to apply to industry funded charities for funding.UKRI opened its call for researchers to work on its “gambling harms research coordination centre” in June.2But a group of researchers have told The BMJ that the call threatens the “opportunity for a fresh start” offered by the levy funds...

Leading urologists have called for an end to the routine use of the digital rectal examination, but it is still an important part of the holistic assessment of patients.1 As access to diagnostic tests in the NHS continues to be a problem, the combination of a borderline concentration of prostate specific antigen together with a prostate that feels abnormal on examination should help fast track a patient for further investigation.Jones et al report the sensitivity and specificity of digital rectal examination as a predictor of prostate cancer in symptomatic patients to be “28.6 and 90.7%, respectively.2 The positive and negative predictive values were 42.3 and 84.2%, respectively.” These numbers are not insignificant and shouldn’t be discounted.A rectal examination can help diagnose many conditions, including prostatitis, constipation, and colorectal cancer, and it is still recommended in NICE guideline NG12: “People with a rectal mass, an unexplained anal mass, or unexplained...

The global south, home to 85% of the world’s population, has disproportionately high disease burden and fragile healthcare systems. Mass net emigration of doctors to the global north—known as “medical brain drain”—is of existential concern to global healthcare and equity. For the countries that raised and educated these doctors, this loss is tied to poor population health and reflects a failing state.1Nigeria exports the most health workers in Africa—13 609 in 2021-22—and is second globally only to India (42 966), with the Philippines third (11 021).23 At least 16 000 doctors have left Nigeria in the past 5-7 years—around nine a day—leaving just 3.9 doctors per 10 000 population (India has 7.3, the Philippines 7.8, the US 36, and the UK 32).45 These doctors largely go to high income economies, where there is a growing demand for primary care physicians for ageing populations.6 On average, it costs $21 000-$59 000...

The author and barrister John Mortimer once quipped that “no brilliance is required in law, just common sense and relatively clean fingernails.”1 I was reminded of this quote on a visit to my GP for a check-up. A medical student was present, and, when the doctor asked them to examine my cubical fossa, I noticed their long, dirty fingernails that lingered on my skin.Medical students who are present at patient consultations may believe they blend into the background, but the opposite is often true. The consultation room, like the courtroom, is a peculiar setting that amplifies actions and words and where a look, a sigh, or a pause can take on great significance. As the student watches the patient, the patient observes them in response, especially during those silent moments when the doctor’s attention is focused elsewhere.In the GP consultation room, I noticed how the student sat with a wide...

United Medical Associate Professionals (UMAPs) has lost its High Court bid to temporarily prevent NHS England from carrying out the recommendations outlined in the Leng review last week (15 August) but insists the “fight goes on.”1The union for physician assistants, known as physician associates before Gillian Leng’s independent review recommended a name change,2 sought an injunction to halt NHS England from rolling out this name change and barring PAs from seeing undiagnosed patients.UMAPs said that the case, although it “did not result in injunctive relief,” had clarified that it was up to individual NHS employers to decide whether to implement the changes. The union has urged “all NHS trusts and primary care networks to await the outcome of our upcoming judicial review before making any changes to medical associates’ job roles.”In response a spokesperson for NHS England said, “We will continue to work with partners across the NHS and the...

When consultant psychiatrist Suhana Ahmed gave birth in 2013 she had a long difficult labour followed by little sleep for months as her baby struggled with colic and reflux.“I can see now there were a number of things that contributed to my postnatal depression (PND),” says Ahmed, who is deputy chief medical officer at West London NHS Trust. “But by the time Daniel was 6 months old I was suicidal. I had written suicide notes and I was probably days away from ending my life.”Talking about this personal and deeply traumatic experience has not been easy—but she has found that when she shares what she has been through, other doctors open up about their own challenges.Even for those working in psychiatry, there remains stigma around doctors having mental health problems, says Ahmed, who is also a north west London higher trainee leadership and management tutor and Royal College of Psychiatrist...

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