Soaring 225 m into the skyline, the so-called cheese grater is one of London's most arresting examples of 21st century postmodernist architecture. On Sept 25, a brilliantly sunlit early autumn day, it seemed an appropriately elevated venue for NHS (National Health Service) England's Chief Executive, Simon Stevens, to lay out plans to an audience of senior management in the public sector as to how NHS hospitals in England will organise themselves in the coming years. No more working in silos, no more competition between neighbouring clinical centres.
The UN Summit for the adoption of the Sustainable Development Goals (SDGs) concluded last week amid ongoing criticism and open admission that the private sector heavily influenced the process. The SDGs, however, are here to stay, and provide an opportunity for broader accountability in health and development. Many of the targets under SDG goal three “to ensure healthy lives and promote well-being for all ages”, rely directly on measures of mortality. These include reducing the global maternal mortality ratio to less than 70 per 100 000 livebirths, and reducing neonatal mortality to at least 12 per 1000 livebirths and under-5 mortality to 25 per 1000 livebirths.
In a bid to increase transparency, Coca-Cola has disclosed spending US$118·6 million in the past 5 years on scientific research and health and wellbeing partnerships. In a list of organisations funded by Coca-Cola, published on Sept 22, they reveal several influential medical organisations that have received funding, including the American Cancer Society, which received roughly $2 million, the American College of Cardiology, which received roughly $3·1 million, and the Academy of Nutrition and Dietetics, as detailed in an article published on Sept 22 in The New York Times.
In the era of the Millennium Development Goals (MDGs), regular reporting of specific health indicators drew public and policy attention, and ultimately resources, to causes such as maternal and child health. On Sept 25–27, 2015, the UN Sustainable Development Summit was held in New York, NY, USA, leading to the adoption of the Sustainable Development Goals (SDGs) by the UN General Assembly. On the basis of the lessons learned from the MDGs, the indicators chosen for each SDG target will probably determine the amount of action and attention each target receives.
The 1·3 million staff in the National Health Service (NHS) are key to an effective, efficient, safe service, and in turn, to the delivery of the Five Year Forward View.1 As pressures on the NHS mount, the need for improved staff health and wellbeing will become only more important, yet it remains a priority that has, thus far, been largely neglected.
“We are now no more than rent boys in the neoliberal takeover of health, nutrition, and development.” The words of one professor of global health last week. He was angry about what has become the most politically charged annual event in global health—the UN General Assembly in New York, a kind of Davos for real people. This year was historic, and not only because Pope Francis shamed heads of state into thinking about someone other than themselves. It was also historic because it signified a turning point in international diplomacy.
Laws that allow terminally ill patients access to experimental drugs are gaining momentum across the USA, but experts say they could do more harm than good. Rita Rubin reports.
Increasing public use of online pharmacies, along with a new mass producer of fake medicines, have widened the global market for falsified drugs. Fiona Clark reports from Moscow.
Steve Silberman discovered a well-kept secret about autism. In his stunning big book NeuroTribes (big in size at more than 500 pages, and big in vision, spanning the history of autism from the late 19th century to the present day), he imparts the secret, drip-feeding it through a remarkable narrative, in one of the most fascinating accounts of autism I have ever read. At one level, this is a who-done-it, in keeping with Silberman's profession of investigative journalist. He digs into the detail of people's lives, and uncovers the secret that one scientist tried to hide.
Sigmund Freud has his promoters; but the best-known psychiatrist of the 20th century was probably Lucy van Pelt. From her first clinical session in 1959 (Charlie Brown: “I have deep feelings of depression…What can I do about this?” Lucy: “Snap out of it! Five cents, please.”), this little girl ministered to the children of her neighbourhood from a lemonade stand emblazoned with “PSYCHIATRIC HELP 5¢. THE DOCTOR IS IN.” (Asked by a bewildered visitor, “Are you a real doctor?” Lucy replied, “Was the lemonade ever any good?”) Her adventures were documented by the artist Charles Schulz in Peanuts, a comic strip that was syndicated in more than 2600 newspapers, in 75 countries, and is still reprinted today.
Pharmacologist who saved the USA from the thalidomide disaster. She was born on Vancouver Island, BC, Canada, on July 24, 1914, and died in London, ON, Canada, on Aug 7, 2015, aged 101 years.
Europe spends about 10% of its gross domestic product (GDP) on health care. Public spending on biomedical and health research in Europe is only about €42 per person per year, less than 2% of the health-care costs.1–3 The USA spends a much larger absolute and relative (compared with GDP) amount on health care (table). Several independent reports3–5 suggest that the USA also spends substantially more on public investment in biomedical and health research, up to 3 times more per person per year than in the EU.
The TRUFFLE trial reported by Christoph Lees and colleagues (May 30, p 2162)1 studied the use of fetal ductus venosus Doppler waveform (DV) indications versus cardiotocography short-term variation to time delivery in mothers of babies with preterm fetal growth restriction. The authors report no statistically significant differences in the primary outcome, but they should be commended for their effort to obtain neurological outcomes in more than 400 2-year-old children.
We thank Ben Mol for his commendation of the TRUFFLE study.1 We designed this study to reflect management of fetal growth restriction in contemporary clinical practice of fetal medicine from the point of its diagnosis. Crucially, management encapsulates two components: monitoring and delivery. Thus, randomisation was done to one of three groups: cardiotocograph short-term variation, early ductus venosus changes, or late ductus venosus changes when a woman met the inclusion criteria and delivery was on average just over a week after this study entry.
The AFRINEST report (May 2, p 1767)1 about simplified antibiotic regimens for the treatment of neonates with serious bacterial infections is a commendable effort towards seeking a simple and cheap regimen for disease management in resource-limited settings. However, extrapolation of these results without contemporary aetiological data warrants caution for several reasons.
Findings from the AFRINEST trial,1 which took place in three sub-Saharan African countries, have shown that simplified antibiotic regimens (including regimens with only 2 days of parenteral treatment) delivered at home or at primary health-care level are as effective as a parenteral regimen (the current WHO recommendation) for the treatment of severe bacterial infection in newborn babies. If these simplified regimens are implemented at scale, thousands of families that currently do not have access to hospital care will benefit from this intervention.
The two AFRINEST field trials1,2 of simplified antibiotic regimens for suspected bacterial infections in neonates and young infants successfully showed that a team of community health workers and nurses can deliver antibiotic treatment, including injectable drugs, very safely and with high coverage in the community. Thus, the investigators confirm that the home-based management of neonatal infections with antibiotics, which we first reported,3 is feasible in programme conditions. We congratulate the authors.
We thank our colleagues for their remarks on our studies. In the AFRINEST studies,1,2 done in a programme setting, we assessed regimens for outpatient treatment of young infants with clinical signs of severe infection whose families could not comply with advice to admit their child to hospital. Hospital treatment of such infants remains the treatment of choice, and about half of infants with signs of severe infection who were referred to hospital were not the target of this intervention.
In their Comment, Brian Potter and Jaques LeLorier (July 11, p 113)1 criticised the authors of the Framingham Heart Study2 on trends in atrial fibrillation for concluding that measures are needed to enhance early detection and screening. They questioned the method and cost-effectiveness of surveillance, and the likely yield and outcome of the undiagnosed population with atrial fibrillation, which they felt represented patients at lowest risk. However, they were seemingly unaware of recent published work addressing these very issues.
The eloquent plea by Arthur Kleinman (July 18, p 240)1 for caregiving to be viewed as an important and positive aspect of life and medicine demands serious attention. It also requires a substantive shift in attitudes and language on the part of health-care professionals. All too often care of those affected by illness and disability, particularly in later life, is portrayed in terms of burden. Although fuelled by good intentions, so-called caregiver burden has become a dominant trope for the state of caring.