The Lancet

We read with interest the results of the ATLAS trial, and we would like to highlight some shortcomings.

The findings from the ATLAS trial demonstrate that extended use of adjuvant tamoxifen beyond 5 years is beneficial for women with oestrogen receptor (ER)-positive breast cancer.

Key findings from trials of 5 years or 10 years of tamoxifen are summarised in the . They are remarkable.

Richard Burt and colleagues (March 30, p 1116) propose from a retrospective analysis of autologous haemopoietic stem-cell transplantation (HSCT) in 90 patients with systemic sclerosis that comprehensive cardiac screening including fluid challenge improves patient selection. They ascribe the higher treatment-related mortality in the ASTIS trial (10% vs 6% in their study) to less rigorous cardiac screening, which mandated right heart catheterisation only if there was pulmonary arterial hypertension on echo.

Richard Burt and colleagues' study of treatment-related mortality of autologous haemopoietic cell transplantation in progressive autoimmune diseases is promising with an acceptable 5% treatment-related mortality, compared with 10% in the ASTIS trial. However, we believe that some issues need to be further clarified.

We thank Jacob van Laar and colleagues and Ioanna Sakellari and colleagues for their comments.

The Lancet, in its excellent Series, acknowledged the importance of non-communicable diseases (NCDs), particularly in low-income and middle-income countries (LMICs). These Series stress, among many important points, the need for global cooperation and partnership towards addressing NCDs. However, it is surprising to observe the over-representation of researchers based in high-income countries and the limited participation of LMIC-based researchers in all four Lancet Series (); an observation that warrants open criticism and immediate pragmatic action.

We appreciate the positive comments by Rodrigo Carrillo-Larco and colleagues on the four Lancet Series on non-communicable diseases (NCDs). We applaud the reference to the efforts being made to encourage the inclusion of contributors from low-income and middle-income countries into major debates and to remove barriers to publishing.

We welcome The Lancet's stance on open access (April 6, p 1166). We note that you wish to review how you can make all publicly funded research as accessible and usable as possible. However, we also note that even with the announced changes, The Lancet will still have less free access than other key general medical journals. For example, there is free access to all research articles in The Journal of the American Medical Association (JAMA) after 6 months from 1998, in the New England Journal of Medicine after 6 months from 1990, and in The British Medical Journal immediately from 1840 onwards.

Judith Glynn and Sara Thomas raise important questions about our current policy to offer open access publications as outlined in our recent Comment. Our announcement is only a first step in a fast evolving movement towards making publicly funded research as accessible as possible, and we are continuously reviewing our approach. However, many of our research papers—all those reporting global health research—are already routinely made free to access immediately at publication. In addition, we are launching the first open access journal within the Lancet family, The Lancet Global Health, on June 25, this year.

The Lancet. Salt: friend or foe? Lancet 2013;381: 1790—In this Editorial (May 25), the fifth line of the second paragraph should have stated “2300 mg sodium”. The last line of this paragraph should have stated “3400 mg sodium (about 1·5 teaspoons of salt) daily”. The fifth line of the third paragraph should have read “less than 2300 mg sodium”. The last two lines of the fourth paragraph should have read “1500–2300 mg daily sodium intake”. These corrections have been made to the online version as of June 14, 2013.

The Lancet. Towards better health in China. Lancet 2013;381: 1959— In this Editorial (June 8), the following sentence in the second paragraph should have read “Chronic obstructive pulmonary disease remains one of the leading causes of death in China.” This correction has been made to the online version as of June 14, 2013.

In this study, daily oral tenofovir reduced the risk of HIV infection in people who inject drugs. Pre-exposure prophylaxis with tenofovir can now be considered for use as part of an HIV prevention package for people who inject drugs.

The raltegravir regimen was no less efficacious than the standard of care and was safe and well tolerated. This simple NtRTI-free treatment strategy might extend the successful public health approach to management of HIV by providing simple, easy to administer, effective, safe, and tolerable second-line combination antiretroviral therapy.

Our findings suggest that sofosbuvir is well tolerated and that there is no additional benefit of extending treatment beyond 12 weeks, but these finding will have to be substantiated in phase 3 trials. These results lend support to the further assessment of a 12 week sofosbuvir regimen in a broader population of patients with chronic HCV genotype-1 infection, including those with cirrhosis.

A 20-year-old man was referred to us for assessment of a 1 year history of dyspnoea on exertion. At the age of 9 years, he had had two episodes of migratory polyarthritis suggestive of rheumatic fever. Cardiovascular examination showed a grade III/VI pansystolic murmur at the apex (see ). We noticed he had painless, correctable deformities of his hands and feet (). He did not know his hands were deformed. His joints were enlarged but there was no evidence of active joint inflammation or functional impairment, and no subcutaneous nodules.

Antiretroviral therapy for HIV infection needs lifelong access and strict adherence to regimens that are both expensive and associated with toxic effects. A curative intervention will be needed to fully stop the epidemic. The failure to eradicate HIV infection during long-term antiretroviral therapy shows the intrinsic stability of the viral genome in latently infected CD4T cells and other cells, and possibly a sustained low-level viral replication. Heterogeneity in latently infected cell populations and homoeostatic proliferation of infected cells might affect the dynamics of virus production and persistence.

In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours.

In February, 2013, a novel avian influenza A H7N9 virus emerged in east China and quickly spread to other areas. By May 27, 130 human infections had been confirmed, with 37 deaths. Transmission can occur through direct or close contact with poultry or through exposure to environments that are contaminated with poultry. No human-to-human transmission has been reported. Co-infection of viruses in human beings, birds, or other animals provides the possibility for the emergence of a new reassortant virus.

The America's Health Rankings 2013 Senior Report has named Minnesota as the healthiest US state for older people. The state ranked first for all health determinants combined, including high availability of home health-care workers. It also ranked first overall for all health outcomes, including a high prevalence of able-bodied seniors.