“There’s a 50% chance that humans will be extinct by the end of the century because of climate change,” said Hugh Montgomery, director of the UCL Institute for Human Health, at last week’s conference on environmental sustainability. I’d heard that before, but it made me think of my daughter, who can expect to live for most of this century. And what about any children she might have? And then I wondered if the apocalyptic vision, true as it might be, is the best way to spur people to act on climate change. more…

“The UK coalition government’s proposals for health reform have generated much heat without a great deal of light. One predictable response has been the “concern” that the private sector is about to take over the running of the health service. Worse still is the prospect of turning the NHS into a clone of the US model of healthcare. more…

Medical students and doctors belonging to the newly created organisation “Big Society NHS” organised a Valentine’s Day themed protest against the Health and Social Care Bill, currently being debated in parliament. The bill, if passed through parliament, would pave the way for free-market style reforms within the NHS. The demonstration was held outside the Sherfield building, where secretary of state for health Andrew Lansley was delivering a speech to mark the opening of the Imperial College School for public health. more…

The world is on the cusp of a major epidemic of breast cancer, said Peter Boyle, head of the international prevention research institute in Lyon, France, at a conference on breast cancer in Oman last weekend. The incidence of breast cancer has tripled in the past 30 years and is expected to double again by 2030 with most of the burden falling on low and middle income countries. In 2008 there were 1.4 million new cases of breast cancer and 460 000 deaths. Mortality rates are coming down in high income countries but not across the world. more…

It would be a stretch to say that I have now adapted to the African way, but after three weeks here at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania, I am getting to do some of what I came here to do without, as far as I can tell, upsetting anyone in the process. The change to my program that I arranged is working and some of the staff are getting to know me and what I want to do.  Having said that, palliative care is a very unknown quantity here and so many do not know what it is or, worse in my view, incorrectly believe they know what it is. One physician thought it was long-term care and wanted me to look after his 16 patients with traumatic paraplegia. A junior physician approached me with great concern because I had seen a patient who was waiting for transfer to the Ocean Road Cancer Institute in Dar es Salaam for radiation therapy. “How can we send her if she’s getting palliative care?” she asked.  Even after I explained that palliative care would provide needed comfort for her while awaiting transfer she (the physician) still had difficulty understanding that active treatment and palliative care are not mutually exclusive.

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Although innocent is a relatively young company (12 years old in 2011), it has a long history of campaigning for the reduction of VAT on fruit juice and smoothies. Both of these count towards your 5-a-day (fruit juice counts as one and smoothies count as two portions [1]), but apart from sweetened dried fruit, they are the only 5-a-day contributors which are subject to VAT. innocent has argued that reducing the cost of both through the reduction in VAT would result in an increase in consumption and get us a step closer to meeting an important public health goal. more…

We are only two months away from it becoming real for GP consortia. I was looking through the information going to one of our pathfinder executive meetings in the next week. The GP consortium is looking good for this year and will deliver within budget unless something unexpected happens.

Buried within the report was some worrying detail. The predominant reason they will be ok this year is because of factors beyond their control. Elective activity is below expected levels and that is something I know our acute provider wants to remedy! In contrast, outpatient referrals are well up and prescribing is overspent against plan. The order book is building, emergency activity is not diminishing, and all the indicators suggest the consortium could be heading for over trading in 2011/12. more…

“There are five things about the NHS that are not sustainable,” said Phil Morley, chief executive of Hull and East Yorkshire Trust, in the middle of a conference last week on sustainability and health. He spoke like Cicero, only with more humour and a strong Northern accent. The conference was about environmental sustainability, but Morley painted on a broader canvas. Although they might simultaneously be horrified, his troops must surely be inspired by his rhetoric. more…

JAMA  9 Feb 2011  Vol 305
569   If I were a woman, the things I would most fear from breast cancer surgery would be arm lymphoedema and recurrence of the cancer. Does one have to be balanced against the other? Common sense would suggest that the more axillary lymph nodes you dissect, the less likely it is that the cancer will recur. But last week we learned that micrometastases in the lymph nodes show very little correlation with survival, and this week we learn from this study that in women with invasive breast cancer and sentinel node metastases, survival is the same whether axillary node dissection is performed or not. The risk of arm lymphoedema goes down from 75% to 25%. So this trial continues the trend to less mutilating surgery for breast cancer begun by Sir Geoffrey Keynes in the 1920s, as I keep reminding readers in the hope that they will secure for themselves a second-hand copy of his autobiography. In The Gates of Memory, Keynes invites Henry James to Edwardian Cambridge, collects Blake manuscripts, grabs casualties under shellfire, pioneers blood transfusion, revolutionises breast cancer management, goes to the ballet, organises surgical services for the wartime RAF, cures myasthenia gravis with thymectomy, has medical students dig him a swimming pool and is criticised for his lapses in seventeenth century bibliography. more…

“Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles. more…