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[Editorial] Abandoning the stigma of leprosy

Sa, 02/02/2019 - 01:00
For thousands of years, leprosy was thought to be a curse of the gods, a punishment for sin, or a hereditary condition. Since ancient Egyptian times, the word leprosy has invoked disturbing imagery of diseased and disfigured bodies. The term has been so heavily stigmatised that it has become synonymous with abandonment, social isolation, and condemnation to a lifetime at the margins of society.

[Comment] Never too old for statin treatment?

Sa, 02/02/2019 - 01:00
In 2005, in a participant-level meta-analysis of large randomised controlled trials, the Cholesterol Treatment Trialists' (CTT) Collaboration conclusively showed that for most patients HMG-CoA reductase inhibitors (statins) reduced major adverse cardiovascular events.1 Since then, generic versions of commonly used statins have become available. An evidence-based life-saving class of drugs with minimal known side-effects is therefore available, and are largely affordable even in lower income countries and for national health services.

[Comment] Evidence-based medicine and infertility treatment

Sa, 02/02/2019 - 01:00
Intracytoplasmic sperm injection (ICSI) is a procedure that is used to help couples with fertility problems achieve parenthood. Initially developed for couples with severely diminished sperm counts,1 it is increasingly used as the method of choice for couples with fertility problems who are undergoing in-vitro fertilisation (IVF) treatment, despite the available data suggesting that IVF is superior to ICSI in couples with normal sperm counts.2 ICSI differs from IVF in that a single sperm is selected by a trained embryologist and directly injected into the oocyte, rather than letting fertilisation take place unaided after adding a few thousand motile sperm to a single oocyte.

[Comment] Has the NHS Long Term Plan forgotten we are all going to die?

Sa, 02/02/2019 - 01:00
“NHS bosses in England say a new 10-year plan could save up to 500 000 lives”, reported the BBC1 when the NHS Long Term Plan2 was launched in the UK on Jan 7, 2019. The plan for the National Health Service (NHS) presents a new service model for the 21st century and makes the case for improvements in prevention, treatment, outcomes, care quality, and reducing health inequalities among other priorities. But you have to search hard to find any mention of end-of-life care. Indeed, it's virtually hidden: care at the end of life appears in one short paragraph in a section headed with the upbeat “People will get more control over their own health and more personalised care when they need it”.

[Comment] Offline: India's health crisis: will democracy deliver?

Sa, 02/02/2019 - 01:00
Last weekend, on Jan 26, India celebrated its 70th Republic Day. The theme was the 150th anniversary of Mahatma Gandhi's birth. 2019 is indeed a year to pause and reflect on India's past achievements and future prospects. Soon, India's Election Commission will announce dates for elections to the Lok Sabha, the House of the People (the lower and more powerful House in India's bicameral Parliament). Elections for 543 seats are held in phases and, based on recent history, will probably take place in April and May.

[World Report] Doctor strikes in Zimbabwe: fighting for provision of health

Sa, 02/02/2019 - 01:00
The substantial fuel price hike that has led to violent protests in Zimbabwe also threatens doctors' livelihood. A 40-day doctors' strike is off, but only for the time being. Munyaradzi Makoni reports.

[World Report] Health agenda close to absent in Nigeria's election campaign

Sa, 02/02/2019 - 01:00
The so-called Giant of Africa is holding presidential elections shortly. Despite the many challenges the country faces, health is far down the candidates' policy priorities. Paul Adepoju reports.

[World Report] Canada's updated food guide promotes mindful eating

Sa, 02/02/2019 - 01:00
In a break from its previous recommendations, the food guide also recommends that water be preferred to fruit juice. Paul Webster reports.

[Perspectives] Scientific conflict and big food companies

Sa, 02/02/2019 - 01:00
Conflicts of interest in drug-company funded research have long been an issue of public concern. Pharmaceutical firms are accused of paying big money for research that will show their pills are better than those of their rivals and the scientists they employ, however good, are accused by some people of taking the company shilling and therefore not to be believed. Pharmaceutical companies these days operate in a climate of hostility and suspicion. Some would say they have only themselves to blame.

[Perspectives] Influenza

Sa, 02/02/2019 - 01:00
In daily life, influenza might seem almost banal: how many of us get through the winter without a bout of flu? For those concerned with global health, however, few diseases provoke more unease. Influenza's history evokes the great themes of modern medicine: the insecure relationship between clinical knowledge and effective treatments; medicine's growing role in global networks of control; and the importance of memory and uncertainty in our responses to disease.

[Perspectives] Scientific collaboration in Michael Lewis's The Undoing Project

Sa, 02/02/2019 - 01:00
In science, we tend to hail solitary geniuses. Often, however, scientific breakthroughs are born not of individual insight but synergistic collaboration. Sometimes one stands on the shoulders of giants. Sometimes, the giants sit in the cubicle next to you. Or, as Michael Lewis writes in his 2016 book The Undoing Project, in the same room: door closed, lost in conversation, laughter spilling into the hallway.

[Perspectives] A tense moment in the emergency room

Sa, 02/02/2019 - 01:00
The young man stormed into the doctors' station in a far corner of the emergency room, and held up his toddler. “My baby's choking and you guys aren't doing anything”, he yelled, the ends of his cornrows slashing against his sweatshirt. This work station was set behind a staff meeting room, so it was clear that the father had entered spaces that were typically off-limits to patients. As soon as he shouted his opening statement, every person on the medical team froze.

[Obituary] Lisa M Schwartz

Sa, 02/02/2019 - 01:00
Advocate for clear communication of medical risks. Born on June 30, 1963, in New York City, NY, USA, she died of cancer on Nov 29, 2018, in Lebanon, NH, USA, aged 55 years.

[Correspondence] Global burden of postoperative death

Sa, 02/02/2019 - 01:00
The Lancet Commission on Global Surgery1 identified that 313 million surgical procedures are performed worldwide each year. Little is known about the quality of surgery globally because robust reports of postoperative death rates are available for only 29 countries.2 The rate of postoperative deaths is a measure of the success of surgical care systems, and improving this metric is a global priority.

[Correspondence] Baricitinib for systemic lupus erythematosus

Sa, 02/02/2019 - 01:00
We read the study on the therapeutic benefit of baricitinib for systemic lupus erythematosus by Daniel J Wallace and colleagues (July 21, 2018, p 222)1 with great interest. However, we raise concerns about the safety of a once-daily 4 mg dose of baricitinib. The Article indicates that the rates of serious infections were higher in the group receiving 4 mg baricitinib, compared with the groups receiving 2 mg baricitinib or placebo. The appendix revealed the proportion of patients with decreased neutrophil counts (<2000 per mm3) was higher in the group receiving the 4 mg dose (27·6%) than in the groups receiving the 2 mg dose (15·2%) and placebo (16·2%).

[Correspondence] Baricitinib for systemic lupus erythematosus – Authors' reply

Sa, 02/02/2019 - 01:00
We thank Kai Yuan and colleagues for their interest in this trial.1 The results from the phase 2 trial informed the baricitinib systemic lupus erythematosus phase 3 programme, including dose selection. We agree that additional data are required to better characterise and establish the overall benefits and risks related to a 4 mg dose of baricitinib. Therefore, we are carrying out a more extensive benefit–risk assessment in the ongoing baricitinib phase 3 global systemic lupus erythematosus programme (ClinicalTrials.gov, numbers NCT03616912 and NCT03616964).

[Correspondence] Repetitive transcranial magnetic stimulation for depression

Sa, 02/02/2019 - 01:00
We read with interest the Article by Daniel M Blumberger and colleagues (April 28, 2018, p 1683).1 Experimenter degrees of freedom can undermine the integrity of findings from randomised controlled trials. Hence, a trial protocol, prespecifying methodological choices and their rationale, is customarily published alongside mandatory trial registration. Blumberger and colleagues make no reference to such protocol. The initial trial registration (NCT01887782) diverges from their publication in myriad ways without explanation: broadening inclusion criteria (age, minimum baseline Hamilton Rating Scale for Depression [HRSD] score), increasing sample size, and extending timeframes for outcome assessment.

[Correspondence] Repetitive transcranial magnetic stimulation for depression – Authors' reply

Sa, 02/02/2019 - 01:00
We thank Adam Mourad Chekroud and Ioana Alina Cristea for their Correspondence. Our protocol and the prespecified statistical analysis plan are available upon request; however, all the changes and outcome measures were documented in our ClinicalTrials.gov (NCT01887782) listing. The changes to the protocol were enacted to address two issues: generalisability to current clinical practice and to ensure an adequate sample size. Our reduction in entry Hamilton Rating Scale for Depression (HRSD-17) score to at least 18 is in keeping with moderate depression and the clinical indication for repetitive transcranial magnetic stimulation (rTMS).

[Correspondence] Top ten hyperacusis research priorities in the UK

Sa, 02/02/2019 - 01:00
Hyperacusis involves a reduced tolerance or increased sensitivity to everyday sounds, whereby they become intense and overwhelming. This condition is experienced by 3·7% of children and up to 9·2% of adults in the world, with a higher prevalence in certain populations, such as people who have Williams' syndrome or autism spectrum disorders.1 Hyperacusis-associated problems are many, including fear, pain, avoidance behaviours, and impairments to quality of life, such as reduced ability to work.2 For children with hyperacusis, the classroom can be particularly challenging, and strategies are needed to ensure their wellbeing and educational needs are met.

[Correspondence] Possibility for science without borders in the Trump era

Sa, 02/02/2019 - 01:00
In July 2004, I participated in the International Association of Universities conference (Sao Paulo, Brazil). In one of the lectures, the acting head of the Ohio State University delivered a speech entitled Globalization in Science. The lecture coincided with the movement generated by President Bush in 2002 when he proposed the problem of the axis of evil in response to the Iranian President Mohammad Khatami's invitation for a so-called dialogue of civilisations. As a consequence, the US Government at the time ordered American publishers not to publish Iranian articles.