With just days to go until the UK's landmark vote on whether or not to stay in the European Union, the British Medical Journal has taken the rather unusual step of taking sides in the debate, voicing strong support for the Remain campaign.

In a break from its tradition of political neutrality, the journal's editors said this week that Britain should remain part of the EU, noting "this issue transcends politics and has such huge ramifications for health and society that it is important to state our case".

Over the last few weeks the BMJ has published a series of impartial articles mulling over the main arguments on both sides of the debate and the potential effects on health and the NHS. However, "as the series has progressed it has become increasingly obvious that the arguments for remaining in the EU are overwhelming, and that now is not the time for balance".

Highlighting the strength of support for 'Remain' from the health sector, Fiona Godlee and colleagues note: "we could not name one prominent national medical, research, or health organisation that has sided with Brexit", and the stress that Brexit claims relating to the NHS are "simply wrong".

In the first instance, they point out that a host of financial and economic experts have denounced Leave campaigners' flagship argument that the UK sends £350 million to the EU every week. Also, the claim that the NHS will be swamped by immigrants wanting to make use of the free health service has been countered by a London School of Economics review, which found that, because they tend to be young, they actually make less use of health services.

"But perhaps the most laughable untruth is that the NHS would be safer in their hands. As John Major said when interviewed on the BBC's Andrew Marr Show, the NHS is about as safe with the prominent Vote Leave campaigners 'as a pet hamster with a python'".

The negative impact of leaving the EU on the NHS would far-ranging, they warn. The Economist Intelligence Unit recently calculated that, because of the impact of Brexit on the wider economy, healthcare spending per head would be around £135 lower by 2020 than it would if the UK stayed in the EU. As the BMJ editors argue, this is on top of the £22 billion in efficiency savings it is expected to deliver by 2020, adding yet more financial strain on on already overstretched service.

Elsewhere, as the NHS relies on overseas doctors and nurses and, while those already here would unlikely be sent home in the case of Brexit, "leaving the EU would jeopardise the free movement of people on which our health service depends". Also, the UK plays host to the European Medicines Agency, which would have to move out in a leave situation.

"Playing host to the agency gives the UK clout in regulatory affairs and also makes the UK an attractive place for US and Asian firms to base the European arm of their clinical trials. And while we may still get access to research funding if we quit the EU, we would no longer have influence in shaping the research agenda", they stress.

The BMJ is also warning of a resurgence in nationalism. "Brexit campaigners have forgotten the evils of virulent nationalism because Europe has succeeded in containing them," according to the article. "After two devastating world wars, a progressive social democratic consensus emerged in Europe. And governments have pursued redistributive policies within the broader European Union bringing enormous gains for health and social justice. But these policies are under threat, menaced by a resurgence in right wing nationalism in Poland, Hungary, Austria, and beyond".

Economic instability
The BMJ's move to voice its opinion comes as the NHS Confederation warns that the likely impact on the economy of a vote to leave the EU would make it harder to provide sustainable future funding for the NHS.

In his opening speech at the NHS Confederation's annual conference, chair Rt Hon Stephen Dorrell, argued that, with significant financial pressures across health and care and 65 percent of Trusts in deficit, the NHS cannot afford a period of economic instability.

"Overwhelming evidence, including from the respected Institute for Fiscal Studies, shows Brexit would mean a reduction in national income. If this is the case then, far from providing an opportunity to increase NHS funding, it is overwhelmingly more likely that Brexit would further undermine the finances of a health and care sector which are already likely to become unsustainable," he said.

The Brexit camp hasn't said much about the impact on life sciences industry directly, but campaigners argue that the NHS is at risk from staying in the EU. Leave campaigner and armed forces minister Penny Mordaunt told the Andrew Marr Show there would be more chance of greater investment in the NHS is Britain votes to leave on June 23, and stressed that the NHS needs the ability to plan better and that uncontrolled immigration made it "impossible" for public services to do so, report BBC News.