The BMJ Today: Crises—each to their own

kristina_fisterIn Crimea, heroin users have more to worry about than disputed referendums and suspended bank accounts. Since 1 May, the 803 clients of a methadone programme must go cold turkey, given the region’s policy on harm reduction has now aligned with that of Russia. “A blatant example of health policy being hijacked for political ends rather than being led by evidence,” writes Michel Kazatchkine in this Personal View. If trends in Russia are anything to go by, Crimea might be in for a worsening of the HIV/AIDS epidemic—not only among heroin users but also in the wider community. Banning harm reduction is believed to have contributed to the sharp increase in the number of people with HIV that Russia has seen over the past decade, from 170 000 to 1.2 million.

The UK’s healthcare system has worries of its own. A think thank has declared that a financial crisis in the NHS is “inevitable” by 2015-16, and possibly sooner. Over 8% of gross domestic product (GDP) is now spent on the NHS, up from 5% in 1997; still, no marked increases have happened since 2010, making it difficult to keep up with the rising costs. While pay freezes and management cuts are deemed “all but exhausted,” the answer may lie in strengthening primary care which, however, requires investment.

Elsewhere, read about how healthy candidate bias can affect assessments of clinical effectiveness for implantable cardioverter-defibrillators; the ins and outs of spontaneous pneumothorax; and drugs to use for sedation and analgesia in people undergoing procedures in the emergency department.

Kristina Fišter is The BMJ’s Associate editor