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Children's doctors call for ban on disposable vapes

Children's doctors are calling for a complete ban on disposable vapes because they are likely to damage young lungs and are bad for the environment.

But an anti-smoking campaign group says a ban would make it harder for some adults to give up smoking and increase the trade in illegal vapes.

UK governments are planning steps to reduce vaping among under-18s.

Prime Minister Rishi Sunak recently said it was "ridiculous" that vapes were designed and promoted to appeal to children when they were supposed to be used by adults giving up smoking.

A BBC investigation found unsafe levels of lead, nickel and chromium in vapes confiscated from a secondary school, which could end up being inhaled into children's lungs. Scientists analysing the vapes said they were the worst lab test results of their kind they had ever seen.

The Royal College of Paediatrics and Child Health (RCPCH) now says the UK government should "without a doubt" ban disposable e-cigarettes.

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Source: BBC News, 6 June 2023

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Leaked data reveals ‘distressing’ scale of ‘unacceptable’ A&E waits

One in five cases in which patients attend A&E needing mental healthcare are spending more than 12 hours in the department – at least double the rate of patients with physical health problems.

Unpublished internal NHS data seen by HSJ also suggests the proportion of mental health patients suffering long waits in accident and emergency has almost tripled when compared to the situation before the pandemic. 

According to the data, the proportion of attendances by patients with a mental health problem who waited more than 12 hours in A&E before being admitted or discharged increased from 7% (34,945 breaches) in 2019-20 to 20% (88,250 breaches) in 2022-23.

The situation has become so difficult, that some acute trusts are spot purchasing private sector mental health in order to discharge patients. 

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Source: HSJ, 5 June 2023

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‘Axe under pillow’: paramedics urged to take police escorts to 1,200 dangerous homes

Paramedics are being told to take a police escort to more than 1,200 addresses for fear of attack, The Times has revealed.

The College of Paramedics said the figure was outrageous and called on courts to implement tougher sentences for assaults on paramedics.

Ambulance services have marked hundreds of addresses after violence towards crew. Notes on addresses include “patient keeps axe under pillow — serrated knife hidden round the house and is known to be a risk”, “shoots/throws acid”, and “patient is anti-ambulance”.

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Source: The Times, 4 June 2023

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Doctor told cancer patient she had anorexia despite three ‘red flag’ signs

A woman was “fobbed off” by her doctors who failed to diagnose her colon cancer for a year, an investigation revealed.

In May 2019, Charlie Puplett, 45, expressed concern at her GP surgery in Yeovil, Somerset, about unexplained weight loss, lack of appetite and a change in bowel habits.

But the surgery did not test her for colon cancer – with one doctor suggesting she had anorexia and was “in denial”, she said.

She was not diagnosed until almost a year later when she was rushed to hospital after vomiting blood.

Ms Puplett’s experience was detailed in an investigation by the Parliamentary and Health Service Ombudsman (PHSO), which found that her symptoms should have been “red flags” leading to urgent testing within two weeks, and said she had been “failed” by her doctors.

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Source: The Independent, 4 June 2023

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Complaints about non-surgical butt lifts ‘rising at alarming rate’ in UK

Complaints about non-surgical Brazilian butt lifts and breast enhancements have risen at an “alarming” rate, up from fewer than 5 to 50 in a year, an industry body has revealed.

Save Face, a national, government-approved register of accredited non-surgical treatment practitioners, is calling for the procedures to be banned, while the Local Government Association has asked Westminster to take urgent action.

Ashton Collins, the director of Save Face, said the organisation had noted an “alarming” increase in complaints about these enhancements, which she said should be banned.

Collins said: “No reputable healthcare professional would offer these treatments as they are very high risk.

“It’s a new and incredibly dangerous trend which has emerged from social media, a trend people think is a cheaper, risk-free alternative to the surgical counterparts. All the cases reported to us have been carried out by non-healthcare practitioners who have prioritised profits ahead of the safety and wellbeing of their clients.

“These treatments are incredibly risky, and we have helped people who have contracted sepsis and have had to undergo surgery to remove the filler. In 2021, we had fewer than five complaints about these treatments. That figure has increased tenfold in the past year alone and we are getting more and more complaints each week.”

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Source: The Guardian, 2 June 2023

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Women ‘traumatised’ by invasive hysteroscopies that are often carried out with just paracetamol

Some women are being left “traumatised” following a routine gynaecological procedure that is often carried out with minimal pain relief, with one pain expert warning there is an “apathy” within the NHS in changing how it is done.

There are various pain relief options for the procedure, including general anaesthetic. However, campaigners say it is common for women to be told just to take paracetamol before they arrive at the hospital.

Doctors claim this is sufficient pain relief for most patients, however a significant number of women have reported pain so severe that it has left them feeling “traumatised” and “violated”.

Jenny Wade, 51, had a hysteroscopy carried out this year after her GP referred her to Leicester General Hospital to investigate her postmenopausal bleeding.

Ms Wade said she asked if she could have the procedure under general anaesthetic and was told she could, but there would be a wait.

She decided to go ahead with the procedure without the anaesthetic, as she was worried she could have cancer and did not want to delay a diagnosis.

“I’ve never known pain like it. I had tears flooding down my face,” she said describing the procedure.

“It was so traumatic. The only way I can describe the pain is similar to childbirth. I’d say it could have even been worse because I had an epidural during childbirth.”

According to a best practice paper published by the Royal College of Obstetricians and Gynaecologists this year, women should be given accurate written and verbal information about hysteroscopies ahead of their appointment, including the various pain control options.

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Source: iNews, 4 June 2023

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‘Archaic’ and risky patient records still used by most GP practices

Most GP practices in England are still using ‘archaic’ Lloyd George paper records despite a commitment to digitise them, HSJ has found.

NHS England’s 2019 GP contract included a commitment to do away with the so-called “Lloyd George envelopes” – named after the early 20th century prime minister who introduced a pre-NHS health insurance scheme – and digitise them by 2022-23. The NHS stopped issuing new envelopes for first-time registrations in January 2021.

But Freedom of Information requests submitted by HSJ have revealed that the famous brown paper records, some of them many decades old, are still widely used in England.

Where they are still used, staff typically use electronic records for new information, but have to find and consult the paper records occasionally, when they need older information. This is less efficient than if the records had been digitised, and storing the paper records takes up several rooms in many practices.

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Source: HSJ, 5 June 2023

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Access to contraception has got harder in England, top doctor says

Women are finding it harder to access contraception than they did a decade ago, resulting in more unplanned pregnancies, the women’s health ambassador has said.

They have been discouraged by bad experiences, a confusingly disjointed system and long delays for procedures such as the coil or implant insertion, according to Prof Lesley Regan, a leading gynaecologist who was appointed women’s health ambassador for England last year.

She said that “destructive” changes made to the NHS commissioning system in England in 2012, which siloed GP surgeries from hospitals, were failing women. “If you’re not commissioned to deal with the problem, there’s no incentive to do a job properly … Contraception has got to be everybody’s business and up until this moment it’s been nobody’s responsibility and no one’s been accountable for it.”

She added that the NHS preoccupation with cost was counterproductive as “contraception is the single most cost-effective intervention in healthcare”. She is pushing to get the progesterone-only pill, which took a decade to become available over the counter, made free in pharmacies so fewer women “fall through the cracks”.

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Source: The Guardian, 5 June 2023

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Error causes 800 patients to be wrongly removed from waiting list

A trust is carrying out a review after hundreds of patients were wrongly removed from the waiting list and potentially missed out on treatment.

York and Scarborough Teaching Hospitals Foundation Trust told HSJ that roughly 800 patients of its referral to treatment waiting list, were affected.

A serious incident was declared after it emerged some patients “had their referral to treat clocks stopped erroneously, resulting in patients not receiving treatment”, according to a report to the trust board.

The trust said reviews were under way but had not yet identified any cases of “moderate or significant clinical harm”, although it admitted some patients had been significantly delayed.

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Source: HSJ, 2 June 2023

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Liver dialysis device safe and effective for treating liver failure

Researchers have completed the first successful in-patient trial of liver dialysis.

The DIALIVE device, invented by researchers at UCL’s Institute for Liver and Digestive Health, was found to be safe and effective, research suggests.

According to a new study, the device is associated with substantial improvement in the severity of symptoms and organ function in a greater proportion of patients with acute-on-chronic liver failure (ACLF), when compared with patients receiving standard of care.

The next step would be a larger clinical trial, which if successful could see DIALIVE approved for clinical use within the next three years.

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Source: The Independent, 1 June 2023

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USA: Eating disorder group pulls chatbot sharing diet advice

A US organisation that supports people with eating disorders has suspended use of a chatbot after reports it shared harmful advice.

The National Eating Disorder Association (Neda) recently closed its live helpline and directed people seeking help to other resources, including the chatbot.

The AI bot, named "Tessa," has been taken down, the association said. It will be investigating reports about the bot's behaviour.

In recent weeks, some social media users posted screenshots of their experience with the chatbot online.

They said the bot continued to recommend behaviours like calorie restriction and dieting, even after it was told the user had an eating disorder.

For patients already struggling with stigma around their weight, further encouragement to shed pounds can lead to disordered eating behaviours like bingeing, restricting or purging, according to the American Academy of Family Physicians.

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Source: BBC News, 2 June 2023

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‘Muddle, frustration and distrust’ at ‘most mature’ ICS

Multiple problems have been highlighted with the leadership and governance of a much-vaunted integrated care system, including a lack of trust between organisations which often hide information that could weaken their position.

HSJ has seen an executive summary of the review of Greater Manchester ICS, which cited widespread concerns around the allocation of resources, confusion about the role of commissioning, and “muddled” governance, including:

a lack of transparency and trust between partners, with some only sharing a “partial overview” of performance and finances which drives choices likely to “bias” some organisations;

complex architecture of system boards, committees and forums, with “muddled” governance, unclear paths for critical decisions to be made, and unclear delegations to localities;

frustration at the quantum of meetings that take place at system, locality and provider level.

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Source: HSJ, 2 June 2023

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Women waiting too long for abortions, health watchdog finds

Women are waiting too long for abortions, according to a major review into a leading UK provider.

The Care Quality Commission (CQC) review of the leadership at the abortion provider the British Pregnancy Advisory Service found there were “delays” in “investigating incidents”.

The remains of some pregnancies were sometimes not stored properly and there were issues were record keeping, patient monitoring and safe care, the review found.

The watchdog also noted “women did not always receive care in a timely way to meet their needs”.

The health watchdog said: “In August 2021 we found significant concerns in we found that safe care was not being provided; ineffective safeguarding processes; incomplete risk assessments were not fully completed; observations were not monitored or recorded; records were not fully completed, clear or up to date.”

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Source: The Independent, 2 June 2023

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ICB defies NHSE over patient record access

An integrated care board (ICB) has advised its GP practices not to give patients automatic access to their records, contradicting NHS England national requirements. 

Instead, North East London ICB has suggested practices only allow access where patients request it, and subject to conditions.

The national go-live date for patients to be allowed automatic access to future entries in their records has been repeatedly delayed since initially being set at December 2021. GPs have argued they needed more time to redact sensitive information, ensure records are not inappropriately shared, and train staff. They have cited workload and safeguarding concerns.

The ICB’s chief clinical information officer Osman Bhatti, who is a GP, told HSJ the ICB instead “wanted a process where patients could access both prospective and retrospective records safely, with less workload for GPs and so patients who actually want access can have it”.

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Source: HSJ. 1 June 2023

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Almost 780,000 on NHS Scotland waiting lists

Almost 780,000 Scots found themselves on an NHS waiting list for an appointment, treatment, or test, new figures show.

Statistics published on Tuesday by Public Health Scotland show a rise in the number of people waiting, from 772,887 on December 31 to 779,533 as of March 31. Some 479,725 people were waiting for an outpatient appointment on March 31, an increase of 0.5% (2,617) from December 31 and 14.5% higher than the same date last year.

Since March 2020 – the beginning of lockdowns in response to the pandemic in the UK – the waiting list has grown by 87%. A Scottish Government target aims to ensure 95% of patients are seen within 12 weeks. Of those waits, 31,498 people had been waiting longer than 1 year for their procedure, the figures show.

Humza Yousaf, Scotland's First Minister said: "There’s going to be a long way to go. The recovery plan is purposely a 5-year recovery plan because we know that recovery from the pandemic—which was the biggest shock the NHS faced for almost 75 years—is going to take us not weeks or months, but years to recover from."

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Source: Medscape, 31 May 2023

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Why the Met shouldn’t stop responding to mental health 999 calls

Sir Mark Rowley, commissioner of the Metropolitan Police, has written to health leaders warning the force will stop sending officers to attend thousands of 999 calls about mental health incidents. The ban will only be waived if a threat to life is feared.

The move by Scotland Yard follows the rollout of a similar policy by Humberside Police in 2020 called Right Care Right Person, which sees mental health professionals dealing with calls. An inspection by His Majesty’s Inspectorate of Constabulary, Fire and Rescue Services in November found the switch had saved the force – which has mental health workers from the charity Mind in the force control room – 1,100 police hours per month.

However, there is a concern that healthcare services cannot possibly set up an appropriate response that will keep vulnerable individuals safe within three months.

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Source: Independent, 31 May 2023

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Florida doctors can soon deny patient care based on personal, religious beliefs

A controversial new Florida bill will allow physicians to opt out of performing certain services because of "sincerely held" religious, moral, or ethical beliefs.

The bill, part of a "medical freedom" legislative package signed last week, permits healthcare providers to make conscience-based objections to providing medical care and protects them from getting sued or losing their licenses.

Critics say the new law could exacerbate health disparities and lead to discrimination against certain groups of patients, including LGBTQ+ individuals and women seeking reproductive healthcare.

Psychologists could refuse to treat someone for gender dysphoria, for example. Doctors could refuse to prescribe birth control, administer childhood vaccines, or accept patients with state insurance.

Kenneth W. Goodman, professor and director of the University of Miami's Institute for Bioethics and Health Policy, told Medscape Medical News the legislation could upset a longstanding precedent.

"To deny care based on unspecified and unarticulated 'moral, ethical, or religious reasons' opens the door to neglect, abandonment, and suspicion," Goodman said. "It undermines two millennia of a cornerstone of medical ethics: take care of your patients — no matter who they are."

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Source: Medscape, 18 May 2023

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Paediatric wards may not be safe for patients with 'high-risk' behaviours


Children presenting with 'high-risk' behaviours are being cared for in NHS paediatric wards that may put them and others at risk of harm, according to a new report from the Healthcare Safety Investigation Branch (HSIB). HSIB's interim report warns that the placement of children and young people with complex mental health issues on NHS paediatric wards can impact on the wellbeing of these patients and their families, and pose a risk to other patients and staff.  

The report emphasises that paediatric wards are designed to care for patients who only have physical health needs and not for those who are exhibiting high-risk behaviours, which include attempts to die by suicide, self-harm, attempts to leave the hospital without permission, and episodes of violence and aggression.

Examples of children and young people being restrained or sedated in front of other sick and vulnerable patients, families feeling concerned for their and their children's safety during incidents, rooms being stripped down to remove any risk of self-harm or death by suicide, and paediatric staff being physically assaulted are cited in the report.

 Saskia Fursland, HSIB national Investigator, said,"We know that NHS staff are trying to provide a safe environment for their patients, but they are facing difficult choices in wards that are not designed to support children and young people displaying high-risk behaviours. Our ongoing investigation will take a longer-term look at effective design, adaptations and risk management in the wards. A whole system response is now needed to ensure we can keep children and young people safe."

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Source: Medscape, 25 May 2023

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Health alert system aims to cut heatwave deaths

A new alert system will warn the public when high temperatures could damage their health this summer in England.

Run by the UK Health Security Agency and the Met Office, it is aimed at reducing illness and deaths among the most vulnerable as climate change makes heatwaves more frequent.

The Heat Health Alert system will operate year-round, but the core alerting season will run from 1 June to 30 September. The system will offer regional information and advice to the public and send guidance direct to NHS England, the government and healthcare professionals. Individuals can sign up to receive alerts directly and people can specify which region they would like to receive alerts for.

Dr Agostinho Sousa, head of extreme events and health protection at the UK Health Security Agency, said, "It is important we are able to quantify the likely impacts of these heatwaves before they arrive to prevent illness and reduce the number of deaths."

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Source: BBC News, 1 June 2023

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NHS productivity lags as recruitment fails to keep pace with demand

The NHS in England faces an uphill struggle to improve productivity as it confronts record waiting lists, with data suggesting that an increase in staff numbers alone will not transform its performance.

Creaking infrastructure, a sicker population and a reliance on less experienced staff are hampering the health service’s attempts to treat people in greater numbers than before the pandemic, according to health experts.

This difficult context is casting a shadow over the government’s goal that hospital waiting lists should be falling by the next election.

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Source: Financial Times, 1 June 2023

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‘Devastated’ director quits after ‘bullying’ row with consultants

A trust director has stepped down after a row with consultants about the leadership culture within her department, HSJ  has learned.

Pratima Gupta quit as director of women’s services at University Hospitals Birmingham Foundation Trust last week after a group of consultants expressed “no confidence” in her leadership. They claimed there was “intimidating and bullying behaviour” by individual managers.

However, Ms Gupta said the allegations are untrue, and said she has faced “obstruction at almost every step” from some consultants when trying to improve training and culture within the department.

Trainee doctors in obstetrics and gynaecology have previously expressed concerns around a lack of support from consultants, with the trust recently receiving a further warning around this from the General Medical Council and Health Education England.

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Source: HSJ, 1 June 2023

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Mental health services that fail to improve could be shut, says watchdog

Failing mental health services that do not improve, whether run by private firms or the NHS, could be shut, a Care Quality Commission (CQC) chief has said.

It follows the watchdog judging as "inadequate" three child wards at the Priory Group's biggest hospital.

The wards at Cheadle Royal, near Manchester, "did not always provide safe care", the CQC found.

The unannounced inspection of Cheadle Royal took place earlier this year "in response to concerns about safety". BBC News first reported in January three women had died at the hospital last year, although not in the wards inspected for this report.

The CQC's new director of mental health services, Chris Dzikiti, said he was determined to drive up standards in all units and warned he will close services who fail to improve.

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Source: BBC News, 31 May 2023

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‘Discrimination’ claim as ‘40 new hospitals’ snubs mental health

A chief executive has compared a lack of investment into mental health estate to ‘institutionalised discrimination’, after no new schemes were accepted on to the ‘40 new hospitals’ programme.

HSJ revealed that almost 50 capital projects from mental health trusts attempted to win one of the final places on the “new hospitals programme”, but all were taken by new acute schemes.

Some of the trusts that submitted unsuccessful bids are using buildings which are more than 100 years old and were constructed without modern care practices in mind. Many of the bids raised safety concerns about the current estates.

Joe Rafferty, chief executive of Mersey Care Foundation Trust, told HSJ: “If there’s been a priority order, mental health has been at the back of the queue.

“It’s almost a sort of institutionalised discrimination in a way… there is a risk that the system itself is stigmatised or discriminated against mental health patients.

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Source: HSJ, 31 May 2023

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New migraine drug on NHS could help thousands of patients in England

Thousands of people in England who get migraines could benefit from a drug that has been approved on the NHS.

The National Institute for Health and Care Excellence (Nice), the drugs regulator, said it was recommending rimegepant for preventing migraines in the approximately 145,000 adults where at least three previous preventive treatments had failed.

The drug, also called Vydura and made by Pfizer, is taken as a wafer which dissolves under the tongue. It is the first time Nice has recommended an oral treatment for preventing migraines.

“Each year the lives of millions of people in England are blighted by migraine attacks,” said Helen Knight, the director of medicines evaluation at Nice. “They can be extremely debilitating and can significantly affect a person’s quality of life.

“Rimegepant is the first oral treatment for migraine to be recommended by Nice and for many thousands of people it is likely to be a welcome and more convenient addition to existing options for a condition that is often overlooked and undertreated.”

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Source: The Guardian, 31 March 2023

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FDA proposes revamping medication guides that come with prescriptions

The US Food and Drug Administration has proposed to add to what you get with your prescription drugs.

The proposed rule would require the prescriptions you get to come with a new kind of single-page medication guide with an easy-to-use set of directions and easy-to-understand safety information, a goal the FDA has been working toward for years.

One study found that nearly 75% of Americans have had trouble taking their medicine as directed. A lot of that is due to cost – people might not be able to afford their medicine, so they don’t take it – but some is due to confusion. They might get more than one kind of written information with their prescription, or the information they receive can be conflicting, incomplete or repetitive, the FDA said.

When people are confused or misinformed about their prescription, there is a good chance they will not take it or will stop taking it, and that can directly hurt their health.

“Research suggests that medication nonadherence can contribute to nearly 25% of hospital admissions, 50% of treatment failures, and approximately 125,000 deaths in our country each year,” the FDA says.

The agency said the new proposal is also meant to help fight the “nation’s crisis with health care misinformation and disinformation.”

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Source: CNN, 30 May 2023

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