Adele Waters

A planned clinical trial to assess the safety of puberty blockers in children with gender distress poses too many ethical and methodological problems to proceed.That was the verdict from experts discussing their concerns at a webinar on 16 September organised by the Clinical Advisory Network on Sex and Gender (CAN-SG), a group of UK and Irish clinicians calling for higher standards of evidence based care in transgender medicine.At the event, chaired by the retired psychiatrist David Bell, a whistleblower of poor care at the now closed Tavistock Gender Identity Development Service, speakers said that the proposed Pathways trial—currently undergoing ethical assessment—could not be justified and should not be approved. But Hilary Cass, who led a landmark review for the NHS into gender identity services for children and young people, told The BMJ that the trial, which is running behind schedule, was still justified.Speaking at the event, Sinead Helyar, CAN-SG member and a clinical trial manager who has worked on trials in the NHS for more than 10 years, argued that there were simply too many ethical concerns. She highlighted how UK legislation specifically required clinical trials to minimise foreseeable risks regarding children’s development and how it prohibited studies where there was a risk of disabling injury.“Children enrolled with any research programme by …

Medical tribunal panels that decide whether UK doctors who are guilty of sexual misconduct are fit to continue practising will work under fresh directions from next month.The Medical Practitioners Tribunal Service (MPTS) published updated guidance on 1 October that introduces several key changes aimed at helping tribunal panels improve their decision making.The move followed criticism by victims of sexual misconduct and researchers that the current sanctions guidance used by panels for managing such cases was not fit for purpose and needed major reform. The guidance applies to all types of allegations against doctors, such as poor performance and clinical failings, as well as sexual misconduct.Authors of a recent BMJ analysis that concluded that the existing guidance led to inconsistencies and sanctions sometimes being too lenient welcomed the changes but warned that further action may be needed to make tribunal outcomes more consistent.12The updated guidance, …

The National Polypharmacy Programme, a successful patient safety programme set up by doctors and pharmacists and run by the NHS’s Health Innovation Network to cut the number of medicines patients take, has been forced to close owing to lack of funding.At a conference last week (29 September)—celebrating the programme’s achievements over its three years of operation—programme managers said that they had been unable to secure ongoing funding from NHS England, after the government’s decision to abolish the wider organisation.1Its closure comes despite evidence of its success in improving health outcomes and prescribing safety, as well as saving the NHS money.Launched in April 2022, the programme used a three pillar approach to tackle inappropriate prescribing across all 42 integrated care boards in England. First, it selected patients who were on multiple medications in each primary care …

Long covid and severe post-covid complications must be recognised as a prescribed industrial disease for health and social care workers, health unions have said.The BMA and the Royal College of Nursing (RCN) have written to work and pensions secretary Pat McFadden urging the government to “act quickly” to provide support to the many doctors and nurses, and their families, who experienced serious financial losses as a result of contracting covid-19 in the workplace and then developing long covid.The move marks three years since the Industrial Injuries Advisory Council (IIAC), an independent scientific body, recognised that some post-covid complications caused persistent impairment and loss of function in some people and recommended that five symptoms should qualify for financial benefits (see box).1The unions’ joint letter, signed by BMA chair of council Tom Dolphin and RCN general secretary and chief executive Nicola Ranger, urges the government to accept the IIAC’s recommendations as “a crucial first step” in recognising …

Two controversial research studies assessing the risks and benefits of giving puberty blockers to young people with gender incongruence will go ahead.1The trials received all necessary regulatory and ethical approvals and will begin recruiting participants soon, with findings expected in four years. But some clinicians have argued that it is “unethical” to expose children to potentially damaging drugs without clear benefit.The first study, the Pathways trial, will measure the impact of puberty blockers on the quality of life and emotional wellbeing of young people with gender incongruence, as well as their cognitive, physical, and social development.Researchers aim to recruit 226 children over three years into one of two study arms. In the first group participants will get puberty blockers at the outset for 24 months, while participants in the second group will have to wait for 12 months before receiving them. Participants will be assessed at the outset, at 12 months, and at 24 months. Researchers will compare these assessments with 300 children with gender incongruence who will not take puberty blockers.The research teams, based at King’s College London and the South London and Maudsley NHS Foundation Trust, say that the study will be large enough …

At just nine years old, Jess Hoque has already experienced several episodes of a life-threatening reaction due to a dairy allergy he's had since birth.

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Domestic abuse in NHS workers is a “silent pandemic,” with some research finding that they are three times as likely to experience it. Adele Waters finds that the NHS needs to do more to end a “double layered stigma” affecting cliniciansCatherine,* a 40 year old psychiatrist from northwest England, recalls the moment she decided to end her 15 year marriage. “I was at work when I noticed a missed call from my 10 year old son,” she says. “That was unusual because he rarely used it for making calls, but I would soon find out why. His father—my ex-partner—had locked our younger child in a dog crate.”She tells The BMJ , “I couldn’t get my head around it. I managed to leave work and drive home as fast as I could, which took me about 20 minutes, to find our little boy—who was then just 3 years old and ill with chickenpox—locked in this tiny crate that was meant for our very small dog.“Even though my ex had agreed to look after our four children while I was at work, he had somehow decided that he shouldn’t have been, and it was his way of protesting. He’d sat the other children down opposite and made them watch their little brother trapped.”That was the point when Catherine made her decision to finally free herself from a long term abusive, controlling husband. “It was like a switch went on,” she says. “I finally gave myself that permission when I saw what he did to my little boy that day.”Catherine’s story is just one of many that have prompted the Doctors’ Association UK and the Medical Women’s Federation to launch a campaign to raise awareness about domestic abuse among healthcare professionals and urge NHS employers to ensure that …

Credit: Asadour GuzelianMedical students who are found to have sexually harassed fellow students could be barred from graduating at the University of Manchester.This is one option being considered in response to 31 alleged incidents of sexual harassment involving medical students by their peers in the faculty of medical sciences.The scandal was brought to light by a final year student, Charlotte Buttercase, after she received sexually explicit calls from a group of male students. It coincides with a police investigation into the harassment claims, as well as a parallel internal investigation by the university.Speaking to The BMJ , Buttercase (pictured) said that the profession needed a zero tolerance approach to this behaviour. “If [these men] did this when they were in their 20s, how bad will they be by their 40s?” she said. “The first patient they harm, it will be too late. The first colleague they harm, it will be too late.”Recalling the incident that sparked the campaign, Buttercase said that she had been sexually harassed just four days after celebrating her graduation ball. “It was 2 …

NHS England (NHSE) has failed to implement changes to ensure that a patient's sex, as well as gender, is recorded in all medical records.Last month the Professional Record Standards Body (PRSB), which advises health providers on what information should be recorded and shared by staff, revised its requirements on sex and gender. This change is designed to ensure that the sex of patients is clear in all records, including data held by GPs, hospital records such as eDischarge summaries, and social care documentation.1In an accompanying note the PRSB said that the previous system carried “major” risks for patients.2 It said that because some records may record only gender and may not record sex at birth - or may record it incorrectly - there was a risk that sex would be misinterpreted in clinical practice.While recognising the likelihood of this as low, it said that the risk carried the potential to cause “severe harm” if patients were sent or not sent for sex specific screening procedures.The PRSB's hazard log reads, “From a clinical perspective …