Sunday, June 4, 2023

Discovering the positives in healthcare

For all the advances made in healthcare delivery it often seems that the public’s overall health is deteriorating as much as it is improving. For every gain we make we take two steps back.

This week Jonathan Valabhji and Partha Kar highlight figures showing a rise in diabetes prevalence in the UK over the first two years of the covid pandemic (doi:10.1136/bmj.p910).1 A think tank points out that every UK government since 1992 has failed to tackle growing rates of obesity, despite having identified it as a major problem (doi:10.1136/bmj.p900).2 And a senior coroner warns of a lack of national leadership and funding to prevent more patients dying from anaphylaxis (doi:10.1136/bmj.p895).3

In the wake of the deterioration of the UK’s health service over the past decade, John Launer describes his fears for the future (doi:10.1136/bmj.p901).4 “I’m scared of dying in pain, dehydrated and unattended, on a trolley in a hospital corridor,” he writes. “I’m frightened that I’ll end my days on a ward where the staff, however hard they try, won’t have the time or resources to give me the care I need, either to cure me or relieve my passing.”

Despite the challenges ahead, Labour’s shadow health secretary, Wes Streeting, argues that a declining health service “is not inevitable” as he sets out his plans for reform (doi:10.1136/bmj.p924).5 But Streeting has reason enough to be outwardly upbeat, as it is undeniably his job to be optimistic about the improvements he believes a Labour government could deliver.

Jocalyn Clark sets out how covid struck a blow to the visibility of the expertise of female academics (doi:10.1136/bmj.p788).6 As soon as the pandemic began, the global scientific publishing machine defaulted to a bias towards white men. Women took the lion’s share of domestic responsibilities during lockdowns, and men were able to take advantage of the opportunities offered to further their careers. This set back decades of progress on gender equity and left gaps in careers, in knowledge, and in research questions being asked.

There are nonetheless grounds for some optimism that advances are being made, not least in the progress made by research funders in cracking down on unpublished clinical trials (doi:10.1136/bmj.p840).7 Two new research papers also carry some good news. Denosumab use for osteoporosis in adults may simultaneously reduce the risk of type 2 diabetes (doi:10.1136/bmj-2022-073435).8 And discussion with patients, using a prognostic algorithm, and providing information could help GPs identify patients with respiratory tract infections who are at lower risk and do not need immediate antibiotic treatment (doi:10.1136/bmj-2022-072488).9

Finally, Helen Salisbury writes about not just good news but “something so positive, so joyful and life affirming”—an initiative in which medical students mentor asylum seekers and support them through the healthcare system (doi:10.1136/bmj.p919).10 A junior doctor who helped coordinate the work spoke of finding focus and purpose and “falling in love with medicine again.” Another bit of progress to celebrate.

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