Creating breathing space: the scandal of missing respiratory diagnostics

Some health scandals remain imprinted on our memories, by bold headlines, emotional testimonies, and sobering inquiry reports or prosecutions, such as the case of Lucy Letby (doi:10.1136/bmj.p2197).1 Others happen quietly and are harder to report. One such “silent scandal” is the missing respiratory diagnostic services in England’s most deprived areas (doi:10.1136/bmj.p2140).2

Lung conditions are a leading cause of death in the UK and cost the nation nearly £5bn each year. England knows it has a problem; witness a government strategy highlighting the need for early diagnosis and a major initiative to narrow inequalities in healthcare, including for chronic respiratory disease. In reality, there are no central data on the availability of diagnostic lung tests, such as spirometry. In seeking data The BMJ found that in many parts of the country access to spirometry is sparse or non-existent. Areas of highest need seem to be worst served, such as Cornwall, a deprived area with long waiting lists for lung disease diagnosis.

There is a way through this crisis: community diagnostic centres are (slowly) being built, although their limited capacity will not replace the role of primary care, which urgently needs funding to provide quality assured testing. Without timely diagnosis, people with lung conditions will continue to experience acute and long term deterioration and die early.

Barriers to timely care exist elsewhere. No surprise then to see the alarm over reported plans to ask GPs to discuss most of their non-urgent cases with a hospital consultant before they refer patients (doi:10.1136/bmj.p2187 doi:10.1136/bmj.p2207).34 The Royal College of General Practitioners is right to warn that this plan mustn’t create a barrier to artificially protect waiting lists and prevent patients getting the care they need.

On the topic of scandals, could you play a more active role in frustrating corporate wrongdoing? Shai Mulinari and Piotr Ozieranski highlight egregious scandals involving drug companies and argue that healthcare professionals and organisations should respond more forcefully to unethical marketing (doi:10.1136/bmj-2023-076173).5 Thousands of health workers, including doctors, accepted biased training from Novo Nordisk, for example, in a furore that saw the Danish company expelled from the industry body in the UK. We should be re-evaluating collaborations with unethical companies, they argue, turning down grants, consultancies, and sponsorships.

Behind these marketing scandals was a drive to get expensive products to patients who ultimately didn’t need them. Back in 1977 the World Health Organisation launched its first essential medicines list, a concept that is still alive today (doi:10.1136/bmj-2023-076783).6 It is also one that some high income countries, such as the US and Canada, are adopting after the covid pandemic in an attempt to prioritise highly effective medicines over new drugs with only marginal additional benefits. This is a promising development, but it also creates a focus for industry lobbying, the danger of industry capture of these lists—and the prospect of yet more bad behaviour to call out.