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Governments, international sports bodies, and industry must take responsibility for barriers to health experienced by migrant workers involved in events such as the Olympic Games and FIFA World Cup, argue Kristine Husøy Onarheim and colleagues

The latest NHS England letter to general practices states that face-to-face appointments should be offered at patient request,12 which is a U-turn on the previous policy of total virtual triage during the pandemic and potentially conflates patient preference and clinical appropriateness. Nonetheless, the rapid shift to physical closure of surgeries, digital appointments, and virtual or form-based online triage presented challenges for marginalised patient groups, who …

OBJECTIVE: To assess the attendance, outcome, compliance with treatment, and response to interferon alfa in patients with chronic hepatitis C who attended during 1995 and were treated according to a biopsy based algorithm. DESIGN: Retrospective audit of all patients with chronic hepatitis C attending outpatient clinics over one year. SETTING: The liver unit at a London teaching hospital. SUBJECTS: 255 patients with chronic hepatitis C. MAIN OUTCOME MEASURES: Patient survival, attendance, and compliance with diagnostic and therapeutic regimens. Response to interferon alfa treatment, based on loss of viraemia three months after cessation of treatment. RESULTS: A large proportion of patients (39%) with newly diagnosed chronic hepatitis C infection do not want to undergo further investigation. Of those patients who do attend for further treatment, a large proportion with severe hepatic fibrosis (42%) do not want to undergo currently available treatment. The response rate to interferon (21%) in treated patients was similar to that previously reported in a trial setting. There was no significant difference in response rates in patients with or without severe fibrosis not amounting to cirrhosis. In patients with cirrhosis there was a high incidence of hepatocellular carcinoma (18%) over a follow up period of 20 months. CONCLUSION: Current strategies aimed at investigating and treating patients with chronic hepatitis C are not acceptable to a large proportion of patients. Many patients with cirrhosis related to hepatitis C infection develop hepatic neoplasms, and management strategies to deal with this problem are urgently required.

New proposals make the NHS the most restrictive healthcare system in Europe for undocumented migrants

The Swiss drug company Novartis is under growing pressure from all sides as its long awaited High Court case against the Indian government began last month in Chennai. Novartis is challenging the government's refusal of a patent for the leukaemia treatment imatinib (Glivec) and also section 3(d) of the Indian Patent Act, which restricts drug patents to innovative drugs. The law was designed to make it easier for poor patients to get cheaper generic drugs. If Novartis succeeds in the case, it would signal the start of more stringent patent laws in India and an end to the current trend of lower prices. “People living with HIV from Lesotho to Laos depend on India …

The UK government should bolster its commitment to supporting and training healthcare workers in resource poor countries, says a report commissioned by the government and written by the former chief executive of the NHS, Nigel Crisp. The United Nations' millennium development goals on health will not be met unless the capacity of the workforce in these countries is improved, warns Lord Crisp in the report, which was published this week. He calls on the UK government to strengthen existing health link partnerships and to increase investment. The international community spends considerable amounts tackling major health problems, such as tuberculosis and HIV and AIDS in resource poor countries, yet many believe that such efforts are futile if systems are not in place …

Ghost authorship, whereby someone who has made a major contribution to a scientific article as an author is not acknowledged, is a widespread practice, says a study published this week. In the clinical trials investigated in the study, three quarters of individuals who had made significant contributions to the final paper were not listed as authors ( PLoS Medicine 2007;4:e19). In most cases these were statisticians working for the company sponsoring the trial. “Ghost authorship is a form of research misappropriation, and we believe that this practice serves commercial purposes,” said the study's lead author, Peter Gotzsche, of the Nordic Cochrane Centre in Copenhagen. “Authorship establishes accountability, responsibility, …

The government faced renewed criticism last week of its strategies for the training and recruitment of NHS staff, which may in the future result in more doctors being trained than the NHS can afford to pay. The chairman of the BMA, James Johnson, told reporters at a press conference in London last week that the NHS's situation “demonstrates an appalling lack of workforce planning.” He called for the reinstatement of more effective planning strategies to avoid wasting millions of pounds of public money. “In 2008 the year on year significant rise in additional NHS resources will fall back dramatically to figures around the 2.5% level. Despite the extra money NHS trusts all over the …

Specialist trainee doctors in England are worried about the effect on their job prospects of government plans to treat more patients outside hospital, concludes research published this week. Ongoing NHS reforms will see a shift in healthcare delivery into the community and a reduction in the need for hospital based specialists, says the report in the Postgraduate Medical Journal (www.postgradmedj.com, doi: 10.1136/pgmj.2006.054320). “For many trainees both the immediate and long term uncertainty generated by these changes have caused alarm,” say the study's authors, from the Leicester General Hospital. The researchers approached specialist …

Diarrhoea will have claimed 92 million lives by 2025. Sally Hargreaves from the medical charity Medecins Sans Frontieres takes a look at the treatment of diarrhoea in emergency settings

The first effects of the implementation of the widely criticised section 55 of the Nationality, Immigration and Asylum Act 2002 were reported by health services in east Kent this week. So far 36 asylum seekers in the area who applied for asylum after having arrived in the United Kingdom, as opposed to applying at the port of entry, have been denied benefit support and accommodation, under new government plans to get tough on asylum seekers. The number of asylum seekers presenting to services as destitute is rising by the day, say health service representatives in East Kent. “As of eight days ago we have noted a sharp rise in cases of asylum seekers who have been refused social support from the Home Office's National Asylum Support Service,” said Dr Peter Le Feuvre, a GP in Dover. “They are still allowed to go on and claim political asylum, but they are being given seven day eviction notices from the Home Office accommodation centres, so they have no money and nowhere to live …

An estimated 7000 NHS consultants will resign or retire from the service if national negotiations cannot resolve the current dispute over their contract, according to details of a BMA survey released this week. The threat came in response to a decision by Alan Milburn, the health secretary, to hold no further national negotiations on the consultant contract after BMA members rejected a deal in October. The questionnaire responses, received from 11000 of 27852 consultants in England, found that nine out of 10 consultants would be willing to take some sort of action if deadlock is reached, ranging from lobbying activity through to working to contract or resigning from the …

An Audit Commission report published this week has found that most NHS trusts have serious flaws in how they collect and report data on waiting lists. Errors in reporting waiting lists were found in 19 of the 41 trusts investigated; system errors that could increase risk of reporting errors were found in 15 trusts; and three trusts deliberately misreported information on their waiting lists. Only three of 41 trusts were given the all clear. The report, part of a five year rolling programme of spot checks …

A debate at the General Medical Council last week into a report of racial bias in the council's treatment of complaints against doctors whoqualified outside the United Kingdom resulted in a unanimous agreement by the council to tackle the issues with utmost urgency. “I am horrified that this investigation was first started in 1996,” said Mr Roland Doven, a council member. “And that the situation shown in this latest work indicates that the situation is getting worse.” He called for the reputation of the GMC to be defended. The report, which based its conclusions on a statistical review ofcases over the past five years, was the third of its kind to be commissioned by the GMC from the Policy Studies Institute, London, since 1996 (22 February, p 411). Again, the report …

The General Medical Council decided last week not to put the independent report into the conduct of council member Jennifer Colman into the public domain until ongoing legal issues have been resolved. The long awaited report of the inquiry led by George Staple QC, a leading City of London lawyer and former head of the Serious Fraud Office, was made available to council members in February. The report, which so far has cost the GMC £500 000 ($790 000; ‡730 000), details a year long investigation into Colman's role on the council and a series of issues that have arisen since her election to the GMC in 2000. Colman claims she has been prevented from sitting on committees and subjected to a whispering campaign since she told the Charity Commission in 2002 that fellow members of the council had fiddled expenses. She told the BMJ that she objects to the inclusion of certain personal information in a report that could …

An acute shortage of places in care homes means that the government is likely to miss its target of speeding up the discharge of elderly patients by 2004, the National Audit Office said this week. Four thousand elderly people each day remain in hospitals throughout England despite being declared fit to leave, at an estimated cost to the government of £1m ($1.6m; €1.5m) a day. …

Eds Michael Peel, Vincent Iacopino Greenwich Medical Media, £39.50, pp 228 ISBN 1 84110 068 4 Rating: ![Graphic][1] ![Graphic][2] ![Graphic][3] I spent some time last month at a medical centre in Dover that deals with the immediate health needs of asylum seekers arriving from the continent. Asylum seekers are routinely pulled off the backs of lorries and freight trains: 40 to 50 claim asylum at these docks every day. Many have travelled for months in poor conditions, and are inevitably exhausted and traumatised. The general practitioner at the medical centre will deal with anything from sprained ankles—often the result of being pushed from lorries at haste—and cuts from scaling barbed wire border fences, to minor ailments stemming from fatigue … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif

The length of time that patients wait for outpatient appointments and for surgery in ear, nose, and throat departments in the United Kingdom varies widely by NHS trust. But waiting times are not directly linked to levels of demand and capacity, according to a report released this week by the country’s public spending watchdog, the Audit Commission. “We noted very wide variations in waiting times within trusts and between trusts,” Jane Laughton, author of the report, told the BMJ . “This is to do with …

Medical organisations around the world have urged governments to put health before commercial trade and profit in the fight against tobacco. They have endorsed a manifesto released this week during international governmental negotiations in Geneva for the World Health Organization's framework convention on tobacco control. An estimated five million people will die from tobacco related illnesses in the next 12 months. Tobacco related illnesses are the single biggest cause of death in Europe, and developing countries are already struggling to cope with …

EDITOR—We were surprised to read the letter from Harris and colleagues disagreeing with our findings on mortality from liver cancer since their data and conclusions are similar to our own.1 2 We are agreed that death rates in England and Wales from all causes of malignant tumours of the liver are increasing (ICD-9 (international classification of diseases, ninth revision) …