👋 Happy Friday. I know you really only came back to hear the low-down on the recent Peppa Pig NHS controversy. So sorry to disappoint. We ran out of time…

Here’s what we got instead:

• ✊ Pay-Rise? Pitiful. Strikes? Going Ahead.

• 💊 SSSRI’s: Great for the Blues, Terrible For Balance

• 🫁 Mild Asthma Kills Too. But Maybe It Doesn’t Have To

• 🦠 World’s First Gonorrhoea Vaccine Programme. And It’s In The UK

• #TheMoreYouKnow: Other Top Stories of The Week

NHS NEWS

✊ Pay-Rise? Pitiful. Strikes? Going Ahead.

Mr Wes Streeting has “awarded” NHS staff a pay rise. Although it feels more like he’s polished off a Michelin-star dinner, summoned the waiter, and said, “I’ve got a little something for you”…before dropping 50p into their palm 😕 

Yesterday, the health secretary announced a “thoroughly deserved” payrise of 5.4%(on average) + £750 consolidation pay for resident doctors. Consultants, GP’s and SAS doctors will receive a 4% uplift. Other NHS staff(nurses, midwives and physios) will get a 3.6% increase. 

The announcement came as the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), released their recommendations for a pay rise. At. Long. Last.

It’s been a bit of whirlwind journey but here’s the TLDR:

• From last year’s general election to date residents have got a combined pay rise of 22.3%. Nice start but still 20% less than 2008.

• In March 2025, the DDRB was formally requested to review pay by BMA. Aired for a month.

• BMA were not having it so threatened strike action. Aired for another 3 weeks.

• The BMA doesn't make empty threats. Ballot for Strikes confirmed 2nd May

• The Gov said no need for that. We’ll get you that pay report.

In a (credit where it’s due) well-crafted statement from Wes, he lauds the staff for their value to the NHS. He stresses how funds are tight and states having to “make difficult decisions on other areas of spend to afford these uplifts.” The sincerity is up for debate.

The BMA has looked at the pay-rise with pity, describing it as “woefully inadequate”

Professor Banfield(BMA council chair) sees this as one big stalling tactic, “delaying pay restoration even more, without a government plan or reassurance to correct this erosion of what a doctor is worth.”

For some context FY1 and FY2 salaries should be £39,480 and £45,120 adjusted for 2008 inflation respectively. In reality it's £36,616 and £42,008–post the recent pay-rise. Quite the shortfall.

With this in mind, the ballot seems to be going ahead. 

What will you think? Vote below 👇️ 

RESEARCH UPDATE

💊 SSRI’s: Great for the Blues, Terrible For Balance

Grandma’s been feeling real blue since her dearly beloved passed away. Life has lost its lustre. Her Tuesday night bingo doesn’t hit the way it used to. There’s no getting around it. She’s depressed. 

You do the obvious things, talking therapy, CBT and a prescription of sertraline for the road. But, now she’s falling…and she can’t get up. Thank God for the Life Alert.

You’ve got a real problem on your hands, why is this poor woman falling over? A recent study published in the British Journal of General Practice says that SSRI you’ve given her could be linked with an increase risk of postural hypotension. 

The aim of the study was to examine if the risk of postural hypotension(PH)–a fall in BP from seated position of 20 mmHg/10mmHg– was associated with antidepressant use in over 60’s in UK primary care. This demographic is often neglected due to older adults being excluded from clinical trials.

Researchers looked at over 41,000 patients aged 60+ in UK primary care, all of whom had a diagnosis of PH and were prescribed one of the big three antidepressant categories between 2000 and 2018. Those antidepressants were SSRI(22%), TCA’s(20%) and ‘others’ like SNRI’s (11%)

They used a self-controlled case series design… which basically means each person acts as their own control. It’s like: “how dizzy were you before sertraline vs. after?” Four exposure risk periods were analysed

• 90-days pre-treatment. 

• Day 1-28 post-treatment.

• Day 29-56 post-treatment 

• Over 57 days 

With this information they used statistical analysis to estimate Incident rate ratios(IRR’s) for each of the risk periods. 

From this study they found:

1. For all classes of antidepressant there was a significant increased risk of PH in Day 1-28 of drug exposure, which reduced thereafter.

2. SSRIs had the highest IRR of 4.22. That’s a 4-fold increased risk of postural hypotension.

3. TCAs had an IRR of 2.12 in Day 1-28. The ‘others’ group an IRR 2.17

So yes. The medication may have given her her mojo back, but that falls risk is no joke. Easy fix though. Keep an extra keen eye on over 60’s for a month after a depression prescription. Check their blood pressure, and ask if they've found themselves spending quality time with the floor.

And after 28 days, they should be alright. Mentally lifted. Physically upright.

RESEARCH UPDATE

 🫁 Mild Asthma Kills Too. But Maybe It Doesn’t Have To

Pop Quiz: What’s inside of the blue inhaler? 3…2…1…
It’s Salbutamol. Was that too easy? Hopefully even the ortho guys got that one.

AKA the reliever inhaler, this short-acting B2-agonist is usually the first drug people meet when being introduced to the wonderful world of wheeze control. For mild asthma, SABA’s are always first up.

Problem is, while we focus on memorising the step-up pyramid–ICS, LABA’s, LTRAs, MARTs and beyond–we fail to stop severe exacerbations nearly enough. 

In fact, the ‘mild’ asthma group accounts for 30% of severe and fatal attacks. Are we really sure this is our best bet?

Researchers from North Carolina were not, prompting the BATURA trial. This double-blinded RCT, published in the NEJM, aimed to investigate whether a SABA-ICS combo(Albuterol-budesonide) was better than SABA(Albuterol) alone for reducing severe asthma exacerbation for patients with mild asthma.

They recruited 2516 participants aged 12 or older with uncontrolled mild asthma and separated the 1:1 into two groups:

• Albuterol–budesonide: 180 μg albuterol + 160 μg budesonide per dose

• Albuterol alone: 180 μg per dose

They monitored this population for 12 to 52 weeks, monitoring time to first severe asthma exacerbation as the primary outcome.

What did they find?

• Severe Exacerbations: SABA+ICS combination had a risk exacerbation of 5.1% vs 9.1% in the albuterol-only group. That's an almost 50% reduction in exacerbation(on-treatment efficacy population; hazard ratio 0.53, 95% CI 0.39–0.73). 

• Annualised rate of severe exacerbation: 0.15 (albuterol–budesonide) vs. 0.32 (albuterol)

• Mean annualised systemic glucocorticoid dose: 23.2 mg (albuterol–budesonide) vs. 61.9 mg (albuterol)

• Adverse events were similar between groups

So it looks like the blue inhaler has some serious competition. ER seems to see almost 50% fewer patients with combined therapy than albuterol alone. Not bad

No study is withouts its limitations. The 97% were adults over 18 years old, which definitely hinders the generalisability of the results. Most people first run-in with asthma as children.

Still, this trial creates a strong nudge towards rethinking “mild” asthma management.

NHS NEWS UPDATE

🦠 World’s First Gonorrhoea Vaccine Programme. And It’s In The UK

We now have a vaccine for the gonorrhoea. 

Yes, the best-worst named STI now has a vaccination programme in England and Wales–the first of its kind in the world. Clap for the NHS 👏 

The programme aims to tackle the rising incidence of STI in the UK. Gonorrhoea cases have exploded in recent times, topping 85,000 new cases in 2023. An all time high and 3x higher than just a decade prior in 2012. 

The vaccine isn’t some new novel treatment. We actually already give it to babies. It’s the 4CMenB vaccine. A inactivated vaccine, containing recombinant proteins from Neisseria meningitidis.

Sure, it was made for Meningitis B but it’s got this great side effect where it protects against Neisseria Gonorrhoeae. Why not widen it’s use case? That’s classic British efficiency right there. 

And the vaccine has appeared when we needed it most. The gonorrhoea we know and love has mutated into something more sinister… 31 cases of ceftriaxone-resistant gonorrhoea have sprung up since 2015

How effective is it? It’s okay… I guess. Studies by the Joint Committee on Vaccination and Immunisation (JCVI), show the vaccine is 32-42% effective. It’s a large reduction from the 0 protection you get without it, but it’s definitely less than 100% protection you get using a condom. So I’d keep it in the wallet. Just in case.

Analysis from Imperial suggests the vaccine could avert 100,000 cases and save £7.9 million for the NHS in the next decade(if the NHS lives that long). Those with the highest risk, gay and bisexual men, will be offered the vaccine first in August this year. Wider roll-out planned for the coming decade.

Now, I’m no epidemiologist, but ever since social media took off, I’ve definitely seen fewer Durex ads knocking about. Maybe there’s a simpler fix here than an off-label meningitis jab. Just saying.

Not sponsored, but If you want to get something extra special for your significant other, check out this gonorrohoea plushie I found researching this article. Because nothing says I love you like an STI 😊 

OTHER NEWS YOU SHOULD KNOW

• Medication for Migraine Prodrome

• Case For Methotrexate as firstline for Sarcoidosis?

• Enhanced Breast Cancer Screening = 3500 extra detections

• Drexit (Doctor Exist) - 50% of Med Students plan to leave NI

• 4D MRI to Enhance Aortic Stenosis Diagnosis

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