Medicine

[Editorial] End of the road for daclizumab in multiple sclerosis

Lancet - 17 March 2018 - 12:00am
On March 7, the European Medicines Agency (EMA) recommended the immediate suspension and recall of the multiple sclerosis drug daclizumab. The announcement follows reports of serious inflammatory brain disorders in 12 patients worldwide, including three deaths, and comes shortly after the voluntary withdrawal of the drug by Biogen and AbbVie on March 2.
Categories: Medicine

[Comment] The future of the NHS: no longer the envy of the world?

Lancet - 17 March 2018 - 12:00am
The UK's National Health Service (NHS) is one of the most comprehensive public health-care systems in the world and has provided free, high-quality care to millions of people since its inception. It was established on July 5, 1948, with the National Health Service Act based on the bold assumption within the 1942 Beveridge Report that a post-war UK would have “a national health service for prevention and for cure of disease and disability” that “will ensure that for every citizen there is available whatever medical treatment he requires, in whatever form he requires”.
Categories: Medicine

[Comment] Offline: Owning up on gender equality

Lancet - 17 March 2018 - 12:00am
There are moments to admit failure. Gender equality is one of those moments. Last week, the first report on gender-responsiveness among the world's most influential global health organisations—The Global Health 50/50 Report—was launched in London. Led by Sarah Hawkes and Kent Buse, together with a largely voluntary team of researchers, strategists, and communications experts, and housed within the University College London Centre for Gender and Global Health, Global Health 50/50 examines seven domains of gender equality across 140 organisations.
Categories: Medicine

[World Report] Life after death—surviving the attacks on civilians in Syria

Lancet - 17 March 2018 - 12:00am
Now entering its eigth year, there is no end to the Syrian war in sight. Civilian casualties are rising, as the bereaved see no respite in the violence that robbed them of their families. Sharmila Devi reports.
Categories: Medicine

[World Report] Frontline: a Safe Hospital on the border with Haiti

Lancet - 17 March 2018 - 12:00am
The Caribbean island of Hispaniola is split by a border that separates the Dominican Republic and Haiti. It sits above a major fault zone, which puts the two countries at constant risk of earthquakes, such as the catastrophic tremor of 2010 that brought Haiti to its knees. Over the past 500 years, the island has been hit by several tsunamis generated by earthquakes. Hurricanes also pass through Hispaniola almost every year, further battering the vulnerable island.
Categories: Medicine

[Perspectives] Rethinking the medical record

Lancet - 17 March 2018 - 12:00am
Electronic health records (EHR) and patient portals, which epitomise the digitisation of medical care, are, ironically, major roadblocks for better health care. Much has been written about the shortcomings of EHRs, yet the unmet needs are broader and include not only the objective of control and ownership but also the capacity to search and share records by patients. The announcement earlier this year that Apple has launched a personal health record feature on its Health app that aggregates existing patient-generated data with a user's electronic medical record is a step in that direction.
Categories: Medicine

[Perspectives] The power of medical storytelling

Lancet - 17 March 2018 - 12:00am
Over two decades ago a surgeon told me the story of a young man with a spinal injury. The young man had a potentially catastrophic injury and either having surgery, or not, was risky. He had the surgery and recovered, but subsequently the surgeon was informed that the young man's sexual function was entirely lost. The patient fell into depression and despair. The surgeon was devastated and blamed himself. The senior ward nurse on the Nightingale ward observed all this. She listened to her patient's anguish and the surgeon's distress.
Categories: Medicine

[Perspectives] Sadness and silencing

Lancet - 17 March 2018 - 12:00am
With the #MeToo and #blacklivesmatter campaigns, it feels as if the world is finally cracking open for human beings to speak their truths. An increasing number of people are working for and demanding change, but wider society does not always want to hear these voices. One part of the world where justice for past and present injury is sorely needed is Australia. What is widely known as Australia Day passed in January—the day in 1788 when the British first stuck a colonial flag in the soil. To many Indigenous Australians, it is known as Invasion Day or Survival Day.
Categories: Medicine

[Perspectives] Giving meaning to art in hospital care

Lancet - 17 March 2018 - 12:00am
Care units are not generally noted for their visual appeal. But Garnet Ward, a dementia care unit in north London, UK, run by the Camden and Islington NHS Foundation Trust, is different. On the walls of one room, stylised paintings of exotic plants from around the world conjure up scenes of travel and exploration. Elsewhere, a landscape mural full of intrigue and wonder glows like stained glass. The wall of one little nook is a swirling wash of abstract blues, pinks, and greens that could be one of J M W Turner's skies at sunrise.
Categories: Medicine

[Obituary] Walter Werner Holland

Lancet - 17 March 2018 - 12:00am
Pioneer of UK health services research. He was born in Teplice-Sanov, Czech Republic, on March 5, 1929, and died of prostate cancer in London, UK, on Feb 9, 2017, aged 88 years.
Categories: Medicine

[Correspondence] Good intentions do not replace ethical conduct in research

Lancet - 17 March 2018 - 12:00am
The Dutch disciplinary tribunal officially warned two Dutch physicians following their study with a Kenyan collaborator on the efficacy of the homeopathic substance Iquilai (“a potentised mineral supplement”) in 228 patients with HIV/AIDS in Kenya.1–3 The case was brought forward by the Dutch Health Inspectorate that launched an investigation into the practice of the two involved physicians. The tribunal deemed the study incompatible with basic medical ethical principles for research on human beings, as specified in the World Medical Association's Declaration of Helsinki: the study did not have a proper study protocol, risk assessment, or ethics approval.
Categories: Medicine

[Correspondence] Questionable efficacy of the rVSV-ZEBOV Ebola vaccine

Lancet - 17 March 2018 - 12:00am
We read with great interest the final report by Ana Maria Henao-Restrepo and colleagues (Feb 4, 2017, p 505)1 on the ring vaccination trial of an rVSV-vectored vaccine for Ebola virus disease (rVSV-ZEBOV). Briefly, among 2119 people who received the vaccine immediately, no cases of Ebola virus disease were identified in a period of 11 days (10–21 days after vaccination). By contrast, 16 cases were identified within the same time frame among 2041 people who did not receive the vaccine immediately.
Categories: Medicine

[Correspondence] Questionable efficacy of the rVSV-ZEBOV Ebola vaccine – Authors' reply

Lancet - 17 March 2018 - 12:00am
We thank Wolfram Metzger and Sarai Vivas-Martínez for expressing their concern about potential sources of bias in the final analysis of our ring vaccination trial of an rVSV-vectored vaccine for Ebola virus disease (rVSV-ZEBOV).1 In that trial, the point estimate of vaccine efficacy was 100%, with no confirmed cases of Ebola virus disease detected in vaccinated people 10 days or more after vaccination in the entire trial. We were careful to ascertain that the risk of exposure to Ebola virus and case ascertainment were low and statistically the same in the rings (clusters) that received immediate and delayed vaccination.
Categories: Medicine

[Department of Error] Department of Error

Lancet - 17 March 2018 - 12:00am
Thiele EA, Marsh ED, French JA, et al. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2018; 391: 1085–96—In this Article (published online first on Jan 24, 2018), J Sullivan should have been listed as a member of the GWPCARE4 Study Group. This correction has been made to the online version as of March 15, 2018, and the printed Article is correct.
Categories: Medicine

[Comment] CD8 T cells and mTOR: new concepts and targets for systemic lupus erythematosus

Lancet - 16 March 2018 - 12:30am
Management of systemic lupus erythematosus and its variable clinical manifestations remain considerable challenges for clinicians and patients. Advances in characterising mechanisms of immune system regulation have been applied to studies of systemic lupus erythematosus, implicating type I interferon and highlighting the contributions of T and B lymphocytes to autoantibody production and tissue damage.1 Despite such progress, the pace of development of more effective therapies for patients has been slow.
Categories: Medicine

[Articles] Sirolimus in patients with clinically active systemic lupus erythematosus resistant to, or intolerant of, conventional medications: a single-arm, open-label, phase 1/2 trial

Lancet - 16 March 2018 - 12:30am
These data show that a progressive improvement in disease activity is associated with correction of pro-inflammatory T-cell lineage specification in patients with active systemic lupus erythematosus during 12 months of sirolimus treatment. Follow-up placebo-controlled clinical trials in diverse patient populations are warranted to further define the role of mTOR blockade in treatment of systemic lupus erythematosus.
Categories: Medicine

[Department of Error] Department of Error

Lancet - 16 March 2018 - 12:30am
Park KB, Khan U, Seung K. Open letter to The Global Fund about its decision to end DPRK grants. Lancet 2018; 391: 1257—In this Correspondence (published online first on March 14, 2018), the following sentence should have read “UK is a Director of Interactive Research & Development.” This correction has been made to the online version as of March 15, 2018, and the printed Correspondence is correct.
Categories: Medicine

[Perspectives] Rehumanising the Syrian conflict: photographs of war, health, and life in Syria

Lancet - 15 March 2018 - 12:30am
The Syrian conflict, which marked its seventh anniversary on March 15, is one of the most live-imaged wars in modern times. Syrian citizen-activists and others have transmitted images extensively to tell the story of the conflict with the hope that this may draw support and change their plight. International media also draw heavily on images—themes of violence, suffering, destruction, and displacement dominate.
Categories: Medicine

[Department of Error] Department of Error

Lancet - 15 March 2018 - 12:30am
Zarocostas J. Libya: war and migration strain a broken health system. Lancet 2018; 391: 824–25—In this World Report, the third paragraph should have read “Libya is now entering its eighth year of conflict and instability, which first engulfed the nation when in February, 2011, dictator of 42 years Muammar Gaddafi used violence to crush pro-democracy demonstrations. The violent clampdown sparked a civil war that led to Gaddafi's ouster from power in August, 2011, by his rebel opponents—backed by strong aerial and naval support from western powers.” This correction has been made to the online version as of March 14, 2018.
Categories: Medicine

[Correspondence] Open letter to The Global Fund about its decision to end DPRK grants

Lancet - 15 March 2018 - 12:30am
Dear Peter Sands and Aida Kurtović,
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