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[Editorial] The doctors' predicament: China's health-care growing pains

Sa, 20/04/2019 - 00:00
The Chinese characters for doctor also refer to scholar-bureaucrats, which was the highest aspiration for intellectuals in ancient China. Doctors were then respected as much as Confucian elites who were supposed to have high moral standards and be well educated, altruistic, and dedicated to serving the country. However, in modern China, medicine is no longer seen as a noble or an attractive profession. Last week, four officials were removed from their posts on the basis of their negligence in reviewing and approving an anti-gang brochure in which doctors were portrayed as gangs and listed as first among the top ten gang categories in China.

[Editorial] Assessing researchers with a focus on research integrity

Sa, 20/04/2019 - 00:00
More than 500 participants will gather in Hong Kong on June 2–5 for the sixth World Conference on Research Integrity (WCRI). One of the ambitions of the WCRIs is to advance research integrity globally by setting standards and agreeing on principles of organising and conducting research. The Singapore Statement, an outcome of the second WCRI in 2010, highlighted four principles and 14 professional responsibilities for researchers and others involved in the research enterprise. The Montreal Statement, developed as part of the third WCRI in 2013, focused on specific challenges for research collaborations.

[Editorial] Universal health care in 21st century Americas

Sa, 20/04/2019 - 00:00
Despite considerable progress, the Pan American Health Organization (PAHO) estimates that 30% of the population of the Americas still do not have access to the health care they need because of multifaceted barriers. On April 9, leaders, including Mexico's President Andrés Manuel López Obrador, PAHO director Carissa Etienne, and UN High Commissioner for Human Rights Michelle Bachelet, gathered with academics, activists, and representatives of social movements in Mexico City to hear the report of the Commission on Universal Health in the 21st Century.

[Comment] Reporting of artificial intelligence prediction models

Sa, 20/04/2019 - 00:00
Data-driven technologies that form the basis of the digital health-care revolution provide potentially important opportunities to deliver improvements in individual care and to advance innovation in medical research. Digital health technologies include mobile devices and health apps (m-health), e-health technology, and intelligent monitoring. Behind the digital health revolution are also methodological advancements using artificial intelligence and machine learning techniques. Artificial intelligence, which encompasses machine learning, is the scientific discipline that uses computer algorithms to learn from data, to help identify patterns in data, and make predictions.

[Comment] Opioid analgesics pass the acid test

Sa, 20/04/2019 - 00:00
Understanding of the neurobiology of pain continues to increase at a remarkable pace, raising optimism for improvements in pain therapy. Physicians can choose from multiple classes of medications to treat acute or chronic pain that can often be highly effective. Many patients, however, do not have their pain well controlled with available drugs, and these drugs often have severe side-effects that can ultimately diminish quality of life and potentially result in serious harm.1 Hence, the need for new medicines for treatment of pain remains very high.

[Comment] Offline: The case for compromise

Sa, 20/04/2019 - 00:00
Surrender. Betrayal. Hypocrisy. Suicide. To be sure, words may only be words. But they do hold meaning. They can hurt. And they certainly suggest something about the health of our societies. By which measure, we could reasonably conclude that the UK is struggling through a grave illness. Brexit has inflicted wounds that are proving hard to heal. It has given permission for a style of public dialogue that is angry, coarse, and increasingly xenophobic. Brexit has sharpened rather than smoothed disagreement.

[World Report] Liberia post Ebola: ready for another outbreak?

Sa, 20/04/2019 - 00:00
Years after the west Africa Ebola virus epidemic, Liberia's health system still carries the burden of the deadly outbreak. Laura Salm-Reifferscheidt reports from Gbarnga, Liberia.

[World Report] Cyclone Idai: 1 month later, devastation persists

Sa, 20/04/2019 - 00:00
Cyclone Idai was one of the most deadliest storms in the southern hemisphere. Funding is now dwindling, at a time where response is still needed. Sharmila Devi reports.

[World Report] DR Congo Ebola outbreak not given PHEIC designation

Sa, 20/04/2019 - 00:00
UN committee decided that the outbreak does not fit the criteria for Public Health Emergency of International Concern, as outbreak grows at worrying rate. Andrew Green reports.

[World Report] Concerns raised about NHS gender identity service

Sa, 20/04/2019 - 00:00
The Tavistock and Portman NHS Foundation Trust service draws controversy for prescribing hormone blockers to adolescents, others support the approach. Talha Burki reports.

[Perspectives] Climate Armageddon

Sa, 20/04/2019 - 00:00
David Wallace-Wells opens his book, The Uninhabitable Earth: Life After Warming, with “It is worse, much worse, than you think.” And within the first 36 pages, the American writer races through evidence of damage already caused by climate change and forecasts humanity's future, peppering sentences with words like annihilation, Armageddon, extinction, and “existential crisis”. There are no safe zones of optimism or passages of hope in Wallace-Wells' book, even in his closing chapter where he avers “The emergent portrait of suffering is, I hope, horrifying.

[Perspectives] Alzheimer's disease

Sa, 20/04/2019 - 00:00
In his genre-defining Encyclopédie (1765), the French philosopher Denis Diderot defined dementia as “a disease consisting in a paralysis of the spirit characterised by abolition of the reasoning faculty“. For Diderot's generation, dementia (from the Latin demens, “without mind“) was a new frame for an old and diverse set of labels—imbecility, fatuitas, dotage—denoting a progressive and irreversible decline in what we'd now call cognitive and social functioning, typically associated with old age.

[Obituary] Margaret Susan Povey

Sa, 20/04/2019 - 00:00
Molecular geneticist and early gene mapper. She was born in Leeds, UK, on April 24, 1942, and died of ovarian cancer in Cheddington, UK, on Jan 11, 2019, aged 76 years.

[Correspondence] Awareness of the link between obesity and cancer in UK school curricula

Sa, 20/04/2019 - 00:00
In 2016, a panel of international experts, under the sponsorship of the International Agency for Research in Cancer, concluded that there was sufficient evidence for causal links between body fatness, commonly approximated as body-mass index of 25 kg/m2 or more and increased risk of incidence of 13 cancer types.1 In parallel, Arnold and colleagues2 estimated that elevated body-mass index is responsible for 3·2–7·8% of the burden of new cancers in countries with a very high Human Development Index, making obesity the second commonest cause of cancer after smoking.

[Correspondence] Functional capacity and preoperative risk evaluation

Sa, 20/04/2019 - 00:00
I wish to draw attention to two methodological issues that might affect the interpretation of findings in Duminda Wijeysundera and colleagues' Measurement of Exercise Tolerance before Surgery (METS) study (June 30, 2018, p 2631).1

[Correspondence] Functional capacity and preoperative risk evaluation

Sa, 20/04/2019 - 00:00
Duminda Wijeysundera and colleagues' prospective cohort study1 challenges concepts of preoperative risk assessment, showing that neither subjective assessments of fitness nor exercise testing were correlated with important cardiopulmonary outcomes. Instead, the structured Duke Activity Status Index (DASI) questionnaire and the predictive assessment of complications through measuring serum concentrations of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) were better correlated with the outcomes.

[Correspondence] Functional capacity and preoperative risk evaluation

Sa, 20/04/2019 - 00:00
We commend Duminda Wijeysundera and colleagues1 for testing the prognostic value conferred by assessment of subjective functional capacity in non-cardiac surgery and read the results with interest. We raise two issues with the published data.

[Correspondence] Functional capacity and preoperative risk evaluation – Authors' reply

Sa, 20/04/2019 - 00:00
We thank the correspondents for their interest in our study.1

[Correspondence] Orphan drugs

Sa, 20/04/2019 - 00:00
Lucio Luzzatto and colleagues1 (Sept 1, 2018, p 791) have called for collaboration from EU member states on negotiation of orphan drug prices to take advantage of the fact that with 500 million inhabitants, the EU is the largest customer for any new drug. Low-income and middle-income countries (LMICs), with more than 6 billion inhabitants and 360–480 million patients with rare diseases,2 are in need of orphan drugs and should join forces in this area.

[Correspondence] Orphan drugs

Sa, 20/04/2019 - 00:00
The Viewpoint by Luzzatto and colleagues1 on drug pricing addresses a very crucial issue because an increasing number of orphan drugs have been marketed in the past decade, and genetic treatments costing more than €300 000 are being made available. Among the determinants of drug pricing reported in the Viewpoint,1 benefit to the patient is the main factor that is typically examined in cost-effectiveness analyses; disease-specific factors are already recognised to influence drug prices because an inverse association exists between treatment cost and disease prevalence.