Around 5% of all cancers worldwide are caused by the human papillomavirus or HPV.

In the late 1990s and early 2000s two vaccines were developed that protect against the two types of HPV that cause around 80% of cervical cancers. In the UK, girls who are aged 12-13 years old in year 8 at school are now offered one of these vaccines as part of the childhood immunisation programme. The vaccine that is used as part of the UK programme also protects against two types of HPV that cause genital warts. Recently, a third HPV vaccine called the nonavalent or 9-valent vaccine has been licensed for use in the European Union, as well as in the US, and it may be introduced into the UK immunisation programme in the future.

The new 9-valent vaccine
The 9-valent vaccine, as the name suggests, protects against nine types of HPV more…

The latest round of strike action from junior doctors in England is taking place this week. In a similar vein to the action taken last month, junior doctors will be offering emergency care only for 48 hours between 8am on Wednesday 6 April and 8am on Friday 8 April. The BMJ will once again be charting events as they unfold this week. If you have any news, pictures, thoughts, or tweets to offer us on the industrial action, please send them to Gareth Iacobucci at [email protected].

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Our behaviour is more influenced by our surroundings than we think—it is a response to what happens around us: physically, socially, and culturally. We are shaped by norms more than we shape them. Consequently, when an influential group of people have the chance to re-set norms in visible and newsworthy ways, and where results benefit almost everyone both immediately and long term, why wouldn’t we seize the opportunity?

Well, health professionals and health organisations have such a chance. The case for divesting from fossil fuel is now very strong. The British Medical Association (BMA) is committed to this journey of divestment and, since its 2014 Annual Representatives Meeting (ARM), has been actively investigating how best to send out a powerful message on health and social justice. more…

I looked down at my left leg. It had been aching for a day or two. Thanks to the laser eye surgery that I had had the previous month, I could see that the left calf was definitely more swollen than the right. I sat back in my chair and reminisced.

Back when I was a GP, in the early part of the 21st century, we would often be confronted with patients with swollen legs. The diagnosis that we worried about was deep vein thrombosis. I could even remember when it was called “economy class syndrome,” owing to one of the risk factors being the immobility and dehydration experienced on long haul flights. more…

Peer review seems to be researchers’ favourite whipping boy. Whenever two or three academics gather together, they tell each other horror stories of the journals, granting bodies and peer reviewers who have failed to recognise the latest great work. My perspective on this may be skewed by a couple of decades spent as an editor at selective journals—but there is serious work to suggest that the business of selecting and rewarding research is not working optimally. more…

The recent release of a study by the Sackler Centre for Consciousness Science, University of Sussex, which said that it had found changes in the structure of the brain caused by technology media multi-tasking, coincided with a panel discussion about just that at the Cheltenham Literary Festival. more…

I’ve finally hit the “Submit” button on my patient review of a research paper submitted to The BMJ—and in time for its deadline. Hurray!

This is the first project of this type I’ve ever been involved in, and at first blush I wondered if I would have anything at all meaningful to contribute—as a non-scientist who wouldn’t know a Hosmer-Lemeshow test from my left elbow at the best of times. more…

An oncologist from Tulcea, a city 280 kilometres east of Romanian capital Bucharest, returned to work one week into his retirement because there was no other specialist to care for his 4000 patients. In Maramureș, a Romanian county on the northern border with Ukraine, an anaesthesiologist has to commute between two towns so that emergency surgeries can be performed–other operations are being postponed for less crowded days. Călărași, a poor county in the south, only has one diabetologist.

All of these reports are partly owing to the massive migration of medical personnel, which began after Romania’s accession to the European Union in 2007. Between 14 000 and 20 000 doctors—and probably at least as many nurses—have left the country over the past seven years, leaving behind patients with even poorer access to care and overwhelmed colleagues. Many Romanians are pinning their hopes for solutions on the EU—the destination for most migrant health workers. more…

Tunisia, like all low and middle income countries, is having to respond to non-communicable disease after making good progress in reducing infectious disease and improving child and maternal health. Premature deaths from cardiovascular disease increased there by 35% between 1990 and 2010; they increased by 112% in Egypt and by 61% in Saudi Arabia—but fell by 21% in the United States. How best Tunisia might respond was discussed recently at a meeting in Sousse, organised by the Department of Epidemiology, University Hospital Farhat Hached.

Tunisia doesn’t have to start with a blank sheet. High income countries have already experienced the transition from infectious to non-communicable disease, and the aspiration is that countries like Tunisia can learn from the successes of high income countries without having to repeat their mistakes. more…

Modern medicine is an increasingly wary place for the digitally illiterate. With medical records turning electronic and computers springing up at the bedside, there is little hiding place for doctors who are averse to the machine. In an attempt to prepare students for 21st century clinical practice, Leicester Medical School recently became the first medical school in Britain to give teaching in e-consultations. This has made me reflect on one core skill at the heart of the modern day consultation: engaging with the computer.

Throughout medical school I saw a wide discrepancy in doctors’ digital abilities. While the single digit typer, forever searching for the next character, is a caricatured extreme, a lot of doctors do not find computers intuitive. Poor navigation of software and slow typing is a waste of doctors’ time, patience, and energy. more…