Recent rapid responses

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They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. <i>The BMJ</i> reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation. </p> <p> From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit. </p> <p> The word limit for letters selected from posted responses remains 300 words. </p> </div> </div> <div class="view-filters"> <form action="/rapid-responses" method="get" id="views-exposed-form-bmj-rapid-responses-rapid-response-archive" accept-charset="UTF-8"><div><div class="views-exposed-form"> <div class="views-exposed-widgets clearfix"> <div class="views-exposed-widget views-widget-sort-by"> <div class="form-type-select form-item-sort-by form-item form-group"> <label for="edit-sort-by">Sort by </label> <select class="form-control form-select" id="edit-sort-by" name="sort_by"><option value="field_highwire_a_epubdate_value_1" selected="selected">Date Published</option></select> </div> </div> <div class="views-exposed-widget views-widget-sort-order"> <div class="form-type-select form-item-sort-order form-item form-group"> <label for="edit-sort-order--2">Order </label> <select class="form-control form-select" id="edit-sort-order--2" name="sort_order"><option value="ASC">Ascending</option><option value="DESC" selected="selected">Descending</option></select> </div> </div> <div class="views-exposed-widget views-widget-per-page"> <div class="form-type-select form-item-items-per-page form-item form-group"> <label for="edit-items-per-page">Items per page </label> <select class="form-control form-select" id="edit-items-per-page" name="items_per_page"><option value="5">5</option><option value="10" selected="selected">10</option><option value="20">20</option><option value="40">40</option><option value="60">60</option><option value="80">80</option><option value="100">100</option><option value="120">120</option><option value="140">140</option><option value="160">160</option><option value="180">180</option><option value="200">200</option></select> </div> </div> <div class="views-exposed-widget views-submit-button"> <input class="btn btn-info form-submit" type="submit" id="edit-submit-bmj-rapid-responses" name="" value="Apply" /> </div> </div> </div> </div></form> </div> <div class="view-content"> <div class="views-row views-row-1 views-row-odd views-row-first"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj.q2575/rr"><h3>Re: Anaesthetist shortage is preventing over a million operations a year, warns royal college</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj.q2575">Anaesthetist shortage is preventing over a million operations a year, warns royal college</a> <strong>Gareth Iacobucci. </strong> 387:doi <strong>10.1136/bmj.q2575</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor,<br /> I’m incredibly pleased that the shortages within anaesthesia is being advertised and spoken about more frequently online and discussed here in the BMJ.<br /> I have personal experience of the lack of registrar posts available in the UK. I have been in the “bottleneck” following core training for just over 3 years. 7 disappointing applications and I know of many others in the same position.<br /> During this time I have been developing my skills as an anaesthetist in a fellow post and doing many of my lists independently under the supervision of a consultant within the theatre complex. Despite the skills and experience I have gained, I feel that I’m lacking the knowledge I would gain from being on a training programme. I would have greater exposure to training lists with enthusiastic consultants as well as training placements working at cardiac, neuro and paediatric centres.<br /> I can’t agree more with the statement of more training posts need to be created now, not in the future. This will ultimately help the NHS workforce but also increase patient safety by having well-rounded and experienced consultant anaesthetist. </p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>24 November 2024</strong> </div> <div class="response-author"> S L James </div> <div class="response-occupation"> Anaesthetic fellow </div> <div class="response-other_authors"> </div> <div class="response-affiliation"> </div> <div class="response-address"> Merseyside, UK </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/387/bmj.q2575/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/387/bmj.q2575/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-2 views-row-even"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj.q2500/rr-2"><h3>Re: Assisted dying bill: Two doctors would need to approve action</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj.q2500">Assisted dying bill: Two doctors would need to approve action</a> <strong>Gareth Iacobucci. </strong> 387:doi <strong>10.1136/bmj.q2500</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor</p> <p>As the article itself portrays, the bill has adequate provision to prevent coercion within the decision process by "mak[ing] it illegal to coerce, pressure, or induce anyone into dying". I would argue that, as is evidenced by another article in very same issue 'How outsourcing has contributed to England's social care crisis' (1) citing that "9 in 10 adult social service directors in England did not believe there was adequate funding or workforce to meet care needs of older and disabled people in their area" with the social care system being 'brought to their knees' and approximately over 300,000 deaths contributed to the UK's austerity policies between 2012-2019 (2), as the environment is currently for any disabled or terminally unwell person is inherently coercive. </p> <p>No one can facilitate a fully autonomous choice without coercion when they face adverse outcomes. Are we to carefully assess in detail whether someone is making this decision because of their own choice or being perceived as a burden, without carefully considered and detailed framework included might I add, in a society that explicitly portrays disabled people as so injurious to our moral fabric? Professor Katherine Sleeman effectively outlines these concerns in the BBC ‘Better Off Dead’ documentary with Liz Carr (3). It must also be noted that, in a recent survey done by Kings College London of over 2,000 people in England and Wales (4), reducing pain or distress, and giving more people dignity in death are their principal reasons for their support (99%), with 83% citing that low standards of palliative care are an important reason, with this article saying so itself, with patchy palliative care provision. It also provides data that 53% of those in favour of the legislation in parliament are concerned some people would be pressured into it. </p> <p>In conclusion, this is a piece of legislation, which I fundamentally believe can never really be to a sufficient standard to be ethical, which has been hasty and not considered carefully at all, even if it is a legislation that can never really be reversed in its consequences. I would hazard to say that the focus should be on adequately funding and organizing palliative care, social care provisions and empowering clinicians to make decisions to withdraw active medical and surgical intervention to ensure dignified person-centred deaths. </p> <p>References:<br /> 1) Goodair, B. et al (2024) ‘How outsourcing has contributed to England’s social care crisis’. BMJ;387:e080380<br /> 2) University of Glasgow (2022) ‘The devastating cost of austerity on health across the UK’ Available at: <a href="https://www.gla.ac.uk/news/archiveofnews/2022/may/headline_852679_en.html">https://www.gla.ac.uk/news/archiveofnews/2022/may/headline_852679_en.html</a><br /> 3) BBC (2024) ‘Better Off Dead?’ Liz Carr. Available at: <a href="https://www.bbc.co.uk/programmes/m001z8wc">https://www.bbc.co.uk/programmes/m001z8wc</a><br /> 4) Duffy, B, et al. (2024) ‘Assisted Dying Principles, practice and politics’ Available at: 14587oct-assisted-dying-survey-friday-4-oct.pdf </p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>24 November 2024</strong> </div> <div class="response-author"> Catherine Mills </div> <div class="response-occupation"> Foundation Year 1 Doctor </div> <div class="response-other_authors"> </div> <div class="response-affiliation"> </div> <div class="response-address"> Swansea </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/387/bmj.q2500/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/387/bmj.q2500/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-3 views-row-odd"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj.q2604/rr-0"><h3>Chris Hoy and cancer screening: is celebrity campaigning a bad way to make policy?--value judgements of doctors about quality of life</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj.q2604">Chris Hoy and cancer screening: is celebrity campaigning a bad way to make policy?</a> <strong>Margaret McCartney. </strong> 387:doi <strong>10.1136/bmj.q2604</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor</p> <p>Hashim Ahmed is quoted as saying, ““With 20-30% having leakage of urine needing pads, and 30-50% losing erections, that is 30-40 years of poor quality of life with little to no benefit from being treated for such disease.”[1]. Trust, Ahmed has incontrovertible evidence to support the assertion that “20-30% having leakage of urine needing pads, and 30-50% losing erections” following radical prostatectomy. It’s not difficult to accept that such post-surgical complications would have a significant adverse impact on quality of life. However, what is not clear is whether Ahmed is suggesting that some or majority of radical prostatectomies are carried out as a preventative measure rather than following firm histological confirmation. Perhaps, McCartney or Ahmed might consider clarifying.</p> <p>As quoted, Ahmed also asserts that such radical prostatectomies lead to “30-40 years of poor quality of life with little to no benefit from being treated for such disease”[1]. However, it is not clear, on what basis such seemingly precise “30-40 years of poor quality of life” has been worked out. Further it is questionable, if radical surgery has prolonged one’s life, irrespective of post-surgical complications, then on what basis one could safely say that there is “little to no benefit from being treated for such disease”. Alternatively, is Ahmed arguing that “poor quality of life” after surgery is the primary reason why, there is no merit in treating suspected or unequivocally confirmed prostate cancer?</p> <p>As for “poor quality of life”, assuming patients have given their fully informed consent, is it not the patients who should be judging the post-surgical “quality of life”. Arguably, Ahmed’s view as to “poor quality of life” is a value judgement, thus should not be the basis to reject surgery as having “little to no benefit”. Such view also devalues the fundamental importance of informed consent, patients’ wishes, and decision-making competence of those who carry out radical prostatectomies. Especially in the current climate of debating assisted-dying, value judgements of doctors could come into conflict with ethical principles and sanctity of life.</p> <p>References<br /> [1] <a href="https://www.bmj.com/content/387/bmj.q2604">https://www.bmj.com/content/387/bmj.q2604</a></p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>24 November 2024</strong> </div> <div class="response-author"> Jay Ilangaratne </div> <div class="response-occupation"> Founder </div> <div class="response-other_authors"> </div> <div class="response-affiliation"> www.medical-journals.com </div> <div class="response-address"> Yorkshire </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/387/bmj.q2604/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/387/bmj.q2604/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-4 views-row-even"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj.q2472/rr-3"><h3>Re: Rammya Mathew: GPs have to be able to request MRI scans for patients in primary care</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj.q2472">Rammya Mathew: GPs have to be able to request MRI scans for patients in primary care</a> <strong>Rammya Mathew. </strong> 387:doi <strong>10.1136/bmj.q2472</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor QUASI-GATEKEEPING: A GROWTH INDUSTRY</p> <p>Mathew reports GPs could lose their ability to order MRI scans for patients with musculoskeletal symptoms (BMJ 2024;387:q2472). Instead they are advised to refer them to a clinical assessment and triage service (CATS). This raises broader concerns: gatekeeper creep and deleterious filtration.<br /> The GP as gatekeeper has wide support in scientific and policy literature. But other health care professionals have now been given the role in response to medical shortages in primary and secondary care. Most recently it is physician associates who have hit the headlines. CATS physiotherapists are another example.<br /> With the arrival of quasi-gatekeepers, and the requirement to refer to them, it is unsurprising that GPs will employ a filter with a wide mesh. It is then left to Advanced Practitioners or lesser experienced physiotherapists to filter still further.<br /> For patients it is frustrating to wait for many weeks and then encounter another hurdle before any treatment is offered. A perception can exist of being downgraded, not getting an opinion about which they can be confident. Eliciting a good history requires a knowledge base of the breadth and depth found only in medical training.<br /> In the future AI could come to the rescue with scans having been read and treatments suggested to the referring GP. In the meantime, such is the demand on the musculoskeletal front that GP practices should ensure they have special interest capability. As gatekeepers they must be the sole decision-makers who control entry to the right part of the NHS.</p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>24 November 2024</strong> </div> <div class="response-author"> Morton M Warner </div> <div class="response-occupation"> Emeritus Professor of Health Strategy and Policy </div> <div class="response-other_authors"> </div> <div class="response-affiliation"> Welsh Institute for Health and Social Care </div> <div class="response-address"> Vale of Glamorgan </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/387/bmj.q2472/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/387/bmj.q2472/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-5 views-row-odd"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj.q2382/rr-3"><h3>Assisted dying - not 300 million people</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj.q2382">Assisted dying: balancing safety with access</a> <strong>James Downar, Eliana Close, Jessica E Young, Ben P White. </strong> 387:doi <strong>10.1136/bmj.q2382</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor,</p> <p>Downar and colleagues state that "over 300 million people across the world already have access to the option" of assisted dying. Unfortunately I believe this to be an incorrect statement. The combined populations of the countries and states where some form of assisted dying option or similar is available may be some 300 million but only a very small proportion of people in those regions will actually be eligible for this option. It would instead be more informative for the reader to know the numbers of people from within this population who have been eligible and the proportion who have availed themselves of assisted dying.</p> <p>The legal availability and the idea of normalising assisted dying raises another point. It is not uncommon for patients with very severe and difficult to manage conditions (whether terminal or not) and prolonged and complicated hospital stays to at some point lose hope of recovery and request their life-sustaining treatment to cease or even for staff to help hasten their death. At present, staff can feel confident in encouraging such patients not to seek to end their lives prematurely. However, if assisted dying were a legally available option, such requests would have to be considered more formally, potentially involving considerable amounts of staff time, effort and bureaucracy. Clinicians may even become reluctant to challenge their patients' perceived wishes, in case this were seen as obstruction of their legal rights and thereby a criminal offence. Furthermore, clinicians' views on whether an individual patient's condition is recoverable or terminal will naturally vary. In borderline cases, it will likely be possible for a patient to make sure they can find two doctors who can agree to sign the required form. It is therefore highly likely that passage of the Assisted Dying Bill would lead to instances where it would be used beyond its intended scope.</p> <p>Yours faithfully,</p> <p>Dr Andrew G. L. Douglas</p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>23 November 2024</strong> </div> <div class="response-author"> Andrew G L Douglas </div> <div class="response-occupation"> Consultant in Clinical Genetics </div> <div class="response-other_authors"> </div> <div class="response-affiliation"> Oxford University Hospitals NHS Foundation Trust </div> <div class="response-address"> Oxford Centre for Genomic Medicine, Nuffield Orthopaedic Centre, Oxford </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/387/bmj.q2382/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/387/bmj.q2382/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-6 views-row-even"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj.q2501/rr"><h3>Re Assisted dying. Thr concept is a chimera! . {If I were still an MP I’d be voting against Kim Leadbeater’s bill on assisted dying</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj.q2501">If I were still an MP I’d be voting against Kim Leadbeater’s bill on assisted dying</a> <strong>Steve Brine. </strong> 387:doi <strong>10.1136/bmj.q2501</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor<br /> There is a fundamental flaw to the proposals. How can people who have less than 6 months to live be given preferential treatment over others who face many years, sometimes a lifetime, with unbearable pain whose condition is incurable and pain whether physical or mental incapable of alleviation.<br /> There is no practical answer and allowing legalised killing for a small minority or, come to that, anybody or everybody, is not one surely?<br /> P. Davidson</p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>23 November 2024</strong> </div> <div class="response-author"> Patricia M Davidson </div> <div class="response-occupation"> Children's author </div> <div class="response-other_authors"> N/a </div> <div class="response-affiliation"> None </div> <div class="response-address"> Honeywood House RH123QD </div> <div class="twitter-address"> <a href="https://twitter.com/--">--</a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/387/bmj.q2501/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/387/bmj.q2501/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-7 views-row-odd"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj-2024-081720/rr"><h3>Re: Patients deserve better information on new drugs</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj-2024-081720">Patients deserve better information on new drugs</a> <strong>Steven Woloshin, Huseyin Naci, et al. </strong> 387:doi <strong>10.1136/bmj-2024-081720</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor,</p> <p>In "Patients deserve better information on new drugs", the authors make an extrodinary claim: "For example, over two thirds of new cancer medicines, which now comprise the largest category of new treatments, are approved based on single arm trials that have no control groups and only short follow-ups." In the print edition, this sentence is repeated in bold near the title. </p> <p>The citation for this claim is study by Salcher-Konrad, Naci, and Davis. However, the citation does not support the claim. The cited study is limited to a sample of 21 cancer drug-indication pairs that (a) received special approval from FDA and/or EMA, and -critically- (b) for "which data on efficacy and safety was less complete than that required for regular approval at time of market entry." The study design of the citation cannot support the claim that over two thirds of new cancer medications are approves based on single arm trials without control groups. Moreover, in the cited study, the 21 cases are a small subset of the 447 approved by either EMA (between 2006-2016) or FDA (1992-2017), the vast majority of which received regular approval and which are not the subject of the cited study.</p> <p>I appreciate that Davis and Naci are authors of both articles, and hope they can provide clarity. </p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>23 November 2024</strong> </div> <div class="response-author"> David G Jeffery </div> <div class="response-occupation"> PhD Student </div> <div class="response-other_authors"> </div> <div class="response-affiliation"> </div> <div class="response-address"> United Kingdom </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/387/bmj-2024-081720/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/387/bmj-2024-081720/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-8 views-row-even"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj.q2538/rr"><h3>Re: Matt Morgan: Don’t lose the “why”</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj.q2538">Matt Morgan: Don’t lose the “why”</a> <strong>Matt Morgan. </strong> 387:doi <strong>10.1136/bmj.q2538</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor<br /> Dr Matt Morgan make several very important points in his discussion about ‘what’ and ‘why’ and the proper use of protocols and guidelines. Put another way; ‘doctors know what to do when they don’t know what to do’. Expertise comes from experience and its acquisition cannot be hurried or short-circuited; it takes what it takes. Both depend on a deep knowledge of the underlying processes which the doctor can access immediately at the bedside.<br /> There are important implications for assessment which may not always be recognised. There may be a tendency, particularly in constructing written assessments, to write ‘what’ questions; ‘what is this?’, ‘what do we do?’. We also need ‘why’ questions; ‘why has this patient presented at this time in this way, with this problem and needing this management?’. A focus on the ‘what’ will lead to learning the ‘what’ and an inability to do the slow thinking (1) needed for the ‘why’.<br /> 1. Kahneman D. 2012. Thinking Fast and Slow. Penguin.</p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>23 November 2024</strong> </div> <div class="response-author"> John B Cookson </div> <div class="response-occupation"> emeritus undergraduate dean </div> <div class="response-other_authors"> Derek Gallen emeritus postgraduate dean </div> <div class="response-affiliation"> </div> <div class="response-address"> Magnet Cottage Wells Road, Bisley </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/387/bmj.q2538/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/387/bmj.q2538/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-9 views-row-odd"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/386/bmj.q1518/rr"><h3>Revisiting sugar taxation</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/386/bmj.q1518">UK sugar tax led to fall in consumption in children and adults</a> <strong>Luke Taylor. </strong> 386:doi <strong>10.1136/bmj.q1518</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor</p> <p>The Labour government has, in the view of many, taken some missteps in the recent budget.</p> <p>It is objectively verifiable that the late unlamented Tory government gravely damaged the UK in many ways but especially economically. Low tax, low regulation, small state beliefs are not an intelligent way of dealing with the vast complexity and horrifying expense of running an advanced, developed state - rather it is an abdication from responsibility.</p> <p>The error that both regimes make is to assume that only existing taxes may be adjusted and both fail to grasp the opportunity offered by other options. It is easy to generate beneficial secondary effects whilst raising revenue and the changes can be presented as creating a form of voluntary taxation - the citizen has to chose to pay.</p> <p>A sugar tax exists but raises nugatory sums whilst achieving modest benefits. </p> <p>The UK consumes 2.21 million tons of sugar annually. A tax set at 0.1pence per gram and imposed as the material enters the human food chain would raise £221,000,000,000 - those more numerate than I may wish to check my figures. </p> <p>Similar arguments can be made for salt, alcohol. tobacco etc. </p> <p>£221,000,000,000 would certainly be a huge boost to the whole of UK life - national debt, health, education, defence, law'n'order, infrastructure, local government...</p> <p>Why not?</p> <p>Yours sincerely</p> <p>Steve Ford</p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>23 November 2024</strong> </div> <div class="response-author"> Steven Ford </div> <div class="response-occupation"> Retired GP </div> <div class="response-other_authors"> </div> <div class="response-affiliation"> </div> <div class="response-address"> Five-Stones, Heugh House Lane, Haydon Bridge </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div class="respond-to-article"> <a href="/content/386/bmj.q1518/submit-a-rapid-response">Respond to this article</a> </div> <div class="response-read-all"> <a href="/content/386/bmj.q1518/rapid-responses">Read all responses to this article</a> </div> </div> </div> <div class="rr-separator" class="clearfix"> <div class="light-grey-line"></div> </div> </div> </div> </div> <div class="views-row views-row-10 views-row-even views-row-last"> <div class="node node-highwire-comment node-promoted clearfix"> <div class="row rr-header"> <div class="rr-left-column" class=""> <div class="response-title"> <a href="/content/387/bmj-2024-080257/rr-2"><h3>Re: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline</h3> </a> </div> <div class="article-response-title"> Re: <a href="/content/387/bmj-2024-080257">Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline</a> <strong>Farid Foroutan, Bert Aertgeerts, Frederic Coyac, Pauline Darbellay Farhoumand, et al. </strong> 387:doi <strong>10.1136/bmj-2024-080257</strong> </div> <div class="content"> <div class="response-body"> <p>Dear Editor<br /> Whilst these guidelines have merit - and great colour infographics- I was unable to find any ‘Numbers Needed to Treat’ anywhere in the five pages. All doctors wish to share evidence based decision making with their patients. Dr John Launer, writing ‘Why Guidelines can be Hard to Swallow’ in the same BMJ issue, would be deeply disappointed, because NNTs are so easy for the patient (and doctor) to understand.</p> <p>In Dr Keith Ridge’s recent DoH report on National Over-Prescribing: Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions Recommendation 3 states: In developing and updating guidelines, NICE and professional bodies should include recommendations for reviewing and discontinuing medicines where appropriate, and in the context of shared decision-making supported by decision aids.</p> <p>NICE does NOT routinely publish accessible NNTs in the majority of their guidance, despite requests from patients and others. Considering they are the experts in reviewing the evidence, NICE should calculate NNTs. If they are unable to do this, or if they do it but fail to produce accessible helpful decision aids that include NNTs, perhaps they are abrogating their responsibility to prescribers and the population? Why should busy clinicians either have to search elsewhere, or ‘fudge’ the issue with an enquiring patient? This smacks of ‘Thou shalt do this because I say so’ from guideline writers, rather than ‘Here is the evidence with decision aids’.</p> <p>The NNT for an appendicectomy for a gangrenous appendix is N=1 – that’s obvious! The NNT for secondary prevention at a population level for some interventions is in the hundreds – patients are routinely denied this information by NICE and other guideline authors. Certain vested interests (both enthusiastic professional and commercial) would like high patient compliance – and therefore avoid publicising NNTs unless favourable. I’m sure NICE haven’t been ‘nobbled’ - so why won’t they and other guideline producers reveal easy to understand NNTs’ as a matter of course?</p> <p>By expecting NNTs to be included routinely in guidelines, the BMJ and other reputable journals could easily raise standards in this area.</p> </div> <div class="response-competing"> <p><strong>Competing interests: </strong> No competing interests</p> </div> </div> </div> <div class="rr-right-column" class=""> <div class="response-date"> <strong>23 November 2024</strong> </div> <div class="response-author"> Andrew Tresidder </div> <div class="response-occupation"> Clinical Lead for Medicines Management and Evidence Based interventions </div> <div class="response-other_authors"> </div> <div class="response-affiliation"> NHS Somerset ICS </div> <div class="response-address"> Wynford House, Lufton Way, Yeovil, Somerset BA21 8HR </div> <div class="twitter-address"> <a href="https://twitter.com/"></a> </div> <div class="response-links"> <div 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