[Perspectives] Flight from despair
One out of every 113 people in the world is either an asylum seeker, a refugee, or internally displaced, according to the United Nations High Commissioner for Refugees (UNHCR). The war in Syria, now in its sixth year, is a major driver of these numbers and the acute distress of those immediately affected by the conflict —an estimated 6·5 million internally displaced, 5 million Syrian refugees in host countries in the region, and about 1 million seeking refuge in Europe and elsewhere. Yet in the past 5 years millions of other people have also been leaving home to improve their chances of survival, driving the t...
Source: LANCET - November 10, 2017 Category: General Medicine Authors: Jennifer Leaning Tags: Perspectives Source Type: research

[Perspectives] The digitised clinical trial
Nicole is a 46-year-old mother of two who works for her local bank. She has an autoimmune condition that has been difficult to control. She was excited to see a video on her patient community website about a research programme for a new therapeutic intervention. After absorbing the details of the study, being informed of its risks and benefits, confirming her qualifications, and being given the opportunity to ask any questions, Nicole completed the smartphone consent. She then began a rigorous study regimen: daily medication, weekly monitoring of vital signs, and continuous tracking of her activity and quality of sleep. (Source: LANCET)
Source: LANCET - November 10, 2017 Category: General Medicine Authors: Steven R Steinhubl, Patrick McGovern, Jesse Dylan, Eric J Topol Tags: Perspectives Source Type: research

[World Report] Trump administration begins to confront the opioid crisis
As the Presidential Commission releases its recommendations, Trump moves closer to defining his policies against the opioid epidemic. Susan Jaffe, The Lancet Washington correspondent, reports. (Source: LANCET)
Source: LANCET - November 10, 2017 Category: General Medicine Authors: Susan Jaffe Tags: World Report Source Type: research

[Comment] Offline: Planetary health's next frontier —biodiversity
Medicine's inspiring power is the moral importance it attaches to human life. The commitment of health workers to the protection and strengthening of humanity is a bulwark against violence, repression, and abuse. It is in their defence of life and human flourishing that medicine and medical science find their political and social force. But the priority medicine gives to being human is also its great conceit —and flaw. What has become increasingly clear is that, as Emmett Duffy and his colleagues put it in Nature earlier this year, “Human well-being depends strongly on the interacting web of living species, so ...
Source: LANCET - November 10, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Hidden conflicts of interest in continuing medical education
Continuing medical education (CME) is an integral part of postgraduate training for medical professionals in the USA and globally. CME enables physicians to maintain and gain knowledge and skills that ensure optimal medical care and outcomes for patients. For these reasons CME is a required component of licensure in the USA.1,2 Since most physicians regularly complete CME hours, conflicts of interest that could introduce bias into CME must be avoided to prevent potentially detrimental downstream effects on patient care. (Source: LANCET)
Source: LANCET - November 10, 2017 Category: General Medicine Authors: Ladan Golestaneh, Ethan Cowan Tags: Comment Source Type: research

[Editorial] Support for a publicly funded health system in the USA
On Nov 8, a high-level panel —Health for All: #Walktogether—was held in New York City, NY, USA. It brought together two Elders—former Secretary General of the UN Ban Ki-moon and former Director General of WHO Gro Harlem Brundtland—and local health activists and politicians to discuss the need for publicly funded health systems in order for governments to deliver universal health coverage (UHC) by 2030. This event was held as part of a global tour that marks the tenth anniversary of the founding of The Elders, an independent group that provides leadership on the most pressing issues facing humanity. (Source: LANCET)
Source: LANCET - November 10, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] The case for action on childhood pneumonia
Pneumonia kills almost 1 million children each year, and more than 80% of these deaths are children under 2 years of age. While not solely a disease of developing countries —it is the leading cause of child hospitalisation in the USA—it disproportionately affects children living with poverty or malnourishment who are the most vulnerable to infection. A key defence is immunisation, but over 25 million children under 2 years were not immunised with the pneumococcal c onjugate vaccine in 2016. Available vaccines are produced by just two manufacturers and priced out of the reach of many countries, even with assista...
Source: LANCET - November 10, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Eliminating viral hepatitis: time to match visions with action
Viral hepatitis caused an estimated 1 ·4 million deaths in 2015—similar to tuberculosis and more than either HIV or malaria, yet historically these diseases have received insufficient attention from donors and policy makers. In May, 2016, the World Health Assembly adopted the Global Health Sector Strategy on Viral Hepatitis, 2016–2 0, which aims to eliminate viral hepatitis as a major public health threat by 2030. The strategy set global targets to reduce new viral hepatitis infections by 90% and to reduce deaths due to viral hepatitis by 65%, focusing mainly on hepatitis B virus (HBV) and hepatitis C vi...
Source: LANCET - November 10, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial
Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding. (Source: LANCET)
Source: LANCET - November 10, 2017 Category: General Medicine Authors: Sonia S Anand, Jackie Bosch, John W Eikelboom, Stuart J Connolly, Rafael Diaz, Peter Widimsky, Victor Aboyans, Marco Alings, Ajay K Kakkar, Katalin Keltai, Aldo P Maggioni, Basil S Lewis, Stefan St örk, Jun Zhu, Patricio Lopez-Jaramillo, Martin O'Donnell Tags: Articles Source Type: research

[Articles] Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial
In patients with stable coronary artery disease, addition of rivaroxaban to aspirin lowered major vascular events, but increased major bleeding. There was no significant increase in intracranial bleeding or other critical organ bleeding. There was also a significant net benefit in favour of rivaroxaban plus aspirin and deaths were reduced by 23%. Thus, addition of rivaroxaban to aspirin has the potential to substantially reduce morbidity and mortality from coronary artery disease worldwide. (Source: LANCET)
Source: LANCET - November 10, 2017 Category: General Medicine Authors: Stuart J Connolly, John W Eikelboom, Jackie Bosch, Gilles Dagenais, Leanne Dyal, Fernando Lanas, Kaj Metsarinne, Martin O'Donnell, Anthony L Dans, Jong-Won Ha, Alexandr N Parkhomenko, Alvaro A Avezum, Eva Lonn, Liu Lisheng, Christian Torp-Pedersen, Petr W Tags: Articles Source Type: research

[Comment] Antithrombotic therapy in peripheral artery disease
Peripheral artery disease is a systemic atherothrombotic disease in which plaque builds up in the arteries that carry blood to the limbs. If severe enough, impaired blood flow can cause critical limb ischaemia, which presents as resting pain, ulceration, or gangrene, and might require a limb amputation in the most extreme cases.1 People with peripheral artery disease often have plaque in other arterial beds, and thus are at increased risk for myocardial infarction, ischaemic stroke, and cardiovascular death. (Source: LANCET)
Source: LANCET - November 10, 2017 Category: General Medicine Authors: Jeffrey S Berger Tags: Comment Source Type: research

[Comment] Secondary prevention shifts into second gear
Aspirin has been a mainstay in the secondary prevention of cardiovascular events since the 1990s.1 In the mid-1990s, the antiplatelet clopidogrel was tested against aspirin in patients with atherosclerotic vascular disease and was found to reduce vascular death, ischaemic stroke, and myocardial infarction by 8 ·7%.2 The combination of clopidogrel and aspirin for secondary prevention to reduce cardiovascular events was tested in patients with symptomatic atherothrombosis; however, no benefit was observed. (Source: LANCET)
Source: LANCET - November 10, 2017 Category: General Medicine Authors: E Magnus Ohman Tags: Comment Source Type: research

[Articles] Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial
Among post-menopausal women with severe osteoporosis, the risk of new vertebral and clinical fractures is significantly lower in patients receiving teriparatide than in those receiving risedronate. (Source: LANCET)
Source: LANCET - November 9, 2017 Category: General Medicine Authors: David L Kendler, Fernando Marin, Cristiano A F Zerbini, Luis A Russo, Susan L Greenspan, Vit Zikan, Alicia Bagur, Jorge Malouf-Sierra, P éter Lakatos, Astrid Fahrleitner-Pammer, Eric Lespessailles, Salvatore Minisola, Jean Jacques Body, Piet Geusens, Rü Tags: Articles Source Type: research

[Comment] Prevention of fractures in patients with osteoporosis
Patients with osteoporosis who have previously had fragility fractures have the highest risk of recurrent fractures, and 10 –20% of those with recent fractures will re-fracture within just 2 years.1 Yet most patients who have had fractures are untreated and those who are tend to be treated conservatively, namely with an oral bisphosphonate.2 Antiresorptive drugs, such as bisphosphonates and denosumab, and bone-forming agents, such as teriparatide, both increase bone mineral mass and reduce fragility fractures in patients with osteoporosis. (Source: LANCET)
Source: LANCET - November 9, 2017 Category: General Medicine Authors: Serge Livio Ferrari Tags: Comment Source Type: research

[Department of Error] Department of Error
Kande Betu Ku Mesu V, Mutombo Kalonji W, Bardonneau C, et al. Oral fexinidazole for late-stage African Trypanosoma brucei gambiense trypanosomiasis: a pivotal multicentre, randomised, non-inferiority trial. Lancet 2017; published online Nov 4, 2017. http://dx.doi.org/10.1016/S0140-6736(17)32758-7 —In this Article, the route of administration of nifurtimox eflornithine combination therapy was corrected in the Background section in the Summary. This has been corrected as of Nov 9, 2017. (Source: LANCET)
Source: LANCET - November 9, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Department of Error] Department of Error
Kingston A, Wohland P, Wittenberg R, et al. Is late-life dependency increasing or not? A comparison of the Cognitive Function and Ageing Studies (CFAS). Lancet 2017; 390: 1676 –84—In this Article (published online first on Aug 15, 2017), in the last sentence of the Methods paragraph within the Summary, the population projections should be for the UK and not for England, and should read as “…the proportions in each dependency state (by age group and sex) were appli ed to the 2014 UK population projections”. (Source: LANCET)
Source: LANCET - November 9, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Articles] Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)
In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition. (Source: LANCET)
Source: LANCET - November 8, 2017 Category: General Medicine Authors: Jean Reignier, Julie Boisram é-Helms, Laurent Brisard, Jean-Baptiste Lascarrou, Ali Ait Hssain, Nadia Anguel, Laurent Argaud, Karim Asehnoune, Pierre Asfar, Frédéric Bellec, Vlad Botoc, Anne Bretagnol, Hoang-Nam Bui, Emmanuel Canet, Daniel Da Silva, Mi Tags: Articles Source Type: research

[Comment] Nutrition in the ICU: sometimes route does matter
The NUTRIREA-2 trial by Jean Reignier and colleagues1 in The Lancet provides an important piece in the puzzle of intensive-care unit (ICU) nutrition management. This pragmatic multicentre study done at 44 French ICUs randomly assigned patients aged 18 years or older requiring invasive mechanical ventilation and vasopressors (median 0 ·5 μg/kg per min) to receive either enteral nutrition (n=1202) or parenteral nutrition (n=1208), both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation or ICU admission. (Source: LANCET)
Source: LANCET - November 8, 2017 Category: General Medicine Authors: Lisa Van Dyck, Michael P Casaer Tags: Comment Source Type: research

[Department of Error] Department of Error
Landrigan PJ, Fuller R, Acosta NJR, et al. The Lancet Commission on pollution and health. Lancet 2018; 391: 463 –512—In this Commission (published online first on Oct 19, 2017), the y-axis of figure 11 was “Estimated global DALYs” but did not include the multiplier “(millions)”. This correction has been made to the online version as of Nov 7, 2017, and the printed Commission is correct. (Source: LANCET)
Source: LANCET - November 7, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Articles] Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40  138 bleeding patients
Death from bleeding occurs soon after onset and even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately. Further research is needed to deepen our understanding of the mechanism of action of tranexamic acid. (Source: LANCET)
Source: LANCET - November 7, 2017 Category: General Medicine Authors: Ang èle Gayet-Ageron, David Prieto-Merino, Katharine Ker, Haleema Shakur, François-Xavier Ageron, Ian Roberts, Antifibrinolytic Trials Collaboration Tags: Articles Source Type: research

[Comment] Tranexamic acid: is it about time?
For decades, the antifibrinolytic drug tranexamic acid has been used for indications such as dental extractions in patients with haemophilia. Additionally, tranexamic acid has been widely used, although not routinely across the world, to reduce blood loss in surgery. More recently, the potential of tranexamic acid in trauma and post-partum haemorrhage has been of interest.1 In two large, randomised controlled trials, CRASH-22 and WOMAN,3 tranexamic acid reduced mortality from bleeding in patients with these conditions. (Source: LANCET)
Source: LANCET - November 7, 2017 Category: General Medicine Authors: David J Dries Tags: Comment Source Type: research

[Review] Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition
Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. (Source: LANCET)
Source: LANCET - November 4, 2017 Category: General Medicine Authors: Dorairaj Prabhakaran, Shuchi Anand, David Watkins, Thomas Gaziano, Yangfeng Wu, Jean Claude Mbanya, Rachel Nugent, Disease Control Priorities-3 Cardiovascular, Respiratory, and Related Disorders Author Group Tags: Review Source Type: research

[Articles] Oral fexinidazole for late-stage African Trypanosoma brucei gambiense trypanosomiasis: a pivotal multicentre, randomised, non-inferiority trial
Our findings show that oral fexinidazole is effective and safe for the treatment of T b gambiense infection compared with nifurtimox eflornithine combination therapy in late-stage HAT patients. Fexinidazole could be a key asset in the elimination of this fatal neglected disease. (Source: LANCET)
Source: LANCET - November 4, 2017 Category: General Medicine Authors: Victor Kande Betu Ku Mesu, Wilfried Mutombo Kalonji, Cl élia Bardonneau, Olaf Valverde Mordt, Séverine Blesson, François Simon, Sophie Delhomme, Sonja Bernhard, Willy Kuziena, Jean-Pierre Fina Lubaki, Steven Lumeya Vuvu, Pathou Nganzobo Ngima, Hélène Tags: Articles Source Type: research

[Articles] Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial
In patients with infected necrotising pancreatitis, the endoscopic step-up approach was not superior to the surgical step-up approach in reducing major complications or death. The rate of pancreatic fistulas and length of hospital stay were lower in the endoscopy group. The outcome of this trial will probably result in a shift to the endoscopic step-up approach as treatment preference. (Source: LANCET)
Source: LANCET - November 4, 2017 Category: General Medicine Authors: Sandra van Brunschot, Janneke van Grinsven, Hjalmar C van Santvoort, Olaf J Bakker, Marc G Besselink, Marja A Boermeester, Thomas L Bollen, Koop Bosscha, Stefan A Bouwense, Marco J Bruno, Vincent C Cappendijk, Esther C Consten, Cornelis H Dejong, Casper H Tags: Articles Source Type: research

[Comment] Surgery versus endoscopy for patients with infected pancreatic necrosis
Acute pancreatitis remains a commonly encountered clinical entity. The most florid form of the disease is seen when pancreatic necrosis develops and when this necrotic pancreatic tissue becomes infected. Bacterial or fungal infections in this space can result in severe morbidity and in mortality.1 Historically, patients with infected pancreatic necrosis were treated via open surgical debridement —a highly invasive and risky procedure in already compromised individuals—and multiple trips to the operating room for subsequent debridement were not unheard of. (Source: LANCET)
Source: LANCET - November 4, 2017 Category: General Medicine Authors: Douglas G Adler Tags: Comment Source Type: research

[Case Report] Recurrent ascites: a need to evaluate for hereditary angio-oedema
A 34-year-old housewife, in the 15th week of her first pregnancy, was referred to the Romanian Hereditary Angioedema Centre in January, 2015, because she was worried about potential risks to her pregnancy from symptoms she had had for the past 20 years. At age 14 years she began experiencing recurrent swelling of her limbs that would resolve spontaneously after 2 –3 days. Over the next few years she started to develop genital and then recurrent facial swelling, each episode lasting 3–4 days. One episode of facial oedema was accompanied by swallowing and breathing difficulties. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Gabriella G ábos, Daniela Dobru, Enikő Mihály, Noémi Bara, Cătălin Dumitrache, Ramona Popa, Valentin Nădășan, Dumitru Moldovan Tags: Case Report Source Type: research

[Correspondence] Stillbirth caused by syphilis remains a major global health problem
We read with interest the Seminar by Edward W Hook 3rd (April 15, p 1550),1 but were disappointed that the major public health importance of mother-to-child transmission of syphilis was not mentioned. According to WHO estimates, syphilis caused 350  000 adverse pregnancy outcomes in 2012,2 and The Lancet Series3 on ending preventable stillbirths highlighted that syphilis causes 200 000 stillbirths annually. These adverse outcomes can be prevented with a single dose of penicillin,4 which is one of the most cost-effective health intervention s available. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: David Mabey, Michael Marks, Rosanna Peeling, Joy Lawn Tags: Correspondence Source Type: research

[Correspondence] Syphilis in children
The Seminar on syphilis by Edward W Hook 3rd (April 15, p 1550)1 is interesting; however, it does not adequately address the disease characteristics and management in children and therefore should rather have been entitled “syphilis in adults”. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Ulrich Heininger Tags: Correspondence Source Type: research

[Correspondence] Diet, atherosclerosis, and helmintic infection in Tsimane – Authors' reply
We thank Robert H Howland, and Erin E Masterson and colleagues for their interest in our Article1 that reported low levels of coronary artery calcium among Tsimane horticulturalists of the Bolivian Amazon. In the Article,1 we hypothesised that, despite a high inflammatory burden, low coronary artery calcium in the Tsimane population could be due to a combination of low lifetime blood lipids, largely traditional diets, and high physical activity. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Hillard Kaplan, Benjamin C Trumble, Jonathan Stieglitz, Jagat Narula, Michael Gurven, Gregory S Thomas Tags: Correspondence Source Type: research

[Correspondence] Diet, atherosclerosis, and helmintic infection in Tsimane
We examined the Tsimane population at the same time as Hillard Kaplan and colleagues.1,2 We disagree with the authors' description of the Tsimane diet as consisting mostly of non-processed carbohydrates, high amounts of fibre, and very low amounts of simple sugars, as stated in their Article.1 (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Erin E Masterson, William R Leonard, Philippe P Hujoel Tags: Correspondence Source Type: research

[Correspondence] Diet, atherosclerosis, and helmintic infection in Tsimane
In The Lancet, Hillard Kaplan and colleagues (March 17, p 1730)1 noted that more than two-thirds of Tsimane adults suffer from intestinal helminths. Despite such a high inflammatory burden, the authors found a very low prevalence of coronary atherosclerosis, as measured by coronary artery calcium. Preclinical and clinical studies show that inflammation is involved in the pathogenesis of atherosclerosis and reductions in inflammatory processes could result in cardiovascular benefits. Furthermore, autoimmune diseases are associated with an increased cardiovascular risk and a worse outcome following cardiovascular events. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Robert H Howland Tags: Correspondence Source Type: research

[Correspondence] Extending survival for people with hepatitis C using tobacco dependence treatment
The availability of direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) has led WHO to advocate for the elimination of HCV. However, a 2017 Cochrane review1 suggests that DAA treatment might not improve morbidity and mortality in people living with HCV: trials have shown no benefit on these endpoints, despite a sustained virological response. Stefan Wiktor and John Scott (July 8, p 107)2 state that longer term observational data are needed to assess mortality in people receiving DAA treatment for HCV. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Coral Gartner, Alleshia Miller, Billie Bonevski Tags: Correspondence Source Type: research

[Obituary] Per Fugelli
Norwegian general practitioner, professor of social medicine, and icon for his compatriots. Born in Stavanger, Norway, on Dec 7, 1943, he died from cancer on Sept 13, 2017, at his country house in J æren, Norway, aged 73 years. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Barbara Casassus Tags: Obituary Source Type: research

[Perspectives] The CRASH-2 randomised controlled trial: a retrospective
Trauma with subsequent death from exsanguination is a global killer. As most deaths from haemorrhage occur in the first few hours after injury, the need to treat patients as soon as possible is imperative. With more than 90% of trauma deaths occurring in low and middle-income countries, it is clear that even a moderate decrease in these high death rates could have an important impact on global health outcomes. This line of thought underpinned the work of the CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) randomised controlled trial (RCT), undertaken by the Clinical Trials Unit at the Lon...
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Conrad Keating Tags: Perspectives Source Type: research

[Perspectives] Inspiration
Recently married Robin (Andrew Garfield) and Diana (Clare Foy) Cavendish lead charmed lives. Robin imports tea from Kenya, and both enjoy the trappings of a 1950s' colonial lifestyle. There are weekend safaris with chums and tea and tennis at the British ambassador's. Then, suddenly, Robin is taken seriously ill with polio. This leaves him tetraplegic and unable even to breathe for himself. It is, as Robin puts it, “a bit of a bugger”. Breathe is a relentlessly cheerful film about how Robin and his family don't accept that tragedy necessarily follows this disaster. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Stephen Ginn Tags: Perspectives Source Type: research

[World Report] Health commissioners under the Trump administration
City health commissioners look to the federal government for support, but increasingly feel they are working at cross purposes. Ted Alcorn reports. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Ted Alcorn Tags: World Report Source Type: research

[Comment] Offline: Medicine and Marx
When President Xi Jinping addressed the 19th National Congress of the Communist Party of China last month, he spoke of “the scientific truth of Marxism-Leninism”. Marxism (with Chinese characteristics), as President Xi went on to set out, is to be the foundation for a Healthy China. Who would dare today in the West to praise Karl Marx as the saviour of our wellbeing? Marx is long dead. He died physically on Marc h 14, 1883. He died metaphysically in 1991, as the Soviet Union ebbed away into a newly independent Russian state. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Introducing a history of key trials in The Lancet
The introduction of randomised controlled trials (RCTs) by the UK Medical Research Council (MRC) in the 1940s constitutes one of the most important experimental advances in modern medicine.1 Through the examination of the efficacy —or otherwise—of drugs and other interventions, RCTs have become the essential scientific arbiter through which treatments are translated from the laboratory to the clinic. Meanwhile, the fundamental methods that underpin the RCT—quantitative thought and the basic principles of randomisation, replication, and unbiased observation—have led to improvements in health care and...
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Conrad Keating Tags: Comment Source Type: research

[Comment] A call for planetary health case studies
Planetary health investigates the human health impacts resulting from anthropogenic disruptions in the structure and function of earth's natural systems.1,2 The Planetary Health Alliance and The Lancet invite researchers, educators, and decision makers to submit real-world examples of planetary health in action for further development into case studies. We seek examples that show how human disruptions of natural systems (eg, the climate system, specific ecosystems, not solely unaltered ecosystems) can lead to increased burden of disease and show how a better understanding of these connections can lead to interventions or p...
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Sara B Stone, Amalia A Almada, Samuel S Myers Tags: Comment Source Type: research

[Comment] Indigenous health data and the path to healing
The health disadvantages of Indigenous peoples around the world have their roots in colonisation and discrimination and are related to a loss of autonomy over lands and culture. This history has profoundly affected social determinants of health, such as poverty and marginalisation, and contributed to higher rates of communicable and non-communicable diseases in Indigenous people, and life expectancies that are typically 5 years or more lower than in non-Indigenous populations.1,2 Despite persistent health inequities, Indigenous peoples are determining the path to healing their communities. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: Jennifer Walker, Ray Lovett, Tahu Kukutai, Carmen Jones, David Henry Tags: Comment Source Type: research

[Editorial] Counting down to climate change
Climate change is commonly discussed in the context of its future impact, but the Lancet Countdown on health and climate change by Nick Watts and colleagues, published on Oct 30, exposes the urgency for a response as environmental changes cause damaging effects on health worldwide now. The comprehensive Review describes the first results of a global initiative, which will annually report on indicators of climate change and its effects on health. One alarming finding is how rising temperatures have influenced the transmission of infectious diseases. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] The opioid crisis in the USA: a public health emergency
On Oct 26, President Donald Trump called for the ongoing opioid epidemic to be declared a nationwide public-health emergency. Despite this grandiose call to action, the President fell short of allocating increased federal funding to fight the crisis. (Source: LANCET)
Source: LANCET - November 3, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Improving mental health in the workplace
In 1700, Italian physician Bernardino Ramazzini penned De Morbis Artificum Diatriba (Diseases of Workers), the first medical text to describe the ways environmental conditions or hazards associated with various livelihoods could present risks for health. Famously, Ramazzini is cited for encouraging physicians to extend the Hippocratic inquiry of patients to include: “What is your occupation?” Although workers' experiences in the modern world are very different from those in the 17th century, occupational medicine is built on the same fundamental ideals—preventing and treating job-related injury and illnes...
Source: LANCET - November 3, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial
In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy. (Source: LANCET)
Source: LANCET - November 2, 2017 Category: General Medicine Authors: Rasha Al-Lamee, David Thompson, Hakim-Moulay Dehbi, Sayan Sen, Kare Tang, John Davies, Thomas Keeble, Michael Mielewczik, Raffi Kaprielian, Iqbal S Malik, Sukhjinder S Nijjer, Ricardo Petraco, Christopher Cook, Yousif Ahmad, James Howard, Christopher Bake Tags: Articles Source Type: research

[Comment] Last nail in the coffin for PCI in stable angina?
Interventional cardiology began in Switzerland in 1977, when Andreas Gruentzig performed the first successful percutaneous transluminal coronary angioplasty (PTCA) on a 38-year-old man with angina and a focal proximal stenosis of the left anterior descending coronary artery. Despite numerous subsequent randomised trials and meta-analyses of these trials, which have shown no reduction in death or myocardial infarction,1 the use of percutaneous coronary intervention (PCI) has grown exponentially. Some of this growth was driven by data from clinical trials suggesting that PCI was more effective in relieving angina than medica...
Source: LANCET - November 2, 2017 Category: General Medicine Authors: David L Brown, Rita F Redberg Tags: Comment Source Type: research

[Comment] Ireland's Public Health Bill: crucial to reduce alcohol harm
Ireland has become the fourth heaviest drinking nation in the Organisation for Economic Co-operation and Development in terms of quantity of alcohol consumed,1 and ranked joint third for binge drinking in an analysis of 194 nations by WHO.2 Irish adults consume on average 11 ·5 L of pure alcohol per person every year, an increase of more than 100% compared with 60 years ago.3 Most alcohol in Ireland is now consumed at home and alcohol retailing off licences have increased by five-fold since 1990. (Source: LANCET)
Source: LANCET - November 2, 2017 Category: General Medicine Authors: Frank Murray Tags: Comment Source Type: research

[Articles] Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial
Among elderly patients who have PCI, a DES and a short duration of DAPT are better than BMS and a similar duration of DAPT with respect to the occurrence of all-cause mortality, myocardial infarction, stroke, and ischaemia-driven target lesion revascularisation. A strategy of combination of a DES to reduce the risk of subsequent repeat revascularisations with a short BMS-like DAPT regimen to reduce the risk of bleeding event is an attractive option for elderly patients who have PCI. (Source: LANCET)
Source: LANCET - November 1, 2017 Category: General Medicine Authors: Olivier Varenne, St éphane Cook, Georgios Sideris, Sasko Kedev, Thomas Cuisset, Didier Carrié, Thomas Hovasse, Philippe Garot, Rami El Mahmoud, Christian Spaulding, Gérard Helft, José F Diaz Fernandez, Salvatore Brugaletta, Eduardo Pinar-Bermudez, Jos Tags: Articles Source Type: research

[Comment] A SENIOR moment? Bare-metal stents in elderly patients
The WHO International Day of Older Persons1 was on Oct 1, 2017, and saw the release of guidelines on integrated care and equality of care for older people. Now, 40 years since the first percutaneous coronary intervention (PCI),2 we still do not know the optimal revascularisation strategy in elderly patients. Interventionalists face two important questions when considering PCI in elderly patients. First, should drug-eluting stents (DES) be mandated in elderly patients since they tend to have greater numbers of complex coronary lesions with calcification, tortuosity, and bifurcations than do younger patients3 and DES have be...
Source: LANCET - November 1, 2017 Category: General Medicine Authors: Robert T Gerber, Anthony H Gershlick Tags: Comment Source Type: research

[Articles] Effect of tight control management on Crohn's disease (CALM): a multicentre, randomised, controlled phase 3 trial
CALM is the first study to show that timely escalation with an anti-tumour necrosis factor therapy on the basis of clinical symptoms combined with biomarkers in patients with early Crohn's disease results in better clinical and endoscopic outcomes than symptom-driven decisions alone. Future studies should assess the effects of such a strategy on long-term outcomes such as bowel damage, surgeries, hospital admissions, and disability. (Source: LANCET)
Source: LANCET - October 31, 2017 Category: General Medicine Authors: Jean-Frederic Colombel, Remo Panaccione, Peter Bossuyt, Milan Lukas, Filip Baert, Tomas Va ňásek, Ahmet Danalioglu, Gottfried Novacek, Alessandro Armuzzi, Xavier Hébuterne, Simon Travis, Silvio Danese, Walter Reinisch, William J Sandborn, Paul Rutgeert Tags: Articles Source Type: research

[Comment] Targeting Crohn's disease
There are many similarities between Crohn's disease and rheumatoid arthritis, such as in pathogenesis; in disconnect between symptoms, biological inflammatory activity, and structural damage; and in effective therapies (such as corticosteroids, conventional immunomodulators, and inhibitors of tumour necrosis factor). However, one area of divergence is the concept of disease modification in rheumatoid arthritis by cessation or stabilisation of structural damage to joints, which is assessed by simple x-rays of hands and calculation of joint space narrowing and erosions as a so-called “sharp score”. (Source: LANCET)
Source: LANCET - October 31, 2017 Category: General Medicine Authors: Stephen B Hanauer Tags: Comment Source Type: research