Author: kaitiscotland

Adapted from BMJ 21-28 Feb 2026 Menopausal hormone therapy and long term mortality by Mikkelsen, Bergholt and Scheller.

Is HRT a good thing or a bad thing? Most research veers towards positivity but there are occasional surges of bad reports in the press that can put both women and doctors off. The most telling statistic is the effect on the total mortality rate, rather than the effects on specific disease processes.

In this Danish cohort study, all women born between 1950 and 1977 who were alive aged 45 were included in the study. They were followed up from their 45th birthday till 31st July 2023. Of the original 969,424 women, 92,619 were excluded from further study because of thrombophilia, liver disease, arterial or venous thrombosis, breast cancer, endometrial cancer, ovarian cancer, earlier use of HRT or earlier bilateral ovary removal.

They then looked at who didn’t get HRT, who did, and what type. They looked at the main cause of death and any secondary factors listed in the death certificates. 5.4% of the women died during this period of observation. Researchers were looking at cardiovascular causes, cancer, and other causes. They then adjusted for age, calendar year, parity, educational qualification, income quartile, country of birth, diabetes, high cholesterol, hypertension, atrial fibrillation, valvular disease, heart failure and three or more hospital contacts between 44 and 45 years of age. The average follow up time was 14.3 years.

They found that menopausal hormone therapy was not associated with increased mortality.

In addition, women who had undergone bilateral oophorectomy between 45 and 55 years of age had a 27-34% lower mortality than women who did not. My comment: This is a whopping reduction! I was delighted to see this as I’m in this group of women. For a start, removing potentially cancer developing organs will reduce mortality. Oestrogen only HRT is also known to reduce breast cancer onset to a mild degree, and if given within ten years of the menopause, also reduces arteriosclerosis considerably.

104,086 women took prescribed HRT compared to 772,719 who didn’t. This was only 11.9%. I’m surprised the number of HRT users was so low. I offered it to all menopausal women who didn’t have a contra-indication to it.

Adapted from BMJ 7-14 Feb 2026

A Finnish study followed up patients who had been diagnosed with appendicitis over ten years. Some had been given immediate surgery, and some had been given antibiotics.

If appendicitis is complicated, such as the infection is thought to have spread to the peritoneum, then surgery is necessary, but if the infection is thought to be localised, then antibiotics may be given as an alternative to immediate surgery.

257 patients were given antibiotics. Of these all but four of them were able to be followed up for ten years. 44.3% of the antibiotic group eventually had surgery to remove their appendix over this ten year period. The remaining 55.7% kept their appendix.

Complications were fewer in the group given immediate appendicectomy but there was no difference in quality of life between the two groups.

I’m not sure whether you would be given the choice over what treatment you get in the NHS, but given the choice, what would you opt for?

Adapted from BMJ 7-14 Feb 2026 Professor Paul Behrens, University of Oxford.

A government requested study, Global Biodiversity Loss, Ecosystem Collapse, and National Security, makes for grim reading. There is an impeding and serious threat to UK food security, economic stability, and national security.

Britain relies on imports of both food and fertiliser. 40% of our food is imported. A quarter of this comes from the Mediterranean, which is experiencing climate stress and ecosystem loss. 60% of our fertiliser is imported, so is dependent on overseas production.

The UK has very little in the way of food or fertiliser buffers. There is a food stockpile, but it will only last 9 months.

Sweden, Norway and Germany are all rebuilding stocks, for the first time since the cold war. It would be sensible to join them.

Brazil supplies 54% of soybean imports. This is mainly used to feed livestock. But the Amazon is approaching an irreversible tipping point. It is likely to shift to savannah. This would be catastrophic for the whole world.

We can expect rising food prices. Estimates from 2023 indicate that a third of food price rise was related to climate change.

To counteract this we need to do four things:

We need to eat more plants. We need to eat less meat. Presently 85% of agricultural land is used to rear livestock. This change would free up land.

We need to move rapidly towards domestic food production. This means supporting farmers to produce more fruit and vegetables. This would need investing in agricultural research as farmers in the UK would also have to adapt to climate change.

The UK government needs to give more money to international climate finance to protect critical food producing ecosystems. Unfortunately this has been progressively cut rather than increased.

The public need to become aware of the problem and be advised how to prepare for hard times in the future. Sweden and Finland are already doing this. Food access and nutritional inequalities need to be addressed.

It is a strange relief to finally have the UK’s national security apparatus onboard: ecosystem collapse is a national security threat. Do we sit on our hands now and wait till prices spike and meat becomes unaffordable? Do we act now?

The choice belongs to policy makers and the pressure that civil society can bring to bear on them. The consequences will be felt by everyone across the UK.

Adapted from BMJ 7-14 February 2026 Professor Charlotte Blease, Uppsala University, Sweden.

Patients are increasingly disclosing information to artificial intelligence tools (AI) and seeking health advice from them. Large language models such as ChatGTP, Claude and Deep Seek, are being used by millions of people to describe symptoms, seek second opinions, or explore stigmatised topics. Yet many clinicians continue to believe that they bring special empathy to the consultation and that sensitive disclosures to them are irreplaceable by technology.

Even in the 1960s, patients spoke more candidly to non-human interfaces than to clinicians. When it comes to alcohol and tobacco use, suicidal ideation, intimate partner violence, sexual behaviour, and workplace stress, paper based or online questionnaires elicit more information than in-person consultations.

In Denmark, 20% of primary care consultations are conducted by digital messaging. Patients say that they prefer to broach embarrassing topics in writing. As the perceived risk of judgment reduces, disclosure increases.

Unlike humans, digital systems can’t signal disapproval through tone, posture or facial expression. They can’t raise an eyebrow, sigh or signal boredom. They don’t hold any social power over the person confiding in them. For patients who fear being dismissed, blamed or embarrassed, such as adolescents exploring their sexuality, adults hiding alcohol dependence, or older patients reluctant to discuss continence or cognitive decline, digital interfaces feel safer than clinicians.

AI tools can even respond conversationally, offering reassurance, suggestions, or next steps. A recent comparative study across 149 simulated primary care cases revealed that an AI clinical interviewer was felt to be more polite, more attentive, clearer in explanation and better at shared decision making than doctors.

The most valuable aspect of AI consultations for patients is the feeling of freedom for being judged. This fear results in the withholding and distorting of information from doctors by patients. Yet this tendency is rarely acknowledged in medicine.

Clinicians often believe that their empathy can’t be matched by a machine. But machines never get compassion fatigue or even just plain fatigue. They offer a non-judgemental space, at all times.

Yet machines have their risks too. There are worries about data safety and the accuracy of advice given. The advice may not be direct enough and may pander too much to the patient’s presumptions. So, since AI is notably better trusted, more skilled, and usually better informed than the individual doctor, how can such technology be adopted into care systems safely and ethically?

AI disclosure could improve early detection, reduce missed diagnoses, and strengthen shared decision making. If AI took a preliminary history from the patient, this would save the clinician time, give a wider symptom and concerns picture for the doctor to act from, and would save patients discussing distressing details under pressure.

Adapted from BMJ 21 September 2025

Cholecystectomy is a commonly undertaken operation for the relief of gall stone pain. In the US 700,000 of these are done, now usually by laparoscopy.

A few years ago a trial was done that randomised patients with uncomplicated, symptomatic gall stone colic to either immediate operation or restricting the operation only to people who had severe recurrent attacks. After a year, symptoms were the same in each group.

After another five years, results have found that the restrictive strategy results in a small reduction in the operation rate, without any increase in complications.

However, whether operated on or not, two thirds of the patients get remission of the pain while one third do not.

My comment: Presumably it would be worthwhile finding out what is the actual cause of the recurrent pain.