How did it happen that palliative care lost the dignity debate? Palliative care is a discipline dedicated to improving quality of life by preventing and alleviating suffering. There can be few higher callings in medicine. Yet those who advocate “dignity in dying” have successfully claimed that the idea of dignity lies not in palliative care but in assisted dying for the terminally ill. A large majority of the public seems to agree. Those in favour of assisted dying have portrayed palliative care as somehow antithetical to patient autonomy.
Ireland has set a date for a referendum that could be decisive in women's access to abortion. Anita Makri reports on the arguments on both sides of the debate.
Cultural mediators can help migrants, asylum seekers, and refugees to face what can seem an insurmountable wall of cultural difference. Amanda Sperber reports from Polistena.
Obesity and the diseases that are related to it are at the core field of Sydney's Charles Perkins Centre, led by a man whose first area of research was locust behaviour. Stephen Simpson says his own varied background shows why this research body is different.
For early modern physicians syphilis was “the great imitator”, a disease that mystified with the sheer range of its symptoms and the length of time it might take to show itself. Syphilis was first recorded in Europe in the mid-1490s, and the coincidence with Christopher Columbus' first voyage to the New World led contemporary physicians (along with more recent archaeologists and historians) to conclude that his sailors had brought the disease back with them.
There have been times when I've said that if I ended up meeting my teenage self, due to some bizarre time-travel mishap, I'd probably end up trying to strangle the arrogant, bungling, self-absorbed waste of space that he was. I've heard other people echo similar sentiments. It's weird how so many think so little of their adolescent selves, from their older, more mature perspective. How can we change so much and yet remain the same person? And why were we like that, consumed with all the neuroses and priorities that as adolescents were so vital but now just seem ridiculous, or baffling, or even a little sad?
If determination is a predictor of future achievements in medical research, the likelihood that Professor Guo-Qiang Chen would have a flourishing career should have become apparent when he was still a very junior doctor. To leave the provincial medical school to which he was then contracted and relocate himself to a distant and more research-oriented institution, he had to find the money to take on a major debt. It was, as he himself admits, “a gamble”. Now, some 25 years later, Chen is a member of the Chinese Academy of Sciences, Chancellor of Shanghai Jiao Tong University School of Medicine, and Director of its Laboratory of Cell Differentiation and Apoptosis.
Death has become quite modish, and being constantly aware of one's mortality is now regarded as an essential component of spiritual and psychological health. My book The Way We Die Now was published in 2016, and since then I have given many talks and written several articles on the subject of death. I am often asked whether all of this talking and writing about death has prepared me any better for my own demise.
Public health expert who directed the US Fred Hutchinson Cancer Research Center. Born in Framingham, MA, USA, on Oct 22, 1930, he died from lung cancer on Jan 6, 2018, in Seattle, WA, USA, aged 87 years.
Driven by a deplorable trend of unlawful attacks on health-care facilities and workers in armed conflicts throughout the world, on May 3, 2016, the UN Security Council (UNSC) adopted Resolution 2286 calling for an end to such attacks.1 The Secretary-General followed with recommendations of concrete measures for implementation.2 However, unlawful attacks on health care have continued or intensified in many conflicts, notably in Syria. We, academic institutions, civil society, and co-sponsoring Member States, convened a side event during the 72nd UN General Assembly to focus global attention on this issue and the imperative that Resolution 2286 be implemented.
What happens at the end of a trial when a patient responds to an investigational medication and benefits considerably? Many people believe that this patient should continue to receive the beneficial drug. This belief underlies the idea of post-trial access—providing investigational interventions post-trial to participants who benefited from them—and was formally introduced by the Declaration of Helsinki in 2000. But even if this patient did not benefit from the investigational medication, doing nothing for them at the end of the trial seems ethically problematic.
On Jan 14, 2018, during a tense final touchdown in a US National Football League playoff game, numerous Apple Watch users received an alert from their device telling them that they were having potentially harmful arrhythmias.1 Smartphones and wearable technology are increasingly used as public health tools because billions of people worldwide are digital users. In 2020, more than 6 billion people will have smartphone subscriptions.2 Clinicians and researchers can use these devices to effortlessly monitor patients' health and behaviour indicators in real time.
Loneliness was recently described in The Lancet as a public health problem that needs to be solved by the medical community (Feb 3, p 426).1 We believe that the medicalisation of loneliness in this way is damaging, especially at a time when the issue is making its way into public understanding.
On behalf of Mental Health Europe I would like to respond to the Lancet's Editorial (Jan 27, p 282)1 written about our Mapping and Understanding Exclusion report.2 Although we welcome the coverage of our report, we were disappointed to see a reference to the need to uphold the status quo on coercive measures, which might lead to confusion regarding the conclusions of our report. The Lancet's Editorial stated that: “Involuntary treatment and detention are a necessary part of mental health care”.1 This statement is contrary to the core message in our report, which recommended that to reduce coercion in mental health services European states should adopt policies and practices that aim to immediately reduce coercion in mental health services and ultimately make such practices by exception only, in line with human rights standards.
It was with great concern that we read the Editorial in The Lancet (Jan 27, p 282)1 regarding institutional and coercive mental health treatment in Europe, in which Greece was among the countries with substantial shortfalls in mental health services and violations of patients' human rights.
Jean-Frederic Colombel and colleagues' CALM study (Dec 23, 2017, p 2779),1 which investigated the effect of tight control management on Crohn's disease, reported significantly better outcomes with tight control than with clinical medical management. Tight control consisted of prespecified therapy escalation if a patient's Crohn's disease activity index (CDAI) was at least 150, or if they had elevated C-reactive protein or calprotectin, and resulted in significantly better mucosal healing (and clinical remission) than did therapy escalation based on clinical symptoms alone.
The Correspondence from Hans Herfarth and colleagues raised clinically relevant questions about our study1 of patients with Crohn's disease, whose treatment was adjusted based on stringent criteria for clinical symptoms and biomarkers (tight control) or less stringent clinical criteria alone.
[Articles] Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies
In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.
Vector control with long-lasting insecticidal nets and indoor residual spraying accounts for most of the 1·3 billion fewer malaria cases and 6·8 million fewer malaria-related deaths attributable to declining transmission between 2000 and 2015.1–3 However, because resistance to pyrethroid insecticides has spread through African malaria vector populations, concerns over maintaining these gains have been widely voiced—but these are frequently disputed.4 The findings presented by Natacha Protopopoff and colleagues5 in The Lancet provide rigorous, long overdue, new evidence for those working in the field of malaria vector control.
[Articles] Effectiveness of a long-lasting piperonyl butoxide-treated insecticidal net and indoor residual spray interventions, separately and together, against malaria transmitted by pyrethroid-resistant mosquitoes: a cluster, randomised controlled,...
The PBO long-lasting insecticidal net and non-pyrethroid indoor residual spraying interventions showed improved control of malaria transmission compared with standard long-lasting insecticidal nets where pyrethroid resistance is prevalent and either intervention could be deployed to good effect. As a result, WHO has since recommended to increase coverage of PBO long-lasting insecticidal nets. Combining indoor residual spraying with pirimiphos-methyl and PBO long-lasting insecticidal nets provided no additional benefit compared with PBO long-lasting insecticidal nets alone or standard long-lasting insecticidal nets plus indoor residual spraying.