Western medicine is organised into silos. Faced with a patient requiring specialist advice, a general practitioner or emergency doctor has to make a call about where to direct them. Sometimes, the right clinical destination is obvious: a compound thigh fracture will always need an orthopaedic surgeon. But many patients fall foul of this rigid system. An individual complaining of dizziness might get bounced from ENT, to cardiology, to neurology, to psychiatry before achieving a diagnosis.
Clinicians and patients are getting out of touch with one another. When I was a medical student, I spent hours with patients, examining them on the ward, taking blood, and assisting at operations. At first I felt clumsy, inept, and embarrassed at the prospect of physical contact, for touch is surrounded by social conventions and taboos that are difficult to break through. But gradually, through practice, I became more confident. Touching people stopped feeling strange. Ostensibly, the purpose of these examinations was to gather diagnostic information that I would relay to senior clinicians.
Like any milestone, WHO's 70th anniversary offers an opportunity to reflect on its past trajectory and chart the challenges ahead. WHO's promising mandate for health cooperation, forged amid a short-lived post-war optimism, mapped out a world of possibilities. Yet its realisation has been limited across distinct eras by complex geopolitical, economic, and institutional pressures, ranging from the Cold War rivalry between US and Soviet blocs to contemporary assaults on WHO's independence by powerful private actors.
Nobel Prize winner for work on Caenorhabditis elegans and a leader in human genome research. Born in Fulmer, UK, on March 27, 1942, he died on March 6, 2018, from complications of stomach cancer, aged 75 years.
The reduction in the number of poliomyelitis cases by more than 99% is an extraordinary success of the global community. In their Comment, Michel Zaffran and colleagues (Jan 6, p 11)1 assume that eradication will be achieved soon and focus on strategies to ensure that poliovirus will not be reintroduced into a polio-free world.2
A surprising amount of bad history passes peer review in the sciences and medicine. What do we mean by bad history? One example would be the misuse of historical images. Many images of so-called plague used in scientific publications depict patients suffering from leprosy.1 Another example is when commonly repeated claims about historical people or events are lifted from earlier scientific or medical writings, without checking whether professional historical scholarship has revised earlier interpretations.
Marc A Riedl and colleagues (July 25, 2017, p 1595)1 conducted a phase 2, multicentre, randomised, double-blind, placebo-controlled crossover trial in 32 patients to test the prophylactic efficacy of recombinant human C1 esterase inhibitor for hereditary angio-oedema. Once or twice weekly administration of recombinant human C1 esterase inhibitor (50 IU/kg) reached the primary endpoint (reduced number of attacks) in an intention-to-treat analysis.
We thank Yannick D Muller and colleagues for their interest in our Article1 describing results from a randomised, double-blind, placebo-controlled study with the use of recombinant human C1 esterase inhibitor for prophylaxis of hereditary angio-oedema.
Khanna D, Denton CP, Angelika Jahreis A, et al. Safety and efficacy of subcutaneous tocilizumab in adults with systemic sclerosis (faSScinate): a phase 2, randomised, controlled trial. Lancet 2016; 387: 2630–40—In table 3 of this Article (published online first on May 5, 2016), the p value (placebo vs tocilizumab) for a decrease of 4·7 units or more at 48 weeks should have been 0·25. The interpretation of these data remains unchanged. This correction has been made online as of April 5, 2018.
The Lancet. Dementia in the UK: preparing the NHS for new treatments. Lancet 2018; 391: 1237— In the second sentence of this Editorial, the cost of dementia to the National Health Service in the UK should have been £26 billion. This correction has been made to the online version as of April 5, 2018.