Paul Howard

Cancer patients ditch NHS for private chemotherapy share.google/fKKhDJVQqyrf...

12% ⬆️ from 2021 to now. So if I did my maths right.. is less than a 2.9% annual increase in activity.

While the NHS thinks chemo activity increases 6-8% annually. In other words.. private sector under delivering

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One in three dying in pain as palliative care crisis deepens People in their final days are often not getting proper pain relief, as a study reveals an ‘enormous volume’ of unnecessary suffering

🚨 Clare Welch pleaded for help from NHS 111 as her dying mother screamed in pain in the other room. Told a dr would call, 4 years on she is still waiting for that call back.

New @mariecurieuk research has found 170,000 people die in pain every year: www.thetimes.com/article/7552...

Thank you @shaunlintern.bsky.social for covering our new Marie Curie research.

🚨1 in 3 people in England and Wales die with unmet palliative care needs.

🚨That’s 170,000 people each year.

🚨Meaning that every three minutes someone dies with suffering that could and should be alleviated, but is not.

UK loses WHO status as measles-free after rise in deaths and fall in jab uptake UN health body says Britain is one of six countries in Europe and central Asia where disease has become re-established

A terrible consequence of anti-vaccine untruths
www.theguardian.com/society/2026...

Bacterial metabolites induce cell wall remodeling, antifungal resistance, and immune recognition of commensal fungi Davis et al. demonstrate that common gastrointestinal bacteria secrete metabolites that induce global cell remodeling in Candida albicans. C. albicans uses the HOG cascade, a central stress pathway, t...

Bacterial metabolites induce cell wall remodeling, antifungal resistance, and immune recognition of commensal fungi: Current Biology www.cell.com/current-biol...

Real-world effectiveness and safety of apixaban versus rivaroxaban in pancreatic cancer–associated VTE. 739Background: Pancreatic cancer is highly associated with venous thromboembolism (VTE), requiring long-term anticoagulation. However, evidence comparing outcomes between apixaban and rivaroxaban in t...

This "real world" study in pancreatic cancer related VTE reported in a JCO meeting abstract found apixaban was associated with less bleeding, fewer strokes and lower overall mortality compared to rivaroxaban

ascopubs.org/doi/abs/10.1...

British.

But at least I won't have to watch my own children go through what my trainee doctors have to face. The latter is hard enough.

If it was my own kids, I don't think I could bear it.

We need palliative medicine now more than ever.
We could help the Neighbour Health Systems in their hope of taking complex care out into the community - we've been doing that for decades.
We provide a cheaper alternative when hospital care is no longer helping, and yet our funding is being cut.

Even if they do, those in the @rcphysicians.bsky.social ivory tower will only allow them 3 years of specialty training, instead, insisting they spend their time in general hospital medicine.
Most people die outside of hospital; we need to be training community palliative care physicians.
I despair.

I despair of the @bma.org.uk 's ineptitude; they've allowed the debate to focus purely on pay and failed to convey trainee's desperate situation.
Some trainees I meet want to follow me into palliative medicine. They would be fabulous; but will struggle to get onto general medical training.

I enjoy medicine; obviously it can be stressful, but there's nothing I'd rather be doing.
But I am relieved that my own children do not want to follow me.
It's nothing to do with salary; it's because UK trainees have no job security, no stable training pathway, and little sway over where they work.

The most generous explanation for this is that he's an idiot who just hasn't even bothered to look at how vaccines work.

The worst is that he's deliberately spreading misinformation that will put actual lives at risk, in order to please his conspiracy-theory loving base

Chlorinated chicken and why it matters for animal welfare Chlorinated chicken is banned in the UK because it masks low welfare standards. Choose RSPCA Assured for higher welfare chickens and safe, traceable food.

Link summarises why chlorination is concerning:
Is used to mask poor welfare standards, e.g. overcrowding, overuse of antibiotics (cause of antibiotic resistance)
Makes bacterial contamination harder to detect (by reducing bacterial load only on the surface)

www.rspcaassured.org.uk/blog/chlorin...

There is, to my mind, no justification for the continued use by the UK Government of X as a platform for official comms. There hasn't been for some time, in fact, but if the latest developments around AI-generated image abuse and CSAM don't change the policy I really don't know what will.

Partly. But I also want to know how to spot an individual service succumbing to misguided group think. You've followed many disasters, from maternity to Gosport: is there something in common? Maybe senior leaders dismissing recurrent complaints as "not knowing what they're talking about"?

Thought note option 1, 3 and 4 are only realistically possible via a hospital pharmacy, which again highlights the desperate need to think about medicines supply if we're serious about moving more care out of hospitals

Latest UK supply problem to impact drugs used to alleviate distress in the dying: parenteral clonidine.
Shortage predicted until start of February (though these estimates are too unreliable to plan with).
Options:
Import it
Use oral tablets sublingually
SC dexmedetomidine
Clonidine patch (import)

🏆 Its been the biggest honour of my life to win The Lancet 2025 Wakley Prize and have my essay published in the final @thelancet.com of the year 📖 🤩

It was the perfect #Christmas present to receive the paper edition, as a surprise delivery yesterday 🚚 📦

@wolfsonpallcare.bsky.social

Yes, I agree with all of that.
There's also a bias I'm struggling to articulate along lines of: demanding far higher level of evidence to adopt potential new option than needed to retain the existing option. Which reinforces "tradition-based medicine"

A third blind spot is fitting care into what's convenient for the clinician. E.g. the harm caused by abrupt interruptions to established analgesia at admission to hospital. "Yes, I did tell them! But they said they didn't have any/couldn't prescribe it/had wrong colour socks/other excuse"

A second is overestimating how well we understand the patient's experience. E.g. I'm often intrigued at how confidently colleagues pronounce "but that procedure isn't that painful", when I suggest better procedural analgesia after being called afterwards (again) to get their pain back under control

I suspect one (of many) barriers is that clinicians often start from a "presumption of knowing best", so lean towards persuading rather than listening.
When I ask hospital inpatients open questions about their goals/aims, I so often find these just aren't aligned with the care being given

Did Dickens murder Christmas? In 1800, around one in three children died before their fifth birthday, compared to four deaths per thousand births by 2020

In 1800, around one in three children died before their fifth birthday, compared to four deaths per thousand births by 2020 | Amanda Ellison

The British Association for Psychopharmacology | 2026 Summer Meeting – Birmingham The British Association for Psychopharmacology (BAP) promotes research and education in psychopharmacology, and brings together people in academia, health services, and industry

Registration is now open for #BAP2026 Summer Meeting in Birmingham, 19th - 22nd July. For more information, to register and submit your abstract -

The serotonin 1B receptor is required for some of the behavioral effects of psilocybin in mice - Molecular Psychiatry Molecular Psychiatry - The serotonin 1B receptor is required for some of the behavioral effects of psilocybin in mice

New paper drop! 🧠💊 Our new paper out in Molecular Psychiatry shows that the serotonin 1B receptor is important for the neural and antidepressant/anxiolytic behavioral responses to psilocybin in mice.

www.nature.com/articles/s41...

📣Out now in Lancet’s @eclinicalmed.bsky.social
🫁The inverse #PalliativeCare law in advanced lung disease:mixed-methods #SystematicReview & #MetaAnalysis -1st paper from my #PhD provides evidence of #Inqualities in #lung disease
@wolfsonpallcare.bsky.social

www.sciencedirect.com/science/arti...

Interesting. What I'd add is that being in prominent journals is also no guarantee of quality; I've seen some really poor conclusions in the Lancet and BMJ. Particularly by pharmacoepidemiologists ignoring confounding by indication