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[Department of Error] Department of Error

Sa, 08/06/2019 - 00:30
Green A. HIV epidemic in children in Pakistan raises concern. Lancet 2019; 393: 2288—In this World Report, the words “so-called” were mistakenly added to the sentence: “The so-called epidemic could be found to have reached adults as well”. This correction has been made to the online version as of June 7, 2019.

[Editorial] ICD-11

Sa, 08/06/2019 - 00:00
The International Classification of Diseases (ICD) is a health statistics coding tool that aims to describe an entity that is challenging to quantify and even more problematic to standardise—the human condition. The history of ICD dates back to 16th century England where deaths from distinctly medieval causes (scurvy, leprosy, and plague) were announced by the London Bills of Mortality on a weekly basis.

[Editorial] Plan S: the final cut

Sa, 08/06/2019 - 00:00
A consortium of research funders, Coalition S, has published its revised recommendations for accelerating the transition to open access for scientific publications. The fundamental principles of Plan S remain intact. No scholarly publication should be locked behind a paywall. Open access should be immediate, without embargoes. The preferred Creative Commons licence is CC BY. Funders will support open access fees at reasonable levels. Funders will not pay for publication in hybrid journals, unless they are part of transformative arrangements with clearly defined open access endpoints.

[Editorial] Planetary health in the Anthropocene

Sa, 08/06/2019 - 00:00
In May, 29 of 34 members of the Anthropocene Working Group voted to recognise the Anthropocene as the geological epoch entered in the 20th century, characterised by human activity rapidly shaping our planet. Human impact extends beyond geological labelling, affecting all forms of life. Human progress includes multiple successes but has also led to immense pressure on the planetary systems on which we depend, affecting human health through an unfolding climate emergency, human-made air pollution, and broken unsustainable food systems.

[Comment] Novel DMARD monotherapy in rheumatoid arthritis

Sa, 08/06/2019 - 00:00
In The Lancet, Josef Smolen and colleagues1 report the results of a double-blind, placebo-controlled trial of upadacitinib, a new oral Janus kinase (JAK) inhibitor, in patients with active rheumatoid arthritis (RA). Interestingly, upadacitinib was evaluated as a monotherapy, without concomitant methotrexate (MTX). Existing recommendations for management of RA2 do not include novel disease-modifying antirheumatic drug (DMARD) monotherapy as part of the strategy. Nevertheless, there is growing interest in the use of novel DMARDs (namely, biological DMARDs [bDMARDs], such as tumour necrosis factor-α or interleukin-6 inhibitors, as well as targeted synthetic DMARDs [tsDMARDs], such as oral JAK inhibitors) in RA monotherapy.

[Comment] Health care: conflicted, confused, and in need of change

Sa, 08/06/2019 - 00:00
Conflicts of interest in medicine are a serious, pervasive issue. Yet there is insufficient leadership and resolve within global institutions to adequately address this issue. We are concerned with how to ensure transparency of interests and what conflicts of interest should be allowed even if fully disclosed. The second question remains moot while the first remains unsolved, and this is what we discuss here.

[Comment] The Wakley Prize Essay 2019: getting better

Sa, 08/06/2019 - 00:00
“I've got to admit it's getting better / A little better all the time”, sang Paul McCartney; “It can't get no worse” was John Lennon's rejoinder on backing vocals. Medicine, like the music of the Beatles, balances sunshine and shadows. We hear a lot about the misery of modern medicine—short-term agendas, increasing consumerism, high workloads, burnout, fragmentation, insufficient resources, too little time for patients or research. But what about the sunshine? What excites you, fires your commitment, keeps you in the profession, makes change possible, brings moments of transformation or understanding? What are the rewards, pleasures, or surprises of the practice of medicine? Let us know by writing an essay for The Lancet's annual essay competition, the Wakley Prize.

[Comment] Fresh focus on health: Highlights 2019 photography competition open for submissions

Sa, 08/06/2019 - 00:00
Photographs are a powerful way to convey health stories. Earlier this year, The Lancet published a photo feature about a new face for leprosy. These pictures captured moments of humanity and showed patients with leprosy enjoying life, function, and community, in ways that were a departure from conventional pictures of disability. We are looking for equally arresting images for Highlights 2019.

[Comment] Offline: Young people—from listening to leadership

Sa, 08/06/2019 - 00:00
The hypocrisy of global health can be suffocating. Writing in their 2016 Lancet Commission on Adolescent Health and Wellbeing, George Patton and colleagues argued for the “establishment of forums for meaningful youth participation”. Such forums should strengthen “mechanisms for the meaningful participation of adolescents in the design, communication, and implementation and monitoring of policies and practices that affect their health and wellbeing. This is particularly important for socially and economically marginalised adolescents”.

[World Report] UK, Germany, dissociate from WHO drug pricing resolution

Sa, 08/06/2019 - 00:00
The passage of a landmark resolution on improving the transparency of markets for medicines at the latest WHA fails to narrow the political divide. John Zarocostas reports from Geneva.

[World Report] HIV epidemic in children in Pakistan raises concern

Sa, 08/06/2019 - 00:00
The epidemic could be found to have reached adults as well. Experts suspect that it is a marker of systematic failures in health-care provision. Andrew Green reports.

[World Report] AMLO's Mexico leads to drastic cuts to health system

Sa, 08/06/2019 - 00:00
The anti-corruption president has set some stringent targets for the health system—critics worry that these are brash and could be damaging to the system. David Agren reports.

[Perspectives] Personal space

Sa, 08/06/2019 - 00:00
I used to ride a scooter in London. One warm summer's evening I was riding home, visor up, when some boys on the pavement threw a water bomb that hit me in the face. My eye was painful and my vision blurred so I went to my local eye hospital. I was examined by an ophthalmology trainee who seemed very nervous. He didn't say a word but loomed over me, stuck an ophthalmoscope in my face, shone bright lights in my eye, and went away. A while later, I was seen by the consultant. Things couldn't have been more different.

[Perspectives] Opening the box of tricks

Sa, 08/06/2019 - 00:00
The human capacity for credulity seems boundless. Smoke and Mirrors: The Psychology of Magic, an exhibition at Wellcome Collection, London, UK, shows how magicians, mediums, and other tricksters have exploited people's willingness to believe the improbable and accept the impossible for centuries. Curators Honor Beddard and A R Hopwood have selected a fascinating array of material from various sources—from the British Library to the Magic Circle—to lift the lid on the tools and tricks used to create illusion and distort truth from Victorian times to the present day.

[Perspectives] Medical misinformation and the internet: a call to arms

Sa, 08/06/2019 - 00:00
Almost 16 years ago my family and I were deposited on the other side of the stethoscope. Pregnant with triplets, my membranes ruptured at almost 23 weeks and I delivered my first son who I elected not to resuscitate. I managed to stay pregnant until 26 weeks when I developed chorioamnionitis and delivery was required. My sons Oliver and Victor had a long road out of the neonatal intensive-care unit. They both had bronchopulmonary dysplasia. Oliver also had a cardiac defect unrelated to prematurity that needed surgery, and Victor had cerebral palsy.

[Obituary] Richard Valery Mouzoko Kiboung

Sa, 08/06/2019 - 00:00
Public health physician, epidemiologist and front-line responder to Ebola outbreak. Born in Bafia, Cameroon, on May 31, 1977, he was killed during an attack on Butembo University Hospital in DR Congo on April 19, 2019, aged 41 years.

[Correspondence] Inequality, world health, and global governance

Sa, 08/06/2019 - 00:00
Richard Horton1 correctly states that good health depends on political, economic, and social forces that shape conditions of living. To address health care on a global scale, immediate and comprehensive efforts both on an international and national level have to be realised. The most imminent and relevant global issue that is closely linked to world health is probably climate change.2 Climate change has direct negative local effects (eg, droughts, flooding, and famine) and supraregional repercussions (eg, migration).

[Correspondence] Genotype–phenotype association in patients with SCN4A mutation

Sa, 08/06/2019 - 00:00
Roope Männikkö and colleagues1 described an association between dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, and sudden infant death syndrome (SIDS). The authors found that rare SCN4A variants occurred in infants who died from SIDS. Patch clamp studies presented an alteration of sodium channel kinetics.

[Correspondence] Genotype–phenotype association in patients with SCN4A mutation – Authors' reply

Sa, 08/06/2019 - 00:00
We are pleased with Ibrahim El-Battrawy and colleagues' interest in our work.1 We note that the authors are concerned that the sodium current recordings in our patch clamp experiments could have been contributed to by NaV1.5. As described in the methods section,1 we assessed expression in HEK293 cells, which do not express endogenous sodium channels. These cells were transfected with mutant and wild-type SCN4A DNA. This approach excludes any possibility of NaV1.5, or any other sodium channel isoform, contributing to the sodium current recordings.

[Correspondence] Neglect of menarche and menstruation in the USA

Sa, 08/06/2019 - 00:00
Aaron van Dorn1 recently discussed the America's Children in Brief report and the complexities of child poverty and health care in the USA.2 Although appreciating improvement in some key child health indicators, van Dorn highlighted on-going challenges to improving the health of children growing up in poverty today.