News reviews
drug shortages in the UK
The ready availability of common medications can no longer be taken for granted. Various factors, both internal and external, have conspired to impact negatively the supply of drugs in the UK over the last few years.[1] Brexit is one factor that is frequently mentioned, as well as government caps on NHS spending on branded medicines, but other European states are also struggling, so this is not the whole story. Other international factors include the Covid pandemic, the war in Ukraine and the recent Red Sea crisis.
Drugs that have been in short supply include cancer and diabetic medication, and increased demand for certain drugs (eg hormone replacement therapy and those for attention deficit disorder) has also played a part. In an article in the BMJ (November 2023), the British Generic Manufacturers Association reports that ‘111 products are now facing supply problems, the highest on record and more than double the number at the start of 2022’.[2]
Tracking down necessary medication is time consuming for pharmacists and worrying for patients anxious about managing their conditions.
- The Guardian. 14 January 2024. bit.ly/medsshort
- BMJ 2023;383:p2602. bit.ly/drugsshort
new doctors, no placements
The news that there has been a record number of graduating medical students seeking junior doctor training this year is very welcome, given all the talk about doctor shortages. It is surprising therefore that nearly one in nine did not know where they were going to start work when the initial e-mail including this rather important detail was sent out. Some junior doctors did not know until three weeks before their placement starts, which does not give them much time to sort out accommodation, etc. Others with placements were disappointed to find that the placement was not one of their five preferred options. As with drug shortages, there are several factors contributing to this unsatisfactory situation. The sheer number of graduates has left the UK Foundation Programme struggling to find places for them all. Medical students who have come to the UK from abroad now must be given the same priority as UK-trained graduates. Another change this year has been the abolition of a merit-based distribution of available places, which in the past has given the most promising students their preferred placements.[1]
- BBC News. 5 May 2024. bbc.in/3xgyUys
benefits of exercise to brain
Students who are physically active will be pleased to know that two recent studies confirm the benefits to brain and body of regular exercise and begin to tease out the reasons why. One study used innervated muscle tissue models and discovered that the stimulation of these muscles released a hormone and other substances that ‘foster the growth of neuronal connections, enhance signal transmission along the axons, and improve communication between brain cells’.[1]
The other study involved subjecting rats to a vigorous exercise regime and then examining various organs for changes. ‘They found that each of the organs they looked at changed with exercise, helping the body to regulate the immune system, respond to stress, and control pathways connected to inflammatory liver disease, heart disease, and tissue injury.’[2] The benefits of physical exercise to mental health, including mood, have been recognised for some time.[3],[4] Three good reasons to prioritise exercise as part of your weekly routine, and recommend it to your patients after you graduate.
- PNAS 2024. bit.ly/3VE5PpU
- Science Daily. 2024. bit.ly/3Vob1ge
- Medical News Today. 2024. Bit.ly/45mn6Hq
- Cureus. 2023 bit.ly/3KIJOQB
avian flu — an upcoming pandemic?1
The H5N1 strain of avian influenza, so deadly to birds and a few mammals, is now being found in cattle in the USA. Scientists are concerned that this will give the virus an opportunity to evolve into a strain that could eventually infect humans as well, especially as infected cattle are relatively unaffected and may have been harbouring the virus for some time before it was detected. There is also concern that the H5N1 virus could swap genes with other cattle flu viruses which could increase the chances of it making the leap to human hosts, raising the spectre of another pandemic.
‘Eventually the wrong combination of gene segments and mutations inevitably comes along. Whatever opportunity we may have had to nip it in the bud we lost by a really slow detection,’ says Michael Worobey, who is an evolutionary biologist at the University of Arizona.
- Nature, 8 May 2024. bit.ly/3VC8mRv
AI & medicine
Non-generative AI (Artificial Intelligence) is already being used in medicine to assist with mass screening, interpreting images from mammograms, for example, with an accuracy that rivals that of humans and speeds up the process significantly.[1]
Generative AI promises to contribute even more to the advancement of medicine, for example, by assisting with the creation of new drugs. Alphafold is a useful AI research tool that can predict a protein’s structure from its amino acid constituents.[2] Generative AI is expected to be even better at screening for diseases, and should be able to assist with various aspects of healthcare management, including disease surveillance and response. However, the World Health Organization sounds a note of caution. WHO Director-General Dr Tedros Adhanom Ghebreyesus, says ‘Like all new technology, artificial intelligence holds enormous potential for improving the health of millions of people around the world, but like all technology it can also be misused and cause harm’.[3] An article in the Lancet expresses similar concerns and highlights some of the dangers.
In response to perceived threats, WHO has provided six guiding principles which, if followed, should safeguard against the misuse and abuse of AI in its applications to healthcare.
- Lancet, 2023. bit.ly/4bUTlQh
- alphafold.com
- WHO. 2021. bit.ly/3XfUm12
tropical diseases rise in Europe 1
One of the consequences of global warming is the spread of diseases formerly restricted to the tropics into more temperate regions.
A recent report from the European Centre for Disease Prevention and Control (ECDC) warns that Asian tiger mosquitoes, carriers of dengue fever, Zika and chikungunya, are becoming endemic in 13 European countries including Austria, Bulgaria, Croatia, France, Germany, Greece, Hungary, Italy, Malta, Portugal, Romania, Slovenia, and Spain. However, they have also been found in Belgium, Cyprus, Czechia, the Netherlands, and Slovakia, so their range is expanding, aided by the ubiquity of international travel.
Medics working in Europe and the UK will have to learn to recognize and contend not only with these formerly tropical diseases but several others, such as yellow fever, West Nile virus and malaria which are also getting a foothold in the continent.
- BBC News, 12 June 2024. bbc.in/4aZQ4hz
