👋 Happy Friday. Back with your weekly dose of medical news. Here’s what we got:

• GMC vs MPTS: Doctor Not Struck-Off for “One-off” Rape

• Memory Experts: Shingles Vaccine Reduces Dementia Risk by 20%

• Sclerosis or Scoliosis? New Medication approved by NHS

• The Pacemaker the Size of a Grain of Rice

NHS NEWS

GMC vs MPTS: Doctor Not Struck-Off for “One-off” Rape

In the kind of story that shouldn’t be real but somehow is, the GMC is now trying to overturn a tribunal ruling that let a doctor, accused of raping a woman, keep his medical licence.

That’s right. Keep it. 

The case centres around Dr Aloaye Foy-Yamah, a former gastroenterologist at Blackpool Victoria Hospital, who was accused of rape in late 2018. The tribunal(MPTS) concluded last year that yes, on the balance of probabilities, he raped a woman identified only as Ms A.

Not just misconduct. Serious sexual misconduct.
Their words, not mine.

The public file on the case, available on the MPTS website, doesn’t detail the exact nature of their relationship. But it’s clear they knew each other well. According to the tribunal hearing, in late November 2018, Dr Foy-Yamah made sexual advances. On 2 or 3 December, he engaged in non-consensual intercourse.

Even the original MPTS panel admitted this would normally result in erasure from the register. But they decided, in this case, that his otherwise clean record, his “low risk of repetition” and it being a “single, isolated incident” weren’t enough. He has received a 12 months suspension instead

Now the GMC is appealing the decision, saying the ruling is incompatible with maintaining public confidence in the medical profession. And you’d have to agree.

The appeal is expected to go to the High Court later this year. If successful, it could lead to Dr Foy-Yamah being struck off permanently.

Until then, the case remains a pretty damning look at how institutions treat “one-off” sexual assault and how even proven misconduct doesn’t always lead to accountability.

RESEARCH UPDATE

Memory Experts: Shingles Vaccine Reduces Dementia Risk by 20%

Now doesn’t this look like a headline you’d find as a dodgy pop-up ad to download malware on your nan’s laptop.

Memory Experts: Shingles Vaccine Reduces Dementia Risk by 20%

But this time it’s not a spammy wellness blog. It’s a headline study, reported by reputable sources. Like The Telegraph, The Guardian and… The Daily Mail? Sure, why not.

It sounds too good to be true. I’m inclined to call bs 🤔. But it was a study led by Stanford University, published in Nature. And, the study method seems pretty clever—for an observational study. Hmm. Let’s explore…

Stanford Medical had a look at the population in Wales. The obvious thing would be to vaccinate a certain percentage of the population, wait a couple years, then do a MMSE and see who can name more animals without drifting into a monologue about the glory days before Thatcher.

But that would take ages, and the weather is much more forgiving in Palo Alto than Aberystwyth. So instead they had a look at the Welsh electronic health records(SAIL) and found a natural experiment already in the works…

You see, in Wales the decision to receive the vaccine was solely based on your age. And the cut off was strict. If you were born on or after 2nd September 1933, you were in. If you were born before 2nd September 1933? Tough luck. You weren’t allowed the vaccine. 

But this meant there were two groups who were pretty much identical in every way. Age, location, ethnicity. The only difference being the receipt of the shingles jab. Thanks to NHS bureaucracy we have a naturally occurring “treatment” and “control” groups 🤝.

They followed the groups 7-8 years after receiving the vaccine on 1st Sept 2013. Over 280,000 patients were analysed for new dementia diagnoses.

Their key finding were: 

• A relative reduction of 18-37% in shingles diagnosis(matching clinical trial data)

• A 20% relative reduction in new dementia diagnoses

Now, to be clear: this is still an observational study. Not a randomised controlled trial. The researchers used a quasi-experimental design. It’s clever, and it greatly reduces confounding. But it’s not quite an RCT. And we still don’t know how tf it actually works. 

But it is the most convincing population-level evidence so far. And vaccine uptake is declining in certain populations(🇺🇲👀). So if this encourages vaccine uptake, let’s go for it.

NHS NEWS

Sclerosis or Scoliosis? New Medication approved by NHS

How old were you when you discovered Multiple Sclerosis and Scoliosis were not the same thing?!

I was 18 🫣, about to attend a neuro teaching, bewildered as to why MS was in this module and not MSK.

Turns out Multiple Sclerosis is not an extremely messed up spine. It’s that condition with autoimmune attacks on the myelin-sheath of the neurons in the CNS. The one with patients presenting with foot drop one-day then paresthesia and hypersensitivity a couple months later. A real neurological (un)lucky dip.

Tbh…pretty interesting condition as far as it goes. But not for the patients it affects.

MS is notoriously debilitating. It’s like 20 conditions wrapped into one. On top of that, management involves a myriad of medications, regular hospital visits for infusion, self-injection, extensive monitoring, side effects, relapses, more scans… It's really a lot.

There is some light at the end of the tunnel. And no—it’s not the recovery from amaurosis fugax. 

It’s cladribine.

What is that? This is new age disease modifying therapy used relapsing-remitting MS. It’s got a brand name that sounds like an eastern european Marvel villain—Mavenclad. It works by causing a transient reduction in lymphocyte counts, particularly the T and B cells that attack those precious myelinated neurons. This interrupts the immune events that cause the disease

It’s not an injection, infusion or even a suppository(thankfully). It’s a tablet. You take it at home. For a total of 20 days. Across four years. That’s it. That’s the treatment.

Its results are pretty incredible too. During clinical trials 80% of patients didn’t relapse + MRI scans showed 7.5x fewer brain lesions than placebo + it allows women to safely conceive after year 3 of treatment. That last point is massive for family planning.

The NHS is the first healthcare system in Europe to approve widespread access. 2,000 patients are expected to benefit, with the secondary bonus of thousands of clinical hours saved.

If you just found out what the difference between MS and Sclerosis is. It’s fine, no judgement. Tomatoes, tomatoes. Just name-drop Mavenclad and walk away 👌.

MEDTECH

🍚The Pacemaker the Size of a Grain of Rice

Pacemakers, traditionally, are like crazy exes. They’re hard to secure, a nightmare to remove, and if you’re not careful, they’ll leave you with serious scars. Both emotional and surgical.

Cardiology’s newest gadget is a self-powered, bioresorbable pacemaker.  It’s the size of a grain of rice. It dissolves after doing its job. Developed by researchers at Northwestern and published in Nature, this injectable device is designed for temporary pacing—post-op bradycardia, MI recovery, AV block after TAVR, the usual suspects.

The perks? No Wires. No batteries. No retrieval surgery

The device uses magnesium and molybdenum trioxide electrodes to form a galvanic cell with the surrounding tissue. So your myocardium becomes the electrolyte. It’s triggered via Near-infrared light from a skin-worn sensor, which also monitors ECG in real time and provides closed-loop pacing. No transvenous leads. No femoral fishing expeditions.

They’ve demoed it in mice, rats, pigs, dogs, and human hearts, with effective single and multi-site pacing. Fully MRI-compatible, and because it resorbs, there's no explant risk. Estimated degradation: 1.2–2.5 years, though functional life is around 16–20 days, depending on electrode material.

No, it won’t replace permanent devices. But for temporary and paediatric pacing, this thing might just become the new standard.

That marks two weeks. We’re getting into the flow of things now.

If you liked it, tell your mates.
If you hated it, tell your enemies.

See you on Sunday, for the Sunday Clerking. The Secret Business Behind Harley Street

Also, I’m starting a new segment called “Breaking The Bottleneck”. Yes, we’re interviewing the best of the best. Those who recently secure elite training posts and specialty training. Neurosurgery, Plastics, Dermatology, Cardiology and more.

If you’d like to be involved in this segment, interviewing clinicians in your dream roles, reply to this email