Medicine and Science from The BMJ

The US UK trade deal will cost the NHS billions, and only serve to increase pharma profits

The new trade deal struck between the UK and US came into force in April. 
The deal will
double the amount that the NHS spends on new medicines, by the end of 2036 (from 0.6 - 0.6% of GDP).
 increase the threshold that the National Institute for Health and Care Excellence (NICE) sets for drug approvals - which will allow more to be approved, but will also allow companies to charge more for their pharmaceuticals,
 include a change to the rebate the NHS receives, to ensure that the extra drug spend occurs.
Cumulatively this will increase our drug spend by £56 billion in the next 10 years, which will have to come out of current healthcare spending - which experts are calling a catastrophe for the NHS.
Joining Kamran Abbasi to discuss are Sally Gainsbury, a senior policy analyst Nuffield Trust and Karl Claxton, professor of economics at the University of York. We also hear from Francis Ruiz, policy analyst at the London School of Hygiene and Tropical Medicine.
Reading list
The UK government must publish a detailed impact assessment of the costs and benefits of the US-UK medicines partnership
A budget apart: the case for ringfencing medicines in the UK
 
 
 
 

MS drug controversy, adoption outcomes in Sweden, and the multi-factorial reality of Alzheimer’s

A blockbuster MS drug undergoes FDA re-evaluation. We explore the story of Ocrelizumab, a treatment for primary progressive multiple sclerosis, following a patient petition that highlighted internal disagreements among agency reviewers regarding its efficacy.
We look to Sweden, where new research involving sibling pairs separated by adoption investigates how early-life environments shape long-term health and social outcomes.
Finally, we revisit the dominant medical narrative on Alzheimer’s disease. Why is it so difficult to move towards comprehensive treatments? Has the focus on amyloid plaques hindered our understanding of other critical factors like vascular health and social inequality?
Peter Doshi is a senior editor at The BMJ and an associate professor of pharmaceutical health services research at the University of Maryland.
Erik Peterson is an associate professor at the Karolinska Institute in Stockholm, specializing in psychiatric epidemiology and adoption studies.
Carol Brayne is a professor emerita of public health medicine at the University of Cambridge and a leading expert in the epidemiology of dementia.
Reading List:
Multiple sclerosis: Could Roche's bestselling drug Ocrevus be doing more harm than good in women with primary progressive MS?
Home environment conditions during childhood and psychosocial outcomes across three generations in Sweden: population based adoption-discordant sibling comparison study
 

The Trump administration is an international health emergency

Covid 19 was the last Public Health Emergency of International Concern (PHEIC). Our guests in this podcast think that the Trump Administration should be declared the next one.
Joining Kamran Abbasi are, Fatima Hassan,  human rights lawyer and Director of the Health Justice Initiative in South Africa, and Matthew Herder, Director of the Health Justice Institute at Dalhousie University in Canada explain why they think that the actions and consequences of the Whitehouse meet the bar for WHO to delcare an emergency
We examine the global consequences of recent US policy shifts, including:
The withdrawal from the World Health Organization (WHO) and its implications for international health governance.
Significant funding cuts to global health programs, including PEPFAR and the CDC, and how these disruptions affect life-saving HIV and TB treatments in the Global South.
The rise of "unhinged nationalism" in health policy, from North American measles outbreaks to the extraction of trade concessions in exchange for medical aid.
The role of US health leadership in fueling vaccine hesitancy and dismantling scientific research at the NIH.
 
Reading list:
Trump and his administration as a public health emergency of international concern
Why the expanded global gag rule is a deadly triple tripwire for recipients of US foreign aid
The power of the markets: the scandal that keeps on taking

The 15th strike, and bringing compassion back to A&E

Coming up in this week’s episode:
The 15th Strike: As the latest six-day walkout by resident doctors in England concludes, the BMJ's news team examines the state of the ongoing dispute over pay and training places.
Iain Beardsell, consultant in emergency medicine in Southampton explain why he thinks reintroducing compassion could be the key to tackling the systemic issues facing emergency departments
And finally, The BMA announces major changes to how it represents doctors in private practice - we hear why they think the US has some better legislation around health insurance than the UK.
 
Reading list:
Resident doctor strikes: Streeting demands to “meet with the organ grinders” as latest action ends
The BMJ interviews Jack Fletcher 
Make compassion visible in emergency medicine again
BMA boosts support for private practice as NHS failings prompt more patients to pay for care

The unchecked rise of shisha tobacco cafes, and making breastfeeding stick

The BMJ published a negative result this week. A new trial focuses on a peer support intervention for improving breastfeeding rates in the UK, but finds no major improvement. We hear from the lead author who tells us what went wrong, and the insights that can still be drawn from apparent ‘failures’.
Next we turn our eyes to shisha smoking in the UK. With shisha or “hookah” cafes on the rise, we explore the smoking habit in more detail. What are the effects on health? And why are UK laws poor at regulating the practice?
 
Kate Jolly is professor of public health and primary care at the University of Birmingham.
Zainab Hussain is a UK-based freelance journalist writing on behalf of The BMJ.
Links:
Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial
Shisha tobacco’s availability is rising. Why does UK smoking policy fail to tackle it?

New Covid inquiry findings with Dr Kevin Fong, and invasive cosmetic procedures

The UK Covid Inquiry released Module Three of its findings this month. It lays out in startling detail the lived experiences of NHS staff and patients who bore through the pandemic. In the report’s words: ‘healthcare systems coped with the pandemic, but only just’.The BMJ speaks to Kevin Fong, anaesthetist lead for major incidence planning at UCL hospitals, to break down Module Three’s most important takeaways.And, invasive surgical cosmetic procedures are on the rise in the UK, with regulation patchy at best. From botox and fillers, to tummy tucks and breast surgeries, we hear about the gaps in patient protections that leave space for harm.Kevin Fong is a consultant anaesthetist, broadcaster, and anaesthetist lead for major incidence planning at UCL hospitals.Danielle Griffiths is an author and lecturer at the University of Liverpool’s School of Law.Alexandra Mullock is an author and senior lecturer in medical law at the University of Manchester.UK Covid Inquiry Module Three ReportRegulating invasive cosmetic procedures to reduce harm | The BMJ

How the war in Iran will disrupt medical supplies around the world

The Gulf states are not large producers of pharmaceuticals or healthcare products - but the oil they supply, and the transport infrastructure they have built, are key components in a worldwide logistical network that underpin all of the pharmaceutical and other medical consumables we use.
From critical NHS shortages like Bone Cement for orthopedic surgery, to persistent IV fluid supply crises plaguing Australian hospitals, we discuss how the conflict in Iran will affect fragile healthcare logistics.
Joining us today are 
Mark Dayan, Brexit programme lead at the Nuffield Trust) on NHS procurement problems 
Anny Huang, doctor and journalist in Brisbane,on the three-year  IV fluid shortages in Australia.
Prashant Yadav a senior fellow for global health at the Council on Foreign Relations, on the potential global effects of the Iranian conflict on international supply chains.
Reading list
Global bone cement shortage: NHS could cancel or delay knee and hip operations
How Australia survived a sudden shortage of IV fluids
Where the Iran War Could Disrupt Pharmaceutical Supply Chains
 

Is the NHS in danger of making misinformation worse?

The lure of health influencers and AI chat bots is strong. More and more people are placing trust in them to answer their health problems, misplaced trust - as we know these AIs can misinform.
At the same time, people are struggling to access the NHS, and when they do doctors have little time or the right tools to unpick complicated science, and challenge misunderstandings.
So in this roundtable, we’re asking, are we in danger of the NHS making the problem of misinformation worse, and what can we do to combat that.
Joining Kamran Abbasi, the BMJ’s editor in chief are:
Deborah Cohen: Freelance Journalist; Senior Visiting Fellow at LSE Health
Kamila Hawthorne: Chair of the National Academy for Social Prescribing
Nnena Osuji: Consultant haematologist and CEO of North Middlesex University Hospital NHS Trust
Chapters
[00:00] The rise of health influencers
[03:55] Patient satisfaction and the NHS
[05:58] The "Infodemic" and clinical impact
[11:04] Digital literacy and health inequalities
[16:40] Questions from the audience
 
Reading list:
Cohen D. Bad Influence: How the Internet Hijacked Our Health. Oneworld Publications; 2026.
Satisfaction with NHS hits record low, but public still back founding principles - The BMJ

What should GP's make of the new NHS contract?

In this episode, Dr Katie Bramall, Chair of the BMA’s General Practitioners Committee, joins the podcast to discuss her concerns surrounding the new GP contract imposed by the UK government.
GP contract overhaul: What's included and how has it been received?
Helen Salisbury: Another imposed GP contract

Household air pollution, Labour’s lag on child poverty, children forced to cope with conflict

As public health officials warn about rising emissions from urban wood burning, a BMJ investigation finds that just under a third of UK councils in high use areas have faced pressure from the stove industry to tone down or withdraw campaigns.
Almost a third of UK children live in poverty. Leading expert Michael Marmot weighs in on the UK’s "steepest rise" in child poverty among OECD countries and why local government "Marmot Cities" like Coventry and Manchester are taking the lead where national policy falls short.
And, a new BMJ collection has just been published on child mental health in conflict zones. 1 in 5 children globally live in conflict zones, creating a staggering mental health toll. We hear about community-led interventions.
 
Reading list:
The growing threat of domestic wood burning stoves—and industry’s legal attempts to shut down clean air campaigns
Michael Marmot: Labour has reneged on its child poverty promises
Child mental health in conflict settings