Thousands rallied and marched in the rain in the US capital to stand up for science and its place in politics
The March for Science reflects the growing gap between slow, steady, vital scientific gains and quick-fire, opportunist US politics, says Dave Levitan
On Dec 19, 2016, the UN General Assembly adopted its sixth resolution on a moratorium on use of the death penalty. Recognising the poor evidence base for the effectiveness of capital punishment as a deterrent, the idea that a moratorium would contribute to “respect for human dignity and to the enhancement and progressive development of human rights” seems self-evident. Yet although the resolution attracted 117 votes in favour, 32 members abstained and 40 voted against it. Global consensus on the use of the death penalty is still, disappointingly, lacking, but it may not be out of reach.
New draft recommendations released on April 11, this year, by the US Preventive Service Task Force (USPSTF) advise men aged 55–69 years to discuss prostate-specific antigen (PSA)-based screening for prostate cancer with their physicians. The change from previous recommendations, published in 2012, that counselled against PSA-based screening in all age groups is informed by two large randomised trials: one conducted in Europe and the other in the USA. The USPSTF concludes that while many men will experience potential harms of screening (false–positive results, overdiagnosis, and overtreatment), screening 1000 men can prevent one to two prostate cancer deaths and may prevent three men from developing metastatic prostate cancer.
In today's Lancet we publish a clinical Series on neonatal intensive care in higher resource settings. The Series, led by Lex Doyle from The Royal Women's Hospital in Melbourne, VIC, Australia, includes new approaches to the old nemesis of bronchopulmonary dysplasia (which still affects up to 50% of infants born before 28 weeks’ gestation), discusses the delicacy of fine-tuning interventions in response to evolving evidence, and explores the frontier of nutritional research by referring to preterm birth as a nutritional emergency.
There are many uncertainties in global health. Major policy changes risk affecting women's reproductive health, internal displacement and refugee crises are raging in many parts of the world, and weak public health systems are not readily responsive to emerging health threats. Many countries face fragility, conflict, and economic upheavals. But there is also inspiration and hope in the amazing resilience of communities, as seen in post-Ebola west African countries, and in the power of voice and collective action among informed citizens who are advocating for sexual and reproductive health and rights for all women.
“Revolution.” The Dartmouth is the daily student newspaper of one of America's most prestigious Ivy League colleges. Its front cover of April 12, 2017, was both an exclamation and a declaration—a response to this most turbulent period in the nation's recent political history, and a sign of resistance. “Many Dartmouth students are very politically active”, wrote Cristian Cano. But it is not only among students that revolution is being nurtured. At an inspiringly timed conference held last week—Global Health in the Era of De-Globalisation—Dartmouth academics and alumni gathered to discuss what Ambassador Daniel Benjamin called “the great unravelling.” Benjamin directs the Dickey Center for International Understanding at Dartmouth.
A growing body of evidence suggests that in Africa a Zika epidemic could be undetected and overlooked. Cameron Nutt and Patrick Adams report.
“For all the sophisticated diagnostic tools of modern medicine, the conversation between doctor and patient remains the primary diagnostic tool.” This idea lies at the heart of Danielle Ofri's new book What Patients Say, What Doctors Hear, in which she acknowledges, dissects, experiments with, and analyses the complexities and miscues of the patient–doctor exchange.
For those of us outside of the medical profession, the body is at once the most mundane and most mysterious of entities. We live with ours every day, and yet we understand little about what actually happens within it. As long as we are well, we take it for granted, assuming it will always be that way; as soon as we are ill, we're on alert, perplexed, alarmed, and even betrayed by this thing that has suddenly become beyond our control. “Illness is the night-side of life”, Susan Sontag has written, that foreign country that we all do our best to forget about—until we can't.
Christine Montross wrote her first memoir, Body of Work: Meditations on Mortality from the Human Anatomy Lab, when she was still a medical student. In it she described the process of dissecting a cadaver with a poet's attention to detail and metaphor. When her female cadaver inexplicably lacked an umbilicus, for example, she and her lab partners named her Eve. Anatomy lab became for her, as for many medical students, an initiation into the complicated emotional work of being a doctor. She learned to contain her emotions without becoming indifferent.
In India, children usually continue to live with their parents past adulthood, as they become financially and socially stable. Both generations contribute to the running of the household. In turn, as parents grow old, the younger generation provides the emotional and economic support. Ideally, it is a rather beautiful system that inculcates close family ties across the generations. Unfortunately, no system is perfect, and sometimes the needs of ageing and dependent parents are ignored. As physicians it is our moral obligation to motivate the family in these situations to be more involved, lest our patients suffer.
Nobel Prize winning inventor of magnetic resonance imaging. He was born in London, UK, on Oct 9, 1933, and died in Nottingham, UK, after a stroke on Feb 8, 2017, aged 83 years.
We agree with The Lancet Editorial (Feb 11, p 573)1 that bolder leadership is needed to address the Zika virus epidemic and support individuals and families affected by the disease, however, the Editorial missed a crucial element of such leadership: ensuring that comprehensive sexual and reproductive health care, including safe abortion, is part of the Zika response.
The science isn't the only aspect of genomics that can seem impenetrable to the average person; the word itself has the power to confuse. Our work has shown that members of the public often assume there might be a mistake in pronunciation, asking helpfully: “Did you mean to say gnome when you said genome?” We have also discovered that a substantial gap exists between how genomic scientists and health professionals think genomics should be discussed and what the public actually understands.
The overall effect on mortality and morbidity from prehospital transfer strategies has been a strongly debated topic for more than two decades. A 2015 systematic review1 on this issue only identified observational studies and most were retrospective. The latest period covered by this set of studies was up to 2010. 19 studies targeted major trauma from which five studies (three retrospective, one prospective, and one mixed) including 19 910 patients with adjusted outcomes compared initial triage with specialised centres and non-specialised centres.
In a study published in The Lancet (Nov 19, 2016, p 2492)1, Paul Aveyard and colleagues' successful application of a brief intervention for obesity in general practice is yet another example of the important role that GPs play in the health-care system.1
Obesity is a growing public health concern that might be neglected by primary care providers. In one study, 59% of patients with morbid obesity had no record of weight management advice in their primary care records over 7 years.1 The study in The Lancet by Paul Aveyard and colleagues2 that explores the role of brief interventions for obesity in primary care is welcome. Net weight loss following their intervention was 1·4 kg at 12 months. Systematic reviews of randomised trials conducted in primary care, which were not discussed by Aveyard and colleagues, reveal very similar findings.
The study in The Lancet by Paul Aveyard and colleagues1 showed that a physician's more active support is acceptable and effective for patients with moderate to severe obesity. Although a mean decrease in bodyweight of 2·43 kg was seen in the support group, it was surprising that 238 (12%) of the 940 patients in this group had remarkable weight loss of more than 10% of bodyweight over 12 months. The mean bodyweight was 97·1 kg at initial enrollment, so patients lost approximately 10 kg of bodyweight.
We are grateful to the correspondents for their interest in our research. Asaka Higuchi and Masahiro Kami are surprised that 12% of the support group lost 10% of their baseline bodyweight at 1 year and worry that rapid weight loss will lead to rapid weight regain. However, trial evidence suggests it will not.1 No baseline factors predicted 10% loss, but the use of what we termed effective support was strongly associated with weight loss. Effective support meant, in practice, attending a behavioural weight loss programme similar to those that physicians referred patients to in the support group.