The Lancet

The Lancet

Editorial Child nutrition: the need for courageous action

19-10-2019 – The Lancet

Dame Sally Davies has stepped down as Chief Medical Officer for England, using her final report to make strong and ambitious recommendations for the UK to stem childhood obesity. Her proposals include a cap on the calories per serving for food sold in restaurants and takeout outlets, a ban on eating and drinking on public transport, and the possibility of introducing plain packaging for unhealthy foods, similar to that used with success for tobacco. Nearly a third of young people aged 5–19 years in the UK are overweight or obese.

Editorial Canada needs universal pharmacare

19-10-2019 – The Lancet

Canadas often-lauded health-care system has an unusual and unfortunate distinction. Physician care and hospital stays are universally publicly funded, but medicines are not. Canada is the only country in the world with public health care and no universal public system for providing prescription drugs (pharmacare). In the run-up to the countrys federal election on Oct 21, the harms to Canadians, and the costs to the health-care system, of the absence of national pharmacare are again in the spotlight.

Editorial A vision for universal eye health

19-10-2019 – The Lancet

World Sight Day, Oct 10, 2019, opened the final stages of Vision2020 and the Global Action Plan, two global advocacy initiatives that strived to tackle the global burden of avoidable blindness and vision impairment. 80% of vision impairment is preventable or treatable, yet it affects millions of people, and many have no access to affordable, good-quality eye care. WHOs first World Report on Vision, released on Oct 8, 2019, suggests how to meet the worlds growing eye care needs.

Comment Will alcohol harm get the global response it deserves?

19-10-2019 – Sally Casswell

For the first time since the endorsement in 2010 of the WHO global strategy to reduce harmful use of alcohol,1 alcohol had a place on the World Health Assembly (WHA) agenda. At the 2019 WHA, it was agreed that the WHO Director-General will report on “the implementation of WHOs global strategy to reduce the harmful use of alcohol during the first decade since its endorsement, and the way forward” to the WHA in 2020.2 This move comes after several years of civil society and some member states working cooperatively to raise the profile of alcohol at the WHA.

Comment Offline: The necessity of the engaged scientist

19-10-2019 – Richard Horton

What should we expect of scientists in society? To do great science for sure. But to demand more is surely unreasonable. When medical journals publish research on war, the climate crisis, migration, Brexit, President Trump, and even notions of social justice, for some readers we clearly violate a principle that they hold dear—that science and politics do not mix, and certainly should not be mixed in the pages of a medical journal. I remember one ardent (and knighted) advocate of evidence-based medicine saying that journals should focus only on publishing the best available science.

World Report 2019 Nobel Prize awarded for work on oxygen regulation

19-10-2019 – Talha Burki

Three researchers have shared this years prize in Physiology or Medicine. Talha Burki speaks with the laureates.

World Report Global Fund secures US$14 billion from donors

19-10-2019 – Ann Danaiya Usher

The Global Fund achieved its replenishment target, but it has called for substantial increases in domestic financing by developing countries. Ann Danaiya Usher reports.

Perspectives Testament to the times

19-10-2019 – Sarah Ditum

Why has Margaret Atwood gone back to Gilead now? The world of 2019 is, superficially, a very different place for women than it was in 1985, when The Handmaids Tale—the precursor to The Testaments—was published. That novel came out at the fag-end of feminisms second wave and as the backlash was surging. In the USA, which is the site of Atwoods Gilead, external opposition and internal divisions had left the womens movement scattered. Popular culture—in the form of primetime television, evangelical preachers, and bad-science bloviators—was fomenting a back-to-the-home doctrine for women.

Perspectives Senait Fisseha: empowering women through reproductive health

19-10-2019 – Richard Lane

It is a long way from Addis Ababa, Ethiopia, to Omaha, Nebraska, USA, but for Senait Fisseha, Director of International Programmes at the Susan T Buffett Foundation, it is where she exerts great influence in global reproductive health. “I came here to have impact. At the Foundation I oversee grant-making for reproductive health programmes on a global scale, an incredible opportunity for me to contribute to the reproductive rights and health of women around the globe”, she says. Fisseha is clear about the Foundations role.

“Perspectives Medical history at Apothecaries Hall”

19-10-2019 – Briony Hudson

On Oct 21, 1959, the establishment of the Faculty of the History and Philosophy of Medicine and Pharmacy was announced by the UKs Worshipful Society of Apothecaries. Its founding aim was “to foster and extend more general interest in medical history and to attract the co-operation of general historians, so that work in this field may be co-ordinated with wider historical studies”. On the Facultys diamond anniversary, its timely to reflect on the pursuit of this aim, especially from a personal perspective since from April, 2019, Ive served as a “general historian” Faculty President, the 19th person to hold the post.

Obituary Daniel John Callahan

19-10-2019 – Geoff Watts

Philosopher, bioethicist, and co-founder of the Hastings Center. He was born in Washington, DC, USA, on July 19, 1930, and died of chronic obstructive pulmonary disease in Dobbs Ferry, NY, USA, on July 16, 2019, aged 88 years.

Correspondence The need for a global committee on academic behaviour ethics

19-10-2019 – Morteza Mahmoudi

Academic bullying and the complexity that surrounds it are dramatically increasing.1 Academic institutions play a key role in minimising different types of academic bullying by improving their fair and thorough reporting systems with no fear of reprisal.2,3 Although most institutions claim to use a fair and robust process to address academic bullying, they are ill equipped to handle such cases, with departments such as ombuds offices being responsible for informally addressing the issue. Fear of tarnishing their own reputation might subject institutions to bias, so the actions they take against bullying could not only be insufficient, but also of questionable neutrality and independence, raising the possibility that incomplete investigations might potentially be encouraged.

Correspondence Academic medicine and political agendas

19-10-2019 – Owen Dempsey

Paul Gideon and colleagues1 suggest that the term occupied Palestinian territory is a “political statement with intentional prejudice” and should be avoided in medical academic papers. However, they use an alternative term, disputed territories, to describe the West Bank and Gaza Strip. This term is only used by the Government of Israel and always in the service of Israels political aims.

Correspondence Academic medicine and political agendas

19-10-2019 – Maxine Fookson, Alan Meyers, Alice Rothchild, Rachel Rubin, Peter Sporn, Jewish Voice for Peace Health Advisory Council

We disagree with Gideon Paul and colleagues1 in their assertion that academic research should not be divisive. Divisive is a subjective term and at times, if research examines or illuminates factors underlying conflict and its impact on populations, it could be seen by some as being divisive. For example, during the USA-backed war on Nicaraguas Sandinista Government, researchers documented the effects on the civilian population, helping to inform the policy debate;2,3 this certainly did not please advocates of US policy.

Correspondence The YOMEGA non-inferiority trial

19-10-2019 – Hicham El Fara

I read with interest the Article by Maud Robert and colleagues1 reporting a randomised clinical trial comparing the outcomes of one anastomosis gastric bypass (OAGB) with Roux-en-Y gastric bypass (RYGB) at 2 years follow-up. Despite being an interesting topic for investigation and discussion, several aspects make the results questionable. First, they did a non-inferiority trial, which in my opinion might have been the wrong study design, as two previous randomised clinical trials and three meta-analyses2–4 have reported a superiority of OAGB in terms of weight loss and remission of comorbidities.

Correspondence The YOMEGA non-inferiority trial

19-10-2019 – Damien Bergeat, Laurent Sulpice, Bernard Meunier, Karim Boudjema, Florian Naudet

High-quality randomised controlled trials are rare in the field of surgery, so Maud Robert and colleagues, the authors of the YOMEGA1 non-inferiority study, should be congratulated. However, if we agree that a per-protocol analysis is a common rule in non-inferiority trials, it is difficult to understand why the authors performed multiple imputation on 22·5% of the patients who were lost to follow-up at 2 years. These patients did not pertain to the per-protocol population and an imputation of their data could make the two groups more identical.

Correspondence The YOMEGA non-inferiority trial

19-10-2019 – Mario Musella, Antonio Vitiello

Results of the YOMEGA trial1 showed that one anastomosis gastric bypass (OAGB), compared with Roux-en-Y gastric bypass (RYGB), induces better outcomes (even if not significant) in terms of weight loss and diabetes improvement at 2 years. However, we feel some issues regarding the design of this study should be addressed.

“Correspondence The YOMEGA non-inferiority trial – Authors reply”

19-10-2019 – Maud Robert, Delphine Maucort-Boulch, Dominique Delaunay, Emmanuel Disse

We thank all the correspondents for their interest in the YOMEGA trial.1 Randomised trials can often take years to be published and we have to analyse the study within the context at the time the protocol was written.

Correspondence Health risks of Rohingya children in Bangladesh: 2 years on

19-10-2019 – Ahmed Hossain, Shakil Ahmed, Mohammad Shahjalal, Gias U Ahsan

The Rohingya crisis is a concern for Bangladesh, currently hosting more than 1·1 million Rohingya people who have been subjected to genocide, ethnic cleansing, and systematic discrimination for years in Rakhine, Myanmar.1 Children make up 55% of the population, and there is little doubt about the magnitude of their health problems.

Department of Error Department of Error

19-10-2019 –

Cooper K, Breeman S, Scott NW, et al. Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial. Lancet 2019; 394: 1425–36—In this Article, symbols for footnotes were incorrectly included in table 1. This correction has been made to the online version as of Oct 17, 2019, and the printed version is correct.

Clinical Picture A double blow for a patient with leprosy: a reversal reaction and an adverse drug reaction

19-10-2019 – Pugazhenthan Thangaraju, Sajitha Venkatesan

A 28-year-old man from the rural area of Tamil Nadu attended our specialist hospital, complaining of multiple, copper-coloured patches on his skin, forehead, arms, and the front and back of his torso (figure). On examination he also had bilateral thickening of his ulnar and median nerves, without any functional impairment; multiple slit skin smear tests were positive for acid-fast bacilli in most of the patches on his body. We made a diagnosis of multibacillary, or lepromatous, leprosy, and started the patient on a 12-month course of multidrug therapy (MDT)—rifampicin 600 mg once a month, dapsone 100 mg daily, and clofazimine 300 mg once a month and 50 mg daily.

Seminar Hepatitis C

19-10-2019 – C Wendy Spearman, Geoffrey M Dusheiko, Margaret Hellard, Mark Sonderup

Hepatitis C is a global health problem, and an estimated 71·1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23·7 cases per 100 000 population (95% uncertainty interval 21·3–28·7) in 2015, with an estimated 1·75 million new HCV infections diagnosed in 2015. Globally, the most common infections are with HCV genotypes 1 (44% of cases), 3 (25% of cases), and 4 (15% of cases). HCV transmission is most commonly associated with direct percutaneous exposure to blood, via blood transfusions, health-care-related injections, and injecting drug use.

Seminar Colorectal cancer

19-10-2019 – Evelien Dekker, Pieter J Tanis, Jasper L A Vleugels, Pashtoon M Kasi, Michael B Wallace

Several decades ago, colorectal cancer was infrequently diagnosed. Nowadays, it is the worlds fourth most deadly cancer with almost 900 000 deaths annually. Besides an ageing population and dietary habits of high-income countries, unfavourable risk factors such as obesity, lack of physical exercise, and smoking increase the risk of colorectal cancer. Advancements in pathophysiological understanding have increased the array of treatment options for local and advanced disease leading to individual treatment plans.