ASH Daily News for 11 November 2019


  • Election pledges for primary care funding boost


  • US: CDC reports ‘breakthrough’ over vaping lung illnesses
  • US: Trump to pursue higher sales age for e-cigarettes


Election pledges for primary care funding boost

The Conservative Party has promised to invest £2.4bn over four years from 2021-22 to increase the numbers of doctors and other clinicians working in primary care. It would boost primary care’s budget allocations by around £600m a year, should the party win the election.

The announcement claimed the money would be used to train “500 more GPs every year” and that “by 2024-25 we project there will be almost 3,000 additional doctors working and training in general practice” as a result. It also stated a Conservative government would “improve the retention of…GPs and nurses and will work on a number of initiatives to improve international recruitment. We expect these recruitment and retention initiatives to deliver 3,000 more GPs who otherwise would not be working in the NHS.”

The pledge comes at a challenging time for the general practice workforce with GP numbers rising fractionally according to the latest workforce statistics, but with fewer GPs opting to take on the extra burden of becoming GP partners. More junior doctors are training to become GPs, according to the June workforce statistics, but the retention of GPs later in their career has been highlighted as a major issue.

Earlier this year analysis by the Nuffield Trust suggested there had been a sustained fall in GP numbers per head of population since 2009, after four decades of rising numbers.

In September, Jonathan Ashworth, Labour’s shadow health secretary, announced plans to increase the number of GP trainees in England by almost 50 per cent, saying this would provide 27 million additional GP appointments each year once they were trained. He added: “We’ve lost just over 1,600 full-time GPs under the Tories and GPs tell me they are overworked, exhausted and pushed to the brink.”

Source: HSJ, 9 November 2019

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US: CDC reports ‘breakthrough’ over vaping lung illnesses

US health officials have reported a breakthrough in their investigation into the cause of a nationwide outbreak of vaping illnesses. The discovery of vitamin E acetate, in lung samples collected by the CDC (US Centers for Disease Control and Prevention), offers direct evidence of a link between the substance and vaping-related lung injuries. The substance has also been identified in tests by US and state officials of product samples collected from patients with the vaping injury.

In a telephone briefing on Friday, Dr Anne Schuchet, principal deputy director of the CDC, named vitamin E acetate as “a very strong culprit of concern” and referred to the discovery as “a breakthrough” in the investigation. She cautioned that more work was needed to definitively declare it a cause and said studies may identify other potential causes of the injuries as well.

Vitamin E is safe as a vitamin pill or to use on the skin but inhaling oily droplets can be harmful. It has recently been used as a thickener in vaping fluid, particularly in black market vape cartridges. Vitamin E acetate is believed to be used as a cutting agent in illicit products containing THC – the component of marijuana that causes a “high”.

Although the substance was detected in all 29 of the lung samples, which came from patients in several different states, more testing is needed to establish a causal link between exposure and injury, Schuchet said, adding that “many substances are still under investigation”.

The results were published on Friday 8th November in the CDC’s Morbidity and Mortality Weekly Report. In a separate report in the same journal, the Illinois department of public health found that compared with vapers who did not get sick, those who had a lung injury were significantly more likely to use THC-containing vaping products exclusively or frequently, and were nine times more likely to have purchased products from illicit sources, such as from online or off the street. Together, the findings reinforce public health officials’ recommendation that people avoid using e-cigarettes that contain THC or any products that come from illicit sources.

Source: The Guardian, 8 November 2019

See also: CDC. Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — 10 States, August–October 2019.

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US: Trump to pursue higher sales age for e-cigarettes

President Donald Trump said on Friday 8th November that his administration will pursue raising the age to purchase electronic cigarettes from 18 to 21 in its upcoming plans to combat youth vaping. Trump told reporters his administration will release its final plans for restricting e-cigarettes next week but provided few other details.

“We have to take care of our kids, most importantly, so we’re going to have an age limit of 21 or so,” said Trump, speaking outside the White House. Currently the minimum age to purchase any tobacco or vaping product is 18, under federal law. Over a third of US states have already raised their sales age to 21. A federal law raising the purchase age would require congressional action.

Administration officials were widely expected to release plans this week for removing most flavoured e-cigarettes from the market. However, no details have yet appeared. Trump resisted any specifics on the scope of the restrictions.

In a separate event on the same day, Joe Grogan, a top policy adviser to Trump, told reporters that the White House believes e-cigarettes are “a viable alternative to combustible cigarettes.” He suggested the administration’s decision on vaping would reflect that potential benefit: “We really want to make sure we’re data driven on this and striking the right balance between adult choice and protecting kids.”

Source: Mail Online, 8 November 2019

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