Tom Nolan

Selling off NHS hospitals to private equity firms would seem an unlikely option for the new Labour government. But, as the government tries to fill the £22bn budget hole it accuses the previous government of leaving behind and billions more are needed to resolve junior doctor and other pay disputes, you never know. But would private equity firms do what private equity firms often do, and sell off their assets?

Jesus Santos Aguilar def. Stewart Nicoll R1 2:39 via Technical Submission (Guillotine Choke) UFC 305

There was no plausible mechanism to suggest that removing heavy metals such as cadmium and lead using edetate disodium (EDTA) infusions might reduce cardiovascular events in people who have had a myocardial infarction, but the TACT randomised control trial was funded nonetheless. In 2013 the findings surprised the academic world when those in the EDTA chelation arm of the trial were found to have lower rates of cardiovascular events than those in the placebo group. Eleven years on, the TACT2 study has failed to reproduce these results, finding no cardiovascular benefits from EDTA chelation compared with placebo among the nearly 1000 participants with type 2 diabetes and a history of myocardial infarction. An aptly tactful editorial note accompanying the study in JAMA calls for us to learn from this story and reminds us that “common sense dictates that not all hypotheses need be subjected to a clinical trial.”

You never have to wait too long for a trial of a new drug for migraine. The latest one is Lu AG09222, a monoclonal antibody to pituitary adenylate cyclase-activating polypeptide (PACAP). The phase 2 trial recruited adults with migraine with an average of 16.7 migraine days per month and for whom two to four preventive treatments had failed. Those given a single infusion of Lu AG09222 750 mg had an average of 6.2 fewer migraine days over the following month, compared with 4.2 fewer in the placebo group (a between-group difference of two days (95% confidence interval −3.8 to −0.3)). With this positive phase 2 result, it's time for Lu AG09222 to PACAP its bags and go to phase 3.

Before 2011, when checkpoint inhibitor treatments became available, the median survival for people with advanced melanoma was 11 months. The final results of the Checkmate 067 study, just published in the New England Journal of Medicine , confirms the dramatic improvements in survival since then. The phase 3 study randomised 945 people with stage III or IV melanoma to receive either the checkpoint inhibitors nivolumab plus ipilimumab, nivolumab with placebo, or ipilimumab with placebo. Median survival in those allocated to nivolumab plus ipilimumab was 71.9 months, and 10 year overall survival was 43% with nivolumab plus ipilimumab, 37% with nivolumab, and 19% with ipilimumab.

Prostate cancer screening may be less controversial if we could reduce overdiagnosis of low risk disease. A new study suggests that magnetic resonance imaging (MRI)-targeted biopsy could help achieve this. Over 13 000 men aged 50-60 years were invited for a prostate-specific antigen (PSA) test, and if the result was ≥3 ng/mL they were randomised to have a prostate biopsy only if suspicious lesions were found on MRI (the targeted biopsy group) or a targeted biopsy in addition to a systematic biopsy (the systematic biopsy group).

Stigma, language, and cultural barriers make it harder for women from minority ethnic groups with postnatal depression to access and benefit from mental health care. A randomised controlled trial recruited women with postnatal depression from five areas across England and Scotland with high South Asian populations. The trial delivered a 12-session group intervention that included nine culturally specific topics, including: “the challenges of being a British South Asian woman, the role of religion and spirituality in mental health, and tackling social isolation.” After four months, 138 (49%) of 281 in the culturally adapted cognitive behavioural therapy (CBT) group and 105 (37%) of 281 in the control group had recovered—but by 12 months there was no difference between the groups, when only 54% of women in each group had recovered.

Plus Paula Hawkins’s “The Blue Hour” and Alan Bradley’s “What Time the Sexton’s Spade Doth Rust.”

BMJ doi: https://doi.org/10.1136/bmj.q2378 (Published 31 October 2024) Cite this as: BMJ 2024;387:q2378 Tom Nolan

When it comes to peripherally inserted lines for outpatient parenteral antimicrobial therapy (OPAT), where should one draw the line? Midline catheters, which end in peripheral veins, are thought to offer lower risks of infection and thromboembolism than peripherally inserted central catheters (PICCs). A new cohort study supports this, finding that, for a device dwell of 14 days or less, midline catheters were associated with a lower risk of major complications (0.9% v 5.3%, adjusted hazard ratio 0.29 (95% CI 0.12 to 0.68)). However, the study design means that confounding by indication—whereby lower risk patients received a midline catheter—is hard to measure and exclude.