To support a review of evidence on the possible association between the acne medicine, isotretinoin, and psychiatric and sexual disorders, a call for information has been launched today by the Medicines and Healthcare products Regulatory Agency (MHRA).

Patients and their families, healthcare professionals, researchers and organisations are being invited to contribute to the review through the MHRA’s call for information.

Isotretinoin is an effective medicine for severe forms of acne that has not responded to other treatments, however as with all medicines, there are suspected side effects, some of which can be severe.

An Expert Working Group is reviewing the available evidence relating to isotretinoin, and will advise whether the MHRA should take additional regulatory action, for example, improving the information for patients to help minimise the risks of psychiatric and sexual side effects, suspected to be associated with isotretinoin.

Dr. Sarah Branch, Director of Vigilance and Risk Management of Medicines at the MHRA, said:

We want patients taking isotretinoin to be informed of the risks and benefits and have recently issued a reminder to healthcare professionals.

All medicines can cause side effects, and we need to ensure that the benefits of taking isotretinoin outweigh the potential risks associated with this medicine. That is why we need people’s help to gather information on psychiatric or sexual disorders, that they have suffered, and suspect to be associated with isotretinoin treatment.

We are asking patients, family members and healthcare professionals to contribute to the review so that the Expert Working Group has-up-to-date information to consider. All information we receive will be treated confidentially.

We know this is a personal issue for anyone who suspects they have suffered psychiatric or sexual disorders with isotretinoin treatment, therefore we would appreciate any help you may be able to give us.

The MHRA will work with patients and their families, as well as healthcare professionals and organisations, to ensure everyone has an opportunity to contribute to the review. The agency is particularly interested to hear the experience of patients and families in the UK, but would also welcome contributions from those living outside the UK.

Details about the call for information, including what and how to submit, are available here.

Any queries regarding the review or the call for information should email info@mhra.gov.uk or phone 020 3080 6000.

Due to its suspected side effects, isotretinoin should only be prescribed under the supervision of consultant dermatologists, to treat severe forms of acne that have not responded to antibiotics and topical treatments (creams or gels). Isotretinoin capsules are also known by the brand names Roaccutane, Reticutan, and Rizuderm in the UK.

Anyone in the UK who suspects they may have experienced a side effect with isotretinoin, or any other medicine, can submit a report to the Yellow Card Scheme. This helps makes medicines safer for everyone.

The Falkland Islands are now finally free of lethal minefields almost 40 years after the end of the conflict during which thousands of exploding devices were laid.

A UK-funded programme which started in 2009 has completed its dangerous mission to de-mine the islands in the South Atlantic three years ahead of schedule.

The removal of the mines laid during the 1982 conflict with Argentina means the UK has now met its obligations set by the Anti-Personnel Mine Ban Convention.

As a result the warning signs and fences that have been a feature on the islands since the end of the conflict will be removed during a local event. The removal of the last mine means there are no anti-personnel mines on British soil anywhere in the world.

Islanders will mark the moment with the detonation of the final mine and the cutting down of fences which will finally re-open their access to beaches. Games of cricket and football will be played on the beach itself, to enjoy unrestricted access.

Minister Wendy Morton, UK Minister with responsibility for the Falklands, said:

This is a huge achievement for the Islands and we must pay tribute to the brilliant team of deminers who put their lives at risk day to day removing and destroying landmines to make the Falklands safe.

Our commitment to ridding the world of fatal land mines does not end with our territories being mine free. A further £36 million of UK funding will allow demining projects across the world to continue, protecting innocent civilian lives.

The demining team from Zimbabwe, with supervising staff from British companies SafeLane Global and Fenix Insight had to struggle with the islands’ challenging physical conditions, often working in remote locations and through the unpredictable and sometimes extreme Falklands weather, to achieve the goal to rid the Falklands of mines.

The UK is one of the world’s leading forces in ridding the world of mines. An additional £36 million of funding has therefore been given to the UK-funded Global Mine Action Programme 2, bringing the total to £124m, to continue demining projects in Africa, the Middle East and Asia. This recognises that landmines continue to cause harm and damage lives, many years after conflicts are over.

Further detail:

• The Falklands will be officially declared landmine free on the 14 November in a local celebration. There will also be an official celebration hosted by the UK at Government House on the 17 November, where the deminers will be presented with certificates signed by Minister Morton.

• Countries benefitting from the additional £36 million of funding under the Global Mine Action Programme 2 are Afghanistan, Angola, Cambodia, Iraq, Laos, Lebanon, Myanmar, Somalia, Sudan, South Sudan, Sri Lanka, Vietnam, Yemen, and Zimbabwe.

• GMAP2, which started in 2018, addresses the threat posed by landmines and other explosive remnants of war. By June 2020 it had cleared and confirmed safe the equivalent of 28,800 football pitches of mines and delivered mine risk education to over 2 million people.

During the month-long Operation Thunder, Border Force officers at ports and airports made 178 seizures containing thousands of products regulated under the Convention on International Trade in Endangered Species (CITES). These included elephant tusks and other ivory goods, live corals and reptile skin products. Border Force also made a number of non-CITES seizures including heroin, cocaine, cannabis and cigarettes.

The international operation was co-led by the World Customs Organisation (WCO) and INTERPOL and involved police, customs, environment, wildlife and forestry agencies from 111 countries. The aim was to focus enforcement activities on criminal groups, leading to the disruption of organised wildlife trafficking.

Chris Philp, Minister for Immigration Compliance and the Courts, said:

The trade in endangered species is driven by organised crime groups and the movement of banned animal products is key to how they operate.

This is why Border Force’s specialist officers will continue their vital work at the border to prevent the importation and exportation of endangered animals and plants, as well as working alongside enforcement partners such as the National Wildlife Crime Unit, and police from across the UK to eradicate this ruthless and exploitative trade.

Worldwide, Operation Thunder ran from 14 September to 11 October, leading to the seizure of, among other items, 1.3 tonnes of ivory, more than one tonne of Pangolin scales, 1,400 live turtles and 1,800 reptiles.

Border Force officers at ports and airports across the UK have intensified their enforcement activity to coincide with the international operation. UK seizures included:

• elephant tusks and ivory goods
• cacti Astrophytum asterias (which is in the highest CITES protection category)
• queen Conch Pearl
• Brazilian Rosewood furniture (Dalbergia nigra)
• mounted Butterflies
• agarwood products (Oud)
• live Corals
• reptile skin products
• health/ beauty supplements containing Cactus, Orchid and Crocodile blood.

Non-CITES UK seizures included:

• two kilos of heroin from Tanzania to The Netherlands
• 174,400 sildenafil tablets from India to the UK
• over 100,000 cigarettes
• 2.5 kilos of heroin from Kenya to The Netherlands
• 28 kilos of cannabis from South Africa to the UK
• 500 gms cocaine from Nigeria to India
• 500 gms cocaine from Ghana to Australia
• 8 kilos of dried Khat from Kenya to Sweden
• other class B and C drugs

Border Force is responsible for frontline detection and seizure of items covered by the CITES convention, which tackles the illegal trade in endangered animals and plants. The Heathrow-based Border Force CITES team are specialist officers who are recognised as world leaders in their field.

Anyone with information about smuggling or trafficking should contact Crimestoppers on 0800 555 111 anonymously or visit http://www.crimestoppers-uk.org

At about 16:07 hrs on Wednesday 12 August, a Great Western Railway (GWR) service from London to Bristol travelled at around 117 mph (188 km/h) over an emergency speed restriction (ESR) of 20 mph (32 km/h), near Dauntsey, Wiltshire. This incident did not result in any damage or injury.

GWR notified RAIB of this incident soon after it occurred. We have since gathered evidence from the railway industry and from witnesses, and carried out a preliminary examination of the incident.

An ESR had been in place on the down main line at Dauntsey since 27 June 2020. The line speed in the area is 125 mph (201 km/h). This restriction, for a track defect (a geometry fault known as cyclic top) over a length of about 100 metres, was to 30 mph (48 km/h) for freight trains only. The signs indicated a differential speed restriction of 30/125 mph (30 mph for freight trains and 125 mph for passenger trains).

On the day of the incident the weather was very warm, and at 13:55 hrs local track maintenance staff imposed a restriction of 20 mph (32 km/h) for all trains over the same length of line, because a critical rail temperature had been reached. In accordance with the railway Rule Book, trains were stopped and cautioned by the signaller until 15:52 hrs, when revised lineside signage was put in place.

The first train to pass over the section of line after this was the 15:12 hrs service from London Paddington to Bristol Temple Meads. The driver of this train had booked on for duty at 14:36 hrs at the GWR depot at Paddington. When he booked on he was issued with a hard copy of a notice advising him of the ESRs currently in force on the lines which he would be driving over. This included the ESR at Dauntsey, which he noted. He was aware that this ESR was in force as he had driven over it several times in the previous few days, but it did not require the passenger trains that he drove to reduce speed.

Network Rail did not inform GWR of the revised ESR at this location until 16:33 hrs. The driver had no means of knowing that the ESR at Dauntsey had been changed earlier that afternoon, and that his train would be required to reduce speed to 20 mph (32 km/h). He therefore took no action when the flashing emergency speed indicator came into view. The automatic train protection (ATP) system had not been modified to take account of the changes to the ESR, because they were not likely to be in effect for more than a few hours, so the driver received no warning from ATP that a reduction in speed would be required.

When the driver saw the ESR warning board, he did not register that 30 mph had become 20 mph. However, he did notice the absence of any 125 board below the 20. He assumed this had become displaced, and after a momentary brake application, the train continued at speed for about 37 seconds, covering over one mile (1.6 km), until the driver was able to read the 20 mph board at the point where the ESR started. At this point the train was travelling at 117 mph (188 km/h). The driver then made a full service brake application. This reduced the speed of the train to around 105 mph (169 km/h) by the time it had passed clear of the affected section of line. The driver then reported the incident by radio to the signaller, saying that he believed some of the ESR signage was missing. The boards in place were checked and found to be correct. The ESR for critical rail temperature was removed at 19:07 hrs on the same day.

We have reviewed the findings of this preliminary examination and have decided not to carry out any further investigation of the incident. RAIB has previously made recommendations in our investigation into the similar incident at Sandy on the East Coast Main Line on 19 October 2018 (RAIB report 10/2019), which cover topics which are relevant to the incident at Dauntsey. Recommendation 1 was that train operating companies should review their practice in relation to drivers’ prior awareness of ESRs. The information which the GWR driver was provided with was in accordance with the intent of this recommendation, as far as the company was able to do, at the time the driver booked on. Recommendation 2 was that the rail industry should consider and review options for a safe and suitable means of providing drivers with warning of emergency speed restrictions on the route ahead through the use of available technologies.

This incident is an example of circumstances in which a warning of an ESR ahead would be valuable. The driver was misled by the way the lineside information was presented, which did not sufficiently highlight that the existing ESR had been modified such that passenger trains were now affected. The 30/125 ESR had been allowed to remain in place for some time without being converted to a Temporary Speed Restriction (TSR), which would have changed the information presented to the driver on this occasion and made it more likely that he would have responded to a newly-imposed ESR arising from the hot weather.

We have written to Network Rail and RSSB, copied to the Office Rail and Road, to alert them to this event and the circumstances surrounding the application of the speed restriction. We have also brought the need for action to implement the previous relevant recommendations to their attention.