BMJ

Twenty women had mastectomies unnecessarily while being treated for breast cancer at County Durham and Darlington Foundation Trust, it has emerged.In a briefing paper presented to the board, the trust stated that 32 women received excessive surgery when a wide local excision would have been appropriate. Of these, 20 had a mastectomy without clinical need, the trust confirmed.Delayed diagnosis of breast cancer was also identified in 20 women during a review of more than 500 cases in response to serious failures of care at the trust.An internal review of other affected patients is ongoing. It includes those who came forward through a helpline set up last year, as well as cases identified by clinicians.There have been longstanding and escalating concerns about the quality of breast cancer care, governance, and patient experience at the trust. The Northern Cancer Alliance, Care Quality Commission, and Getting It Right First Time audit programme had...

What motivated you to write Healthy Scepticism?I had a formative experience with healthcare personally after my brother died suddenly from a genetic heart condition. This led me on my own diagnostic odyssey to see if I had the same condition. Although I had a public health degree and had worked in research for several years, I found the experience challenging. I thought I was asking reasonable questions only to be told repeatedly, “No that’s not right”. It wasn’t that the doctors were bad people, it was more about how the system operates. That experience sparked my interest in scepticism as a historical phenomenon, and how it continues to shape healthcare today.When the covid-19 lockdowns began, I saw real world examples of dispossession, doubt, and distrust emerging, and I felt I had something to contribute to the conversation. I wondered what healthcare history would look like if it were told through...

Marketing authorisation is a critical regulatory decision that determines whether a medicine can enter the market based on an assessment of its benefit-risk balance and the strength of the supporting evidence. Regulators must weigh multiple considerations, including clinical benefit, methodological robustness, evidentiary uncertainty, and unmet medical need.12 This process involves expert judgment, and the same evidence may be interpreted differently.3Although marketing authorisation is a binary verdict, the committee behind that decision may be divided. Experts may disagree on how benefits, risks, and uncertainties should be weighed, but such disagreement is not always visible in the final regulatory decision. At the European Medicines Agency (EMA) applications are assessed by the Committee for Medicinal Products for Human Use (CHMP), and decisions are reached by consensus where possible, otherwise by absolute majority of the voting members. When one or more CHMP member disagrees with the majority, they may formally record their dissent and...

Cellulitis is one of the most common skin and soft tissue infections, with over 100 000 patients admitted to hospital annually in England.1 There are multiple challenges across the patient journey, which are worsened by inequities and fragmentation of care.One of the key challenges is accurate diagnosis. Cellulitis remains a clinical diagnosis without a validated diagnostic test, so misdiagnosis is common, with approximately 40% of patients eventually receiving an alternative diagnosis.2 Clinicians might default to a diagnosis of cellulitis when presented with an erythematous lower limb because alternative diagnoses are less familiar.3 The linked practice pointer by Yadav and colleagues (doi:10.1136/bmj-2026-100505) gives a practical diagnostic approach.4 Key mimics include stasis dermatitis, eczema, and oedema or lymphoedema; these conditions might coexist with cellulitis, which compounds the uncertainty of diagnosis. Thermal asymmetry and composite scores such as asymmetry, leucocytosis, tachycardia, and age ≥70 (ALT 70) might help, but they require further validation.5People...

bmj;394/sep18_9/e100846/VS1F1vs1With the death of Rick van Saene on 25 March, the intensive care community lost a physician-microbiologist who made a significant contribution to the treatment of critically ill patients by introducing the concept of selective decontamination of the digestive tract (SDD).Rick studied medicine in Leuven, Belgium, qualifying in 1972. He then moved to Maastricht, Netherlands, for his training as a microbiologist and began working at the University Hospital in Groningen in the late 1970s. His thesis, “Pathogenesis of Inflammatory Bowel Diseases,” was the first scientific expression of Rick’s fascination with the gut as a source of microorganisms capable of causing disease.In the early 1980s Rick and the intensivist Chris Stoutenbeek published a series of studies that resulted in a revolutionary strategy to control infections in critically ill patients—the four component SDD strategy, which generated considerable interest but also reservations from traditional microbiology and infection disease specialists.In 1987 he moved to...

bmj;394/sep18_8/e100842/F1F1f1Born in Ewell, Surrey, John spent much of the war in Banstead, aside from a brief 1944 evacuation to Edinburgh to escape the blitz. He attended Nork Junior School until 1947, when he travelled with his parents and sister, Clare, to New Zealand to reconnect with family, as both his parents were New Zealanders. Returning to Britain in 1948, the family eventually moved to Kingswood in 1952.It was from here that John completed his senior years at Epsom College, cycling the 10 mile round trip each day. During this period he was tutored on the bagpipes by his uncle, a visiting psychiatrist from New Zealand who had been a piping enthusiast since his youth. This became a lifelong passion for John, and the music of the pipes is something for which he will always be remembered.John entered the London Hospital Medical School in 1958. After medical training he had several...