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[Comment] Offline: On scientific leadership

Sa, 26/01/2019 - 00:00
“Weakness is the only fault that we are incapable of correcting” (François de La Rochefoucauld). What is the responsibility of scientists and physicians in the face of political adversities that damage societies? In recent days, the President of the UK's Royal Society has observed that “A no-deal Brexit would be a disaster for British science and innovation and I urge our elected representatives to put the interests of the country first and get a new plan to prevent this catastrophic outcome.” Robert Lechler, President of the Academy of Medical Sciences, noted that “I am at pains to once again stress that leaving the EU without a deal is a grave threat to biomedical research and the patients and public who rely on our currently collaborative and world-class science.” Paul Nurse, Director of the Francis Crick Institute, commented that “Our scientists unanimously agree that no-deal would be a disaster.” UK scientific leaders seem united in their resistance to a calamitous exit from the European Union.

[World Report] Jim Yong Kim steps down from World Bank

Sa, 26/01/2019 - 00:00
Jim Yong Kim's decision to leave World Bank post early ushers in uncertainty about its future direction. John Zarocostas reports.

[World Report] UK court dismisses AbbVie's legal challenge against the NHS

Sa, 26/01/2019 - 00:00
AbbVie challenged the mechanism used by the NHS to procure hepatitis C treatment in the biggest procurement deal in NHS history. Talha Burki reports.

[World Report] NYC guarantees health care to all

Sa, 26/01/2019 - 00:00
As the longest federal government shutdown in US history continues, the mayor of New York is not counting on Congress for solutions to its health-care problems. Susan Jaffe reports.

[Perspectives] The outrage of human trafficking

Sa, 26/01/2019 - 00:00
In 2000, a protocol on people trafficking supplementing the existing United Nations Convention against Transnational Organized Crime was adopted. This amendment recognised that combatting human trafficking, particularly that of women and children, would need an international effort and universal instrument requiring the buy-in of countries that formed the origin, transit, and final destinations of those trafficked. By 2002, the document had accumulated 117 signatories, one of which was India. Despite this, many women and children still fall victim to sex trafficking in India.

[Perspectives] Liliana de Lima: pioneer in palliative care

Sa, 26/01/2019 - 00:00
Liliana de Lima, Executive Director of the International Association for Hospice & Palliative Care (IAHPC), begins by telling me about all the other people I should be interviewing. Her passion for her work and admiration for her colleagues run throughout our conversation, and it soon becomes apparent that the “emotional reasons and rational reasons”, as she calls them, have defined her career.

[Perspectives] Victorian systems will not solve modern prison health problems

Sa, 26/01/2019 - 00:00
Prisons have been the default punishment for offenders in the UK since convict transportation to Australia was phased out in the mid-19th century. Since that time, prison populations have grown considerably. England and Wales have more than 83 000 prisoners, one of the highest numbers in Europe. Victorian prisons and the ideas that informed their design are still in use. An outdated prison estate contributes to prison violence, high prison staff turnover, and, crucially, wastes opportunities for creating modernised health care for prisoners.

[Obituary] David John Weatherall

Sa, 26/01/2019 - 00:00
Authority on thalassaemia and pioneer of molecular medicine. He was born in Liverpool, UK, on March 3, 1933, and died in Oxford, UK, on Dec 8, 2018, aged 85 years.

[Correspondence] Reducing road traffic accidents in Bangladesh

Sa, 26/01/2019 - 00:00
A Lancet editorial (Aug 18, 2018, p 531)1 highlighted the tragic killing of two students in Dhaka, Bangladesh, by a speeding bus, which was followed by country-wide protests by students demanding improved road safety. Although the protests reflect the severity of road traffic accidents in low-income and middle-income countries and weak enforcement of road safety in Bangladesh, we would like to specify one more aspect to make the picture clearer.

[Correspondence] Beyond IDEAL: the importance of surgical innovation metrics

Sa, 26/01/2019 - 00:00
We read with interest the Health Policy by Peter McCulloch and colleagues (July 7, 2018, p 88),1 in which they concluded that IDEAL has “probably only contributed in a minor way to the improvement seen so far” in surgical research. Two fundamental limitations of IDEAL account for this minor contribution and need to be addressed.

[Correspondence] Beyond IDEAL: the importance of surgical innovation metrics

Sa, 26/01/2019 - 00:00
Peter McCulloch and colleagues1 highlighted that, although the introduction of the IDEAL recommendations has improved the rigour of clinical trials in the field of surgery or similar complex interventions and the CONSORT guidelines have improved the reporting of randomised clinical trials, no progress has been made on the use of qualitative research to improve the outcomes of randomised clinical trials.

[Correspondence] Beyond IDEAL: the importance of surgical innovation metrics – Authors' reply

Sa, 26/01/2019 - 00:00
We thank George Garas and colleagues for their interest in our paper on IDEAL and progress in clinical research in surgery. We agree that the IDEAL Framework and Recommendations are incomplete because they do not include a stage devoted to the preliminary work, which often precedes the first-in-human event in planned surgical innovation. We discuss this deficit in our recent revision of the IDEAL Recommendations.1 We have proposed a stage 0 within IDEAL-D, for use with therapeutic devices,2 but have not yet done so for operations.

[Correspondence] Scotland's National Naloxone Programme

Sa, 26/01/2019 - 00:00
In Scotland and internationally, opioid-related overdose is a major cause of premature mortality that adequate distribution of take-home naloxone kits could help to mitigate.1–3 The risk of dying from drug overdose is particularly high soon after prison release and hospital discharge.1,2

[Correspondence] JAK inhibitors and alopecia areata

Sa, 26/01/2019 - 00:00
The recent introduction of Janus kinase (JAK) inhibitors1 into the management of alopecia areata constitutes landmark progress in the treatment of this common autoimmune disease.2 Although this most welcome new therapeutic option is only symptomatic, with hair loss typically reoccurring within months of the discontinuation of therapy, even alopecia areata patients with long-standing, therapy-resistant disease can experience impressive hair regrowth,1,3,4 which can exert a profoundly positive effect on the quality of life of affected patients.

[Correspondence] Rwanda and revisionist history

Sa, 26/01/2019 - 00:00
We were deeply saddened to read Laurie Garret's book review1 (Sept 15, 2018, p 909) of In Praise of Blood: The Crimes of the Rwandan Patriotic Front2 by Judi Rever. This book, and the accompanying Perspective,1 misrepresents or does not discuss certain facts about Rwanda's history. In particular, this revisionist account does not make any reference to documented plans of the Rwandan genocide against the Tutsis that were systematically implemented in phases starting in 1959. In 2018, over 18 000 bodies were found in 41 mass graves in just two Kigali districts.

[Correspondence] Palestinian ambulances and the Israeli military

Sa, 26/01/2019 - 00:00
Richard Horton (Nov 3, 2018, p 1612)1 cites Israeli informants as alleging that Palestinian ambulances carry explosives. In 2002, Physicians for Human Rights–Israel (PHRI)2 concluded that Israel had only ever provided evidence for one such case, when, in that year, a suicide belt had reportedly been found in an ambulance. But even this case was assessed by Amnesty International3 as suspicious: “The ambulance passed through four checkpoints on the way to Jerusalem without being searched (which is abnormal) and was then delayed for more than an hour before being searched to allow TV cameras to arrive (which suggests that the Israel Defence Forces [IDF] had, at the least, prior knowledge of something hidden there)”.

[Department of Error] Department of Error

Sa, 26/01/2019 - 00:00
Tiwari V, Goyal A, Nagar M, Santoshi JA. Hyperphosphataemic tumoral calcinosis. Lancet 2019; 393: 168—In this Clinical Picture, the affiliation details should have read “Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, India (V Tiwari MS, M Nagar MS, JA Santoshi MS); and Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India (A Goyal DM). These corrections have been made online as of Jan 24, 2019.

[Articles] Prepregnancy and early pregnancy calcium supplementation among women at high risk of pre-eclampsia: a multicentre, double-blind, randomised, placebo-controlled trial

Sa, 26/01/2019 - 00:00
Calcium supplementation that commenced before pregnancy until 20 weeks' gestation, compared with placebo, did not show a significant reduction in recurrent pre-eclampsia. As the trial was powered to detect a large effect size, we cannot rule out a small to moderate effect of this intervention.

[Clinical Picture] Diffuse large vessel giant cell arteritis found by 18Fluorodeoxyglucose PET/CT imaging

Sa, 26/01/2019 - 00:00
An 85-year-old woman was referred to our department for investigation of unexplained nausea, anorexia, malaise, and weight loss of 7 kg over 3 months. She had a history of mild Alzheimer's dementia. Physical examination was unremarkable—specifically, there were no noteworthy abdominal signs. Repeated measurements of her erythrocyte sedimentation rate (ESR) showed moderately raised values ranging from 47 mm/h to 53 mm/h. Full blood count showed she was anaemic with haemoglobin concentrations ranging from 9·5 g/dL to 7·9 g/dL.

[Seminar] Dengue

Sa, 26/01/2019 - 00:00
Mortality from severe dengue is low, but the economic and resource burden on health services remains substantial in endemic settings. Unfortunately, progress towards development of effective therapeutics has been slow, despite notable advances in the understanding of disease pathogenesis and considerable investment in antiviral drug discovery. For decades antibody-dependent enhancement has been the prevalent model to explain dengue pathogenesis, but it was only recently demonstrated in vivo and in clinical studies.