The Lancet

The Lancet

Editorial Research integrity: time for global action

30-11-2019 – The Lancet

China has become a formidable global leader in scientific—including medical—research, with the worlds largest publication output, a rapid surge in the number of highly cited researchers, and an increasingly unparalleled quality of scientific publications. However, there is often a shadow hanging over any countrys progress, especially a nation that has advanced with spectacular velocity. China is no exception. And the current concern, escalated to the highest levels of the Chinese Government, is research integrity.

Editorial The unfolding migrant crisis in Latin America

30-11-2019 – The Lancet

With the political crisis intensifying across Latin America, the difficulties in a region already struggling with massive migration and economic instability are becoming more complex. The number of people migrating across borders within this region has increased by 36% in the past 15 years, reaching 63·7 million in 2015; and of these migrants, 808 000 were defined as refugees, who are the most vulnerable type of migrants and often have insufficient access to appropriate health services. People smuggled by human trafficking and victims of violence are among these migrants.

Editorial Muscular dystrophy: new treatments, new hopes

30-11-2019 – The Lancet

Advances in medical management in the 21st century have led to dramatically improved outcomes for individuals with muscular dystrophy. As described in a Seminar in this issue of The Lancet, the mean life expectancy today for individuals with Duchenne muscular dystrophy, the most common form of muscular dystrophy in childhood, is the late 20s—an increase of around 10 years compared with two decades ago.

Comment Dolutegravir: advancing ethical research in pregnancy

30-11-2019 – Anne Drapkin Lyerly

On July 22, 2019, members of the HIV community seemed to breathe a collective sigh of relief when WHO recommended dolutegravir, a new antiretroviral medication, as the preferred first-line and second-line HIV treatment for all populations.1 The announcement followed more than a year of uncertainty and debate about the appropriateness of using the drug in women who are pregnant or of childbearing potential after preliminary data from a large surveillance study in Botswana showed a potential safety signal for dolutegravir and an increased risk of neural tube defects in periconceptually exposed infants.

“Comment Offline: Its time to prepare your anti-CV”

30-11-2019 – Richard Horton

Editors are merchants of failure. We trade in rejection. But no scientist cites rejected papers on their resumé. Perhaps they should. The anti-CV reveals opportunities won and lost, choices seized and refused. “Truth emerges more readily from error than from confusion.” That was Francis Bacon (1561–1626). Or try William Whewell (1794–1866): “Every failure is a step to success.” Dont be fooled by these efforts to turn failure into triumphant success. Failure is painful. It hurts. It marginalises and excludes.

World Report Will Trump snuff out e-cigarettes?

30-11-2019 – Susan Jaffe

President Trump promised to ban flavoured e-cigarettes, but 11 weeks later, they are still on the shelves. Susan Jaffe reports from Washington.

“World Report Image irregularities found in prominent scientists papers”

30-11-2019 – Brian Owens

Irregularities have been documented in dozens of research papers by Xuetao Cao, a high-profile Chinese scientist and champion of research integrity. Brian Owens reports.

Perspectives Truth and torture in the war on terror

30-11-2019 – George J Annas

The Report, Scott Z Burns new thriller, adopts one of two conflicting narratives about post-9/11 torture by the USA. The “Cheney–Brennan narrative” is that torture is a “black art” that must be deployed in national security emergencies to save lives. The counter narrative, the human rights and science-based narrative, is that torture is a crime against humanity that produces only false information. When images of torture become public, they are horrifying and provoke outcry. For example, the 2004 photographs from Abu Ghraib of US Army troops brutally abusing Iraqi prisoners were devastating to the reputation of the USA.

Perspectives Liz Grant: prioritising palliative care and planetary health

30-11-2019 – Rachael Davies

At a rural hospital in Kenya in the late 1990s, Liz Grant saw diseases like cancer and HIV/AIDS destroy lives. “Patients were dying in severe pain, chewing paracetamol—there wasnt sufficient morphine…The voice of one woman still lives with me: ‘I want to go to sleep and wake up dead’”, says Grant, who has worked tirelessly ever since to improve access to palliative care in low-income and middle-income countries (LMICs). The low priority given to end-of-life care means “it has been an uphill struggle”, says Grant, Assistant Principal and Professor of Global Health and Director of the Global Health Academy at the UKs University of Edinburgh.

Obituary Sadako Ogata

30-11-2019 – Andrew Green

Diplomat and UN High Commissioner for Refugees. Born in Tokyo, Japan, on Sept 16, 1927, she died in Tokyo, Japan, on Oct 22, 2019, aged 92 years.

Correspondence Global health, human rights, and the law

30-11-2019 – Lisa Forman, Claire E Brolan, Kristi Heather Kenyon

As educators in health and human rights, we were thrilled to see the recommendation in the Lancet Commission on the legal determinants of health1 that “Both health graduates and law graduates should be introduced to the basics of international human rights law.” Similar calls have been made by several health professional associations2 and the truth and reconciliation commissions of various governments (eg, in the Truth and Reconciliation Commission of Canada3). Health practitioners are often closely connected to populations that are stigmatised or discriminated against, including sex workers, people who inject drugs, people with disabilities, and refugees.

Correspondence Global health, human rights, and the law

30-11-2019 – Leonard S Rubenstein, Joseph J Amon

The Lancet Commission on the legal determinants of health1 helps to highlight the role of the law as a determinant of health and its contribution to advancing global health. Unfortunately, however, the Commission did not address the role of law in advancing the human rights and health needs of people living in fragile and conflict-affected states.

“Correspondence Global health, human rights, and the law – Authors reply”

30-11-2019 – Lawrence O Gostin, John T Monahan, Jenny Kaldor, Eric A Friedman

We thank Lisa Forman and colleagues, and Leonard S Rubenstein and Joseph J Amon, for commenting on our Lancet Commission report on the legal determinants of health.1 Both letters raise key challenges in national and global health law and the vital importance of high-level leadership.

Correspondence Clinical outcomes after ABO-incompatible renal transplantation

30-11-2019 – Alexandre Loupy, Antoine Bouquegneau, Mark D Stegall, Robert A Montgomery

We read with interest the Article by Florian G Scurt and colleagues1 on clinical outcomes after ABO-incompatible renal transplantation. Their interpretation that expanding the use of kidney paired donation instead of optimising the use of ABO blood group incompatible (ABOi) kidney transplantation should be moderated.

Correspondence Clinical outcomes after ABO-incompatible renal transplantation

30-11-2019 – Christian Morath, Stefan Zschiedrich, Claudius Speer, Martin Zeier, Bernd Döhler, Gerhard Opelz, Caner Süsal

We read with interest the Article by Florian G Scurt and colleagues1 on clinical results after ABO-incompatible kidney transplantation from living donors. Regrettably, we feel obliged to point out a serious technical problem with this meta-analysis.2 The authors included multiple publications from the same authors that were based on overlapping patient populations. They also included data from review articles and registry analyses that contained data from patients already reported in individual studies (appendix).

“Correspondence Clinical outcomes after ABO-incompatible renal transplantation – Authors reply”

30-11-2019 – Florian Gunnar Scurt, Peter René Mertens, Christos Chatzikyrkou

Alexandre Loupy and colleagues emphasise issues deserving special consideration. In the Discussion section of our Article,1 we have outlined shortcomings associated with the use of a meta-analysis for this purpose. Our considerations include the problem of high heterogeneity (I2) in the studies reporting different outcomes. The high between-study variation of the included reports is mostly from differences—eg, in study protocols, populations, and approaches to measurement. Therefore, in our meta-analysis we first used the random-effects approach instead of the fixed-effects model.

Correspondence The harsh effects of sanctions on Iranian health

30-11-2019 – Payman Salamati, Claudia Chaufan

We commend The Lancet for bringing to the attention of readers the devastating health effects of the sanction regime imposed on Iran by the USA.1 Sanctions, a form of collective punishment,2 kill. Although sanctions are not physical weapons of war, they are just as lethal, if not more. For example, as of 1994, more than half a million Iraqi children had died under UN Security Council sanctions3 and more recently, in 2017 and 2018, 40 000 innocent civilians died in Venezuela under the US Government sanctions.

Correspondence Youth activists for our health

30-11-2019 – Jan Skrzypczak, Benedikt W Pelzer, Orsolya Süli

The need for young health activists was emphasised in a recent Editorial.1 Although they might not be as prominent as Greta Thunberg or Malala Yousafzai, plenty of young people are already dedicating themselves to advocate for better health and health care.

“Correspondence Brazils health-care system”

30-11-2019 – Maria Laura Orlandi Demo, Larissa Chaiane Orth, Chaiana Esmeraldino Mendes Marcon

The Global Burden of Disease Health Financing Collaborator Network1 reports that global per capita health expenditures have increased since 1995 and should continue increasing; however, at a lower rate, thus keeping the disparity between the countries evaluated. This fact made us reflect on the financing of health in our country. In Brazil, health is defined as a right of everyone and a duty of the State,2 in accordance with law number 8080/1990.2 These laws structure the Brazilian National Health System (Sistema Único de Saúde), ensuring universal access to health and systems financing through tax collection.

Clinical Picture Now you see it: progressive radiographic findings in avascular necrosis of the hip

30-11-2019 – Paul Stirling, Matthew Moran

A 68-year-old woman presented to our hospital with pain in her left hip. She said it had started 2 weeks previously and had gradually worsened. She gave no history of trauma; however, she did have a history of rheumatoid arthritis, which was well controlled with weekly injections of methotrexate. There was no history of corticosteroid use. She also had a history of squamous cell carcinoma of the anus, which had been treated with chemotherapy. The woman had finished a course of adjuvant external beam pelvic radiotherapy 6 months before seeing us.

Seminar Muscular dystrophies

30-11-2019 – Eugenio Mercuri, Carsten G Bönnemann, Francesco Muntoni

Muscular dystrophies are primary diseases of muscle due to mutations in more than 40 genes, which result in dystrophic changes on muscle biopsy. Now that most of the genes responsible for these conditions have been identified, it is possible to accurately diagnose them and implement subtype-specific anticipatory care, as complications such as cardiac and respiratory muscle involvement vary greatly. This development and advances in the field of supportive medicine have changed the standard of care, with an overall improvement in the clinical course, survival, and quality of life of affected individuals.