The BMJ Today: Consent, discrimination, and the liver

navjoyt_ladherWhat’s the matter with “It’s consent, stupid,” says Margaret McCartney in her latest No Holds Barred column. A leaflet is not sufficient to convey the complex issues around data extraction and potential re-identification. The same applies for screening, where leaflets are often posted to inform people about the benefits and harms of breast and aortic screening. But as Margaret points out: “This isn’t good enough—we all need two way communication with another human being” to offer a more nuanced discussion and check understanding. 

Margaret joined The BMJ as a regular columnist in March. You can find the previous No Holds Barred columns on

Hot on the heels of last week’s two research papers comparing the educational outcomes of UK graduates and international medical graduates in the UK comes this feature from BMJ Careers editor Tom Moberly on the history of ethnic discrimination in the NHS.

There is evidence that both UK and international doctors of black and minority ethnic origin face discrimination throughout their medical careers, affecting everything from entry to medical school, career progression, and recognition in awards.

How can we work to change this situation? As Krishna Kasaraneni, chair of the BMA’s Equality and Diversity Committee, says in the article  “It’s about equity of training provision, rather than equality of training provision. It’s not about race, country, or origin, or where they graduated from. Whoever scores at the lower end of the entry criteria should be identified and provided with extra support.”

Finally, a trio of liver related articles. Adrian O’Dowd reports news of a hepatitis A outbreak in Europe. The European Food Safety Authority are conducting a trace-back investigation of the 240 confirmed cases in this current outbreak. The culprit is thought to be a contaminated batch of frozen berries.

The latest article in the rational testing series is on ordering and interpreting hepatitis B serology. Hepatitis B is a major public health concern and testing should be considered in people with abnormal liver function tests or where there is a high clinical suspicion due to other risk factors.

Serology identifies people with acute infection, people with previous exposure, and those who have been vaccinated, but the array of tests and outcomes can sometimes be confusing. If you don’t know your HbsAg from your anti-Hbc, or if you’re just in need of a refresher, this article is for you.

This week’s clinical review is about gallstones. Kurinchi Gurusamy outlines the diagnosis and management of this common condition. The review also describes the common risk factors for developing gallstones, which include obesity, a refined carbohydrate diet, and a high calorific diet.

It’s something to ponder if you, like me, have eaten rather too much egg-shaped confectionary over the Easter weekend.

Navjoyt Ladher is assistant editor, The BMJ