The BMJ最新文献

{"title":"Self-regulation of UK’s pharmaceutical industry","authors":"Piotr Ozieranski, Shai Mulinari, Cinzia Colombo, Barbara Mintzes","doi":"10.1136/bmj.r1065","DOIUrl":"https://doi.org/10.1136/bmj.r1065","url":null,"abstract":"Industry body’s decision to accept Novo Nordisk back reflects systemic failures The Association of the British Pharmaceutical Industry (ABPI) is one of the UK’s most powerful lobby groups, representing more than 150 companies. In addition to shaping pharmaceutical, science, and trade policy,1 it oversees industry standards for promoting prescription medicines and interacting with patients, healthcare professionals, and the NHS.2 The ABPI sets a code of practice that is administered by Prescription Medicines Code Practice Authority (PMCPA), and companies are expected to uphold the standards. If a company is found to breach the code, it must detail planned corrective actions3 and in severe cases may receive a public reprimand or an audit of company procedures; the ABPI board may also suspend or expel a member.3 The ABPI’s code of practice often surpasses standards adopted by comparable European trade groups,4 and its signatories attract more complaints about ethical breaches.5 For example, in 2023 the PMCPA received 149 complaints6 compared with 103, 59, and 22, respectively, for its counterparts in Switzerland, Sweden, and Germany.7 The ABPI regards the high volume of …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stepping back from the brink: time for reason and rapprochement between India and Pakistan","authors":"Zulfiqar A Bhutta, Sanjay Nagral, Srinath Reddy, Tayyaba Butt, Iqbal A Memon, Huma Cheema, Neelam Mohan, Rajeev Seth, Monica Thomas, Jamal Raza, Samiran Nundy","doi":"10.1136/bmj.r1102","DOIUrl":"https://doi.org/10.1136/bmj.r1102","url":null,"abstract":"Paediatricians from all over the world—including many from India and Pakistan—assembled in Mexico City last week at the biennial International Congress of Pediatrics. They convened just as India and Pakistan once again stepped closer to an open conflict, and we watched and listened with extreme concern and dismay as military exchanges with missiles and drones escalated the situation and inflicted death and destruction in both countries. Just as the region appeared to slide down the slippery slope of war and potential nuclear conflagration, a temporary ceasefire was hurriedly agreed. The region once again teeters at the brink of conflict, reflecting deep rooted mistrust. Relations have sunk to an all-time low, and there is an absence of civil society and track two diplomacy. As medical professionals we are dismayed at this turn of events and its potential consequences, which will affect many generations. We do not dwell on the genesis of the recent conflict, nor the longstanding problems that underlie this mistrust and animosity. We recognise though that the trigger for the current exacerbation was the deplorable act of killing innocent tourists in Pahalgam, Kashmir on 22 April 2025.1 These despicable acts of terrorism against innocent civilians are now commonplace in the region and must be condemned in the strongest terms. Such acts include the hijacking of a passenger train in Balochistan in March …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A village doctor-led mobile health intervention for cardiovascular risk reduction in rural China: cluster randomised controlled trial","authors":"Xingyi Zhang, Siming Wang, Xingyu Zhou, Yajie Tang, Liying Xing, Shaoning Ma, Yan Xu, Chaoqun Wu, Jianlan Cui, Yang Yang, Chunying Lin, Yi Wu, Haibo Zhang, Lei Fan, Chunxiao Xu, Xi Li","doi":"10.1136/bmj-2024-082765","DOIUrl":"https://doi.org/10.1136/bmj-2024-082765","url":null,"abstract":"Objective To assess the effectiveness of a village doctor-led mobile health intervention on cardiovascular risk reduction among residents in rural China. Design Cluster randomised controlled trial. Setting 127 villages from five provinces and autonomous regions in China. Participants 4533 participants from 127 villages: 2297 (64 villages) were randomly assigned to the intervention group and 2236 (63 villages) to the control group. Participants were aged ≥35 years, had no established atherosclerotic cardiovascular disease (ASCVD) but a predicted 10 year risk of ≥10%, had contracted a family doctor service with the local village doctor, and owned a smart phone. Interventions In addition to usual clinical care and basic public health services provided for the control group, the intervention led by village doctors included five components: assessing risk factors to identify individualised intervention targets, setting gradual goals based on doctor-participant communication, providing targeted short videos on health education, conducting health monitoring with periodic feedback, and providing motivation to reduce risk based on gamification. Main outcome measure Mean change in predicted 10 year risk of ASCVD from baseline to 12 months. Results Enrolment took place between March 2023 and May 2023. During the 12 month follow-up (completion rate 99.4%), the 10 year risk of ASCVD decreased from 18.0% to 11.7% in the intervention group and from 17.8% to 13.6% in the control group (absolute difference −1.88% (95% confidence interval (CI) −2.57% to −1.19%; P<0.001). Compared with the control group, the intervention group showed larger reductions in lifetime ASCVD risk (−15.9% v −11.0%; difference −4.59%; P<0.001), systolic blood pressure (−23.2 mm Hg v −15.2 mm Hg; difference −7.64 mm Hg; P<0.001), diastolic blood pressure (−10.9 mm Hg v −6.9 mm Hg; difference: −3.59 mm Hg; P<0.001), fasting blood glucose (−0.9 mmol/L v −0.5 mmol/L; difference −0.30 mmol/L; P=0.008), proportion of daily smokers (−3.1% v −0.6%; odds ratio 0.60, 95% CI 0.43 to 0.84; P=0.003), and insufficient physical activity (−3.0% v 1.3%; odds ratio 0.63, 0.42 to 0.95; P=0.03). No significant differences were observed for change in non-high density lipoprotein cholesterol or proportion of participants with obesity. Conclusions The village doctor-led mobile health intervention was effective at reducing cardiovascular risk and improving control of behavioural and metabolic risk factors. This feasible approach could be scaled up in rural China and other under-resourced settings to improve health management based on the local primary healthcare system. Trial registration ClinicalTrials.gov [NCT05645640][1]. The supplementary files include the code used to analyse the data in the study. The data underlying the study findings are openly and publicly available (<https://doi.org/10.5061/dryad.tmpg4f58w>). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05645640&atom=%2Fbmj%2F389%2Fbmj","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"146 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social prescribing or community referral? Either way, let’s do it","authors":"Allison R Dunne","doi":"10.1136/bmj.r1062","DOIUrl":"https://doi.org/10.1136/bmj.r1062","url":null,"abstract":"McCartney says that doctors shouldn’t be “prescribing” parkrun.1 Let’s not get caught up in the terminology, although perhaps the expression “community referral” might be more appropriate in some cases.2 As a clinical pharmacist who has studied and researched health promotion, including community initiatives such as parkrun, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hugh Malcolm Bristow Busfield","authors":"Rebecca Busfield, Ian Scott","doi":"10.1136/bmj.r1052","DOIUrl":"https://doi.org/10.1136/bmj.r1052","url":null,"abstract":"Malcolm was born in 1935 in Guildford but grew up in Moreton in Marsh during the second world war. Surviving nearby Luftwaffe bombs, he was made of stern stuff. His father had left the family farm in Horsforth, Leeds, to become a municipal engineer and surveyor, and Malcom inherited his love of the countryside, architecture, and a Yorkshire spirit. After the war, the family moved to Headington, Oxford. He passed the 11+ exam, and went to Magdalen College School, which was a direct grant grammar school at the time. He excelled at chemistry, winning the Daubeney prize. He studied medicine at Hertford College, Oxford, from 1955, where he enjoyed rowing for the college first eight. In the holidays he would earn money delivering cars from the BMC factory in Cowley to garages across the UK …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital league tables, targets, and performance incentives should be used with care","authors":"Richard Lilford, Yen-Fu Chen, Matt Sutton, Timothy Hofer","doi":"10.1136/bmj-2024-083517","DOIUrl":"https://doi.org/10.1136/bmj-2024-083517","url":null,"abstract":"Richard Lilford and colleagues argue that the UK government’s plans to use performance metrics to reward or punish hospitals risk doing more harm than good Healthcare consumes a lot of resources and various measures have been used to try to ensure they are used efficiently. In the UK, after the government increased investment in health services, the secretary of state for health and social care announced that “NHS England will carry out a review of NHS performance across England with the results made public in league tables”1 and threatened that managers would be sacked if they don’t improve hospital performance.2 The health secretary is advocating using a performance metric that evaluates an organisation as a whole. The use of this type of metric to improve healthcare is neither new nor unique; policy makers often turn to performance management in the form of incentives based on organisation-wide targets or league tables. For example, in the US the Leapfrog group generates a “single letter grade representing a hospital’s overall performance” for nearly 3000 general acute care hospitals,3 and the Centers for Medicare and Medicaid Services measures whole hospital performance using a much criticised star rating system.4 With the announcement of the abolition of NHS England in March 2025, the government clearly intends to take direct control of the NHS and influence NHS organisations through performance metrics coupled with incentives and sanctions. This makes it important to consider the evidence on their accuracy and whether they have their intended effect. The quality of a measurement is defined by its reliability and validity. An unreliable measure has a low ratio between the signal (the true differences between the objects of measurement) and noise (all other sources of variation in a measurement).56 Low reliability results in misclassification of hospitals. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the gender health gap: a £39bn boost to the economy, as well as lives","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.r1087","DOIUrl":"https://doi.org/10.1136/bmj.r1087","url":null,"abstract":"BMJ was contacted about the quotation of the Manual …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using mobile health to reduce cardiovascular disease risk","authors":"Charell Jansen, Job van der Palen, Monique Tabak","doi":"10.1136/bmj.r972","DOIUrl":"https://doi.org/10.1136/bmj.r972","url":null,"abstract":"Technology can support personalised care Cardiovascular disease is a leading cause of morbidity (40%) and mortality in China.1 The increasing incidence of risk factors such as hypertension, diabetes, smoking, and poor diet, combined with an ageing population, results in a population with an increased 10 year risk of developing cardiovascular disease.2 The linked study by Zhang and colleagues (doi:10.1136/bmj-2024-082765) used a village doctor-led mobile health (mHealth) intervention for cardiovascular risk reduction in rural China.3 The SMARTER (Strategy for cardiovascular disease prevention through tailored health Management and its effectiveness Assessment through a cluster Randomised Trial in individuals with Elevated Risk) study was a cluster randomised controlled trial that included 63 villages (2236 participants) in the control group—receiving usual care, and 64 villages (2297 participants) in the intervention group. In addition to usual care, the intervention group received a multifaceted intervention consisting of individual risk assessment by researchers to identify intervention targets, gradual goals based on doctor-participant communication, short health education videos, monitoring and feedback by weekly reports to the doctors, and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Matt Morgan: The dangers of main character syndrome in healthcare","authors":"Matt Morgan","doi":"10.1136/bmj.r1081","DOIUrl":"https://doi.org/10.1136/bmj.r1081","url":null,"abstract":"History is written in real time. But with figures such as Donald Trump and Elon Musk casting themselves as main characters in some dystopian blockbuster, it feels more surreal than ever. Their self-crafted starring roles highlight a truth about history: it’s often shaped not just by people in power but by those who step into the spotlight and claim it. This often involves what some people call “main character syndrome.” The idea of seeing yourself as the protagonist in every scene may be a concept plucked from social media, but it’s one with profound implications for healthcare. Medicine can feel like a stage: a world where life, death, and recovery collide in real time. Doctors, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"151 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current management of hypertrophic cardiomyopathy","authors":"Nikhil Sikand, John Stendahl, Sounok Sen, Rachel Lampert, Sharlene Day","doi":"10.1136/bmj-2023-077274","DOIUrl":"https://doi.org/10.1136/bmj-2023-077274","url":null,"abstract":"Hypertrophic cardiomyopathy is a common yet under-recognized genetic structural heart condition characterized by left ventricular hypertrophy. Patients may present with obstructive disease characterized by an elevated left ventricular outflow tract gradient or non-obstructive disease. Long established medical and surgical treatment options for patients with obstructive hypertrophic cardiomyopathy and refractory symptoms can be effective in eliminating outflow tract gradients and improving symptoms. Cardiac myosin inhibitors have emerged as a new class of evidence based medical therapy for patients with obstructive hypertrophic cardiomyopathy and an alternative to septal reduction therapies. However, effective treatments for patients with non-obstructive hypertrophic cardiomyopathy remain limited, with several clinical trials ongoing. Variants in cardiac sarcomeric genes are the primary genetic cause of hypertrophic cardiomyopathy and are being investigated as targets for gene based therapies. Stratification of the risk of sudden death is an important component of caring for patients with hypertrophic cardiomyopathy. Recommendations for implantable cardioverter-defibrillator implantation are based on well validated risk factors in combination with shared decision making. Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and anticoagulation is strongly recommended for stroke prevention. Rhythm control is essential for patients with symptomatic atrial fibrillation. Historically, vigorous exercise has been restricted; however, newer data suggest that the arrhythmic risk is less than previously thought and emphasize an individualized approach. Advanced heart failure is an uncommon but important cause of morbidity and mortality. Early identification is key to improving outcomes with advanced therapies including cardiac transplantation. The management of hypertrophic cardiomyopathy is rapidly evolving toward a more personalized approach, based on genotype and phenotype, to alter disease progression and improve patients’ outcomes.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"08 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}