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Advice from the GMC and MHRA to BAD members on abuse, trolling and vexatious referrals to regulatory bodies in relation to isotretinoin

Advice from the General Medical Council (GMC) and the Medicine and Healthcare Products Regulatory Agency (MHRA) following concerns raised by the British Association of Dermatologists (BAD) in relation to abuse, trolling and vexatious referrals to regulatory bodies of members who are involved in the management of acne patients with isotretinoin.

It became clear at the end of 2020 that several, senior and trainee, members of the BAD had been subject to bullying, abuse, trolling, threats and actual referral to regulatory bodies when members were involved in advisory committees regarding the use of isotretinoin for patients with acne vulgaris. Similarly, members involved in training and support of patients with acne vulgaris were being targeted by patient groups and their advocates who oppose the use of isotretinoin.

Dr Tanya Bleiker and Professor Anthony Bewley have liaised with the GMC, the British Medical Association (BMA), the Medical Defence Organisations (MDOs) and the MHRA on behalf of members. This led to correspondence and, eventually, virtual meetings between the BAD and the above bodies.

Following a meeting between the GMC and the BAD (25.2.21), the GMC acknowledged that there was a potential problem with a small number of BAD members being potentially referred on a fitness to practice basis as a result of their research, use and advocacy of isotretinoin for patients with acne vulgaris. The GMC were supportive of the BAD and understood the issues raised. The GMC reported a fast-track system for dealing with complaints rather than a full investigation which should see referrals being assessed (before full investigation) within one month. In addition, the GMC indicated that whilst they could not and would not impede the governance of the complaints process, they were mindful to make triage colleagues aware of the potential for vexatious referrals of BAD members in the above circumstances.

The MHRA, following alerts from BAD members of the Independent Expert Witness Group on Isotretinoin who had received abusive and unsolicited emails, letters and on-line trolling met with BAD representatives (04/03/21) to discuss the issues around BAD members being able to deliver evidence-based expert reports to the MHRA about the use of isotretinoin for patients with acne vulgaris and other diseases. The MHRA indicated that anonymity of BAD expert witnesses was not possible as MHRA expert witnesses are mandated to complete conflicts of interest (COI) statements, and in the interests of transparency these COI statements must be published.  The MHRA was very grateful for and supportive of BAD expert witnesses who engage with them.

The MHRA have suggested the following:

  • To add a generic clear statement on the MHRA EWG website about how they frown upon poor behaviour, bullying, trolling.
  • To provide a standard email response for members to return to anyone who may approach them. (MHRA cannot accept emails unless they have been anonymised).
  • The minutes from the first meeting of the IEWG, which are publicly available will contain a statement regarding the intolerance of poor behaviour, trolling by the public etc.
  • MHRA wish to hold a public meeting with experts to represent BAD. A pre-meeting will be held with full discussion about behaviour of participants.
  • MHRA have suggested a statement is added to the BAD website (public/patients) in relation to intolerance of poor behaviour, trolling etc.
  • The MHRA had indicated that facilitators in IEWG committees are happy for email addresses to be given to the GMC should they wish to speak to the MHRA.

The MDOs (Medical Defence Union and Medical Protection Society) are also aware of BAD members who have been abused, trolled and referred to the GMC whilst involved in roles such as researching, advocating and training juniors in the use of isotretinoin for patients with acne vulgaris. They advise:

  • Contact the MDOs with referrals to the GMC/bullying/trolling immediately
  • Do not respond to any bullying/trolling/abuse
  • Report any bullying/abuse/trolling to your Clinical Lead and Clinical Governance Lead

They also supplied these links:

The BMA was supportive of all the issues raised above and indicated that it intends to follow any developments.  The BMA has an independent and confidential support facility for individual members who are referred to the GMC.

Finally, don’t forget that there are networks available within the BAD and its umbrella organisations for support when BAD members are subject to abuse/trolling/referral:

 

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Higher Orange Consumption Linked To Increased Risk of Melanoma, New Study Suggests

Individuals who consume more citrus fruit, especially oranges and orange juice, are at higher risk of melanoma compared to those with no consumption, according to research published in the British Journal of Dermatology. Findings suggest that consuming more than two servings of citrus a day is associated with a 63% increased risk of melanoma, relative to those with no consumption.

The researchers, from Indiana University, investigated the association between citrus consumption and melanoma, whilst taking into account a number of other factors which are already known to be risk factors for the disease, such as age, tanning habits, and having fair skin.

Using data from the UK Biobank, the researchers were able to review a large sample of 198,964 people, made up of 1,592 people with a melanoma diagnosis and 197,372 controls. Citrus intake data was collected via five rounds of questionnaires, asking participants to recall their citrus intake over the previous 24 hours.

Furthermore, the study found that consumption of oranges was independently associated with an increased risk of melanoma, relative to those with no consumption. The research found that those consuming more than one serving of oranges per day had a 79% increased risk for melanoma compared to those with no consumption and consuming more than one serving of orange juice increased the risk by 54%.

While a relationship between citrus consumption and melanoma risk was observed among this UKBB sample, participants with a fair or very fair skin complexion were found to be particularly at risk with higher citrus intake.

Dr Andrew R. Marley, lead author of the research, said:

“Psoralen has known photosensitising and photocarcinogenic properties and is found in abundance in citrus products. This fact has spurred studies to investigate whether high citrus consumption is associated with melanoma risk due to psoralen photocarcinogenicity. This research suggests a significant increase in melanoma risk associated with a higher citrus intake and these findings could well shape sun-exposure guidance and how we approach advising patients that are already at high risk of developing melanoma.”

Harriet Dalwood of the British Association of Dermatologists, said:

“As melanoma rates continue to rise, improved prevention strategies are needed. Research into contributing factors, such as citrus consumption, are useful in reducing skin cancer rates, particularly amongst those most at risk.

“Citrus fruits, especially oranges and orange juice, are consumed widely in the UK, with fruit juice consumption reported to be increasing year-on-year. This research could help medical professionals better advise patients who already have established risk factors such as a family history of melanoma to lower their citrus intake.”

Previous studies in this area have yielded inconsistent results and have been subject to limitations in their sample pools. For example, the Nurses’ Health Study and Health Professionals Follow-Up Study consisted of health care professionals who would have greater knowledge of UV protection, and the Women’s Health Initiative study, which found there was no significant association between citrus and melanoma risk, could be due to the postmenopausal respondents, who typically are less likely than younger women to engage in certain melanoma-risk behaviours.

There are around 16,200 cases of melanoma in the UK every year, this represents a 135% increase in annual melanoma cases since the early 1990s. It is the 5th most common cancer diagnosis among UK residents and is growing in incidence faster than any other cancer.

The researchers acknowledge the study’s limitations, including the reliance on self-reported citrus consumption data. Results were further limited due to inability to control for unmeasured confounding factors, such as family history of melanoma.

Dr. Xin Li, senior author of the research, said:

"Despite our study limitations, we leveraged data from a large, population-based sample and we were able to control for several key sociodemographic and skin cancer-related variables. We believe that these results, based on biological plausibility, provide evidence in support of an association between high citrus consumption and melanoma risk."

Notes to editors

More statistics on melanoma rates in the UK can befound here. Please notethat the statistics in this press release represent relative risk.

UK Biobank is a large prospective cohort with more than 500,000 participants aged 40-69 years old when recruited in 2006-2010.

Only White/Caucasian participants were included in the analyses due to low melanoma incidence in ethnic minorities in the UK.

This study shows that further research on this topic is necessary, particularly focussing on how the relationship may vary among individuals with different pigmentary phenotypes.

 

Study details:

The Association between Citrus Consumption and Melanoma Risk in the UK Biobank

A.R. Marley,1 M. Li,2 V. L. Champion,3,4 Y. Song,1 J. Han*1,4 and X. Li*1,4

1Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, USA

2Department of Epidemiology and Biostatistics, Indiana University School of Public health,

Bloomington, USA

3Department of Community Health Systems, Indiana University School of Nursing, Indianapolis, USA

4Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, USA

Link to the full study:

https://onlinelibrary.wiley.com/doi/epdf/10.1111/bjd.19896

For more information, please contact the media team: comms@bad.org.uk, 0207 391 6084. BAD Patient Website: www.skinhealthinfo.org.uk

About us:

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.skinhealthinfo.org.uk

The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley-Blackwell. The British Journal of Dermatology is one of the top dermatology journals in the world and publishes papers on all aspects of the biology and pathology of the skin. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133

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Dermatologists warn of risks to medics from HPV, COVID, and other viruses in surgical smoke

The British Association of Dermatologists (BAD) is calling for smoke extractors to be available in all settings where dermatology surgery takes place, following growing concern that surgical smoke plume can transmit viral infections such as HPV. The organisation is also calling for further occupational health research into the risks of viruses being carried from patient to healthcare professionals through surgical smoke

Surgical smoke is formed during surgical procedures that use lasers or cauterisation to destroy skin tissue. As the skin tissue is destroyed, viral particles are aerosolised, remaining suspended in smoke, which can then be breathed in by healthcare professionals.

Dermatologists are spending a larger proportion of their week in the operating theatre than ever before, meaning the risks of catching viral infections have increased. Viral DNA has been observed on the face of surgeons following operations wherein surgical smoke was present.

The viruses which are thought to pose the biggest long-term health concern, include:

  • Human papillomavirus (HPV)
  • Merkel cell polyomavirus (MCPV)
  • COVID-19 – though the risk is currently reduced by the current widespread use of personal protective equipment (PPE)

HPV infection has been shown to be a necessary component in the development of all cervical cancers, as well as a proportion of other genital cancers. The infection is also a contributing element in head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal, tonsillar and laryngopharyngeal cancers.

Concern over the severity of the issue has been growing over the last 30 years and while the threat of COVID-19 transmission has encouraged hospitals to widely adopt PPE, the BAD is calling for the use of appropriate PPE for all surgeries where surgical smoke is present, to prevent transmission of viral infections.

Professor Nick Levell of the British Association of Dermatologists commented: 

“In our hospitals, all kinds of precautions are taken to reduce the risks of cross infection. However, despite being aware of the potential risks for 30 years, surgeons are still breathing in smoke generated by human tissue, along with any viral particles present in the skin.

“Recent data reviews by the Centers of Disease Control and Prevention (CDC) and Health and Safety Executive (HSE) have found that the number of healthcare professionals known to have developed a HPV-associated disease is small, however, there are concerns that this is severely under-reported issue due to the fact that HPV can lie dormant in the body for decades. We are aware of reports of head and neck infections, including cancers, in specialists from ENT surgery, gynaecology, and dermatologists specialising in genital disease.

“More research must be done looking into this issue as an ever-increasing number of dermatologists find themselves in the operating theatre day-in-day-out. We are also urging hospitals to ensure that appropriate PPE and smoke extractors are available for use in all surgeries where surgical smoke may be generated.”

Editor’s Notes

The full position statement from the British Association of Dermatologists on the risk of cancer from viral particles in surgical plume can be viewed here.

For more information contact harriet@bad.org.ukor call 07769000415 

About the British Association of Dermatologists

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.skinhealthinfo.org.uk

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BAD Officer Election Results 2021

The BAD 2021 Officer elections have now concluded, the results are as follows:


President Elect 2021-2022 (leading to President 2022-2024) – Dr Mabs Chowdhury
Academic Vice President 2021-2023 – Professor Richard Warren
Assistant Honorary Secretary 2021-2023 (leading to Honorary Secretary 2023-2025) – Dr Tom Lucke

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