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[Correspondence] Trans people and the myth of homogeneous societies
In their Comment, Arjee Restar and Sari Reisner (Oct 28, 2017, p 1933)1 briefly hint at the diversity in health risk within the transgender (trans) community but then fail to take their recommendations further. For example, among the 60 million refugees worldwide, trans people are particularly at risk of violence and discrimination.2 Yet discrimination based on gender identity and migration status are usually treated separately, as the Comment's omission illustrates.1 Many trans people experience discrimination on multiple grounds, such as refugee status, socioeconomic position, age, and physical and cognative ability, in ...
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Oliver Razum, Yudit Namer Tags: Correspondence Source Type: research

[Correspondence] Challenges of measuring the Healthcare Access and Quality Index – Authors' reply
Estimating national levels of personal health-care access and quality can inform the understanding of settings in which gains in health care can be achieved. Amenable mortality —deaths that should not occur in the presence of high-quality health care—has been used to approximate country-level personal health-care access and quality for decades.1 Drawing from this scientific approach, the Global Burden of Disease (GBD) collaboration developed the Healthcare Access and Q uality (HAQ) Index,2 which aimed to provide a stronger indication of personal health-care quality and access across 195 countries and territorie...
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Christopher J L Murray, Stephen S Lim, Theo Vos, Rafael Lozano, Mohsen Naghavi Tags: Correspondence Source Type: research

[Correspondence] Challenges of measuring the Healthcare Access and Quality Index
We read with interest the article by the Global Burden of Disease (GBD) collaborators on the Healthcare Access and Quality (HAQ) Index.1 However, we believe the scaled indicator on measles amenable mortality should be interpreted with caution. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Cheng-Yi Lee, Jiunn-Shyan Wu, Ding-Ping Liu Tags: Correspondence Source Type: research

[Correspondence] Challenges of measuring the Healthcare Access and Quality Index
We read with interest the GBD 2015 Healthcare Access and Quality study (July 15, 2017, p 231),1 which constructed the Healthcare Access and Quality (HAQ) Index on the basis of risk-standardised cause-specific death rates to facilitate comparisons of personal health-care access and quality for 195 countries and territories from 1990 to 2015. However, we would like to contest some of the findings on the HAQ Index related to chronic kidney disease (CKD). (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Chia-Chao Wu, Shang-Jyh Hwang, Chih-Cheng Hsu, Kuo-Cheng Lu, Taiwan Society of Nephrology Tags: Correspondence Source Type: research

[Correspondence] Influenza vaccination and prevention of cardiovascular disease mortality – Authors' reply
We thank Daniel Caldeira, Joaquim J Ferreira, and Jo ão Costa for highlighting the effect of influenza infection on underlying cardiovascular disease and the role of influenza vaccination in potentially mitigating this risk. Although we briefly mentioned that influenza infection could exacerbate underlying cardiovascular disease in our Seminar,1 we w ere unable to fully expand on this point because of word-count restrictions. In this regard, an epidemiological link between influenza and excess deaths associated with cardiovascular disease was suggested as early as in the 1930s. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Catharine I Paules, Kanta Subbarao Tags: Correspondence Source Type: research

[Correspondence] Influenza vaccination and prevention of cardiovascular disease mortality
Catharine Paules and Kanta Subbarao presented in their Seminar (Aug 12, 2017, p 697) the clinical features, therapeutic options, and controversies regarding treatment and prevention of seasonal influenza infection.1 Although they acknowledged that influenza can impair different organ systems, little attention was given to cardiovascular consequences. Ischaemic heart disease is the leading cause of death worldwide and influenza vaccination could reduce cardiovascular mortality, particularly in patients with coronary heart disease for whom cardiovascular mortality risk has been reported to be halved by influenza vaccination. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Daniel Caldeira, Joaquim J Ferreira, Jo ão Costa Tags: Correspondence Source Type: research

[Correspondence] The growing problem of loneliness
Imagine a condition that makes a person irritable, depressed, and self-centred, and is associated with a 26% increase in the risk of premature mortality. Imagine too that in industrialised countries around a third of people are affected by this condition, with one person in 12 affected severely, and that these proportions are increasing. Income, education, sex, and ethnicity are not protective, and the condition is contagious. The effects of the condition are not attributable to some peculiarity of the character of a subset of individuals, they are a result of the condition affecting ordinary people. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: John T Cacioppo, Stephanie Cacioppo Tags: Correspondence Source Type: research

[Correspondence] Can the scientific world positively influence decision makers on planetary health?
The 2017 G7 Health Ministerial Meeting was on Nov 5 –6, in Milan, Italy, and for the first time the effect of climate and environmental factors on health was addressed in the agenda of the meeting. As reported in the final Health Ministers communiquè after the meeting (signed by all seven countries),1 the delegation agreed to identify and promote some fundamental adaptation actions. In addition to the novelty of these subjects being in the agenda and in the final meeting documents, we believe the process that led to these outcomes is innovative and interesting. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Stefano Campostrini, Ranieri Guerra Tags: Correspondence Source Type: research

[Obituary] Fotis Kafatos
Biologist, science administrator, and founding President of the European Research Council. He was born in Heraklion, Crete, Greece, on April 16, 1940, and died there on Nov 18, 2017, aged 77 years. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] The burning light
“In our life there is a single colour, as on an artist's palette, which provides the meaning of life and art. It is the colour of love”, artist Marc Chagall wrote. While these words encapsulate the strong emotional undercurrent that characterises the work of the Belorussian artist, they also per fectly describe the profound love between Chagall and his first wife Bella, whom he portrayed in many of his canvasses, often flying with him above the roofs of their hometown. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Marco De Ambrogi Tags: Perspectives Source Type: research

[Perspectives] The medical suffragettes
In January, 1918, the women staff of Endell Street Military Hospital in central London, UK, forgot their ward duties for a few hours as they sang and danced in celebration. That evening the women doctors, nurses, and orderlies donned costumes for a fancy dress party, had a sumptuous dinner, and toasted the Queen before marching through the hospital in a grand procession. It was 10 months before the end of World War 1 —and victory for the Allies still hung in the balance—yet the women were intent on celebrating. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Wendy Moore Tags: Perspectives Source Type: research

[Perspectives] Superbugs and us
These days you would have to be peculiarly immune to public health messaging not to know that the world is on the brink of an antibiotic apocalypse. From the back of pill packets to the panels on the back of buses, prompts urging us to “keep antibiotics working” are almost as ubiquitous as the drug-resistant microbes themselves. Although medical experts have been warning about the indiscriminate use of antibiotics since the 1940s, their consumption continues to grow. This is not only a problem in countries like South Africa an d India where antibiotics are widely available over the counter. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Mark Honigsbaum Tags: Perspectives Source Type: research

[Perspectives] Virtual care for improved global health
Global access to health care is far from adequate, with health disparities widening; the rise of economic inequities and shortages in the health workforce are contributors. This is especially true for people who live in rural areas in low-income countries without access to essential health services. Yet digital infrastructure and technologies exist that could allow virtual and rapid provision of health care for many health conditions, for almost everyone, at any time, irrespective of their location. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Steven R Steinhubl, Kwang-il Kim, Toluwalase Ajayi, Eric J Topol Tags: Perspectives Source Type: research

[World Report] A new paradigm for the MRC Units in The Gambia and Uganda
Two major medical research institutions in sub-Saharan Africa came under the purview of the London School of Hygiene& Tropical Medicine (LSHTM). The Medical Research Council (MRC) Unit The Gambia and the MRC/Uganda Virus Research Institute (UVRI) Uganda Research Unit transferred to LSHTM from their current positions under the MRC at the beginning of February. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Andrew Green Tags: World Report Source Type: research

[World Report] Developing countries in the digital revolution
A multidisciplinary commission was launched to question what role developing countries can and should have in the rapidly changing technological landscape. Talha Burki reports. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Talha Burki Tags: World Report Source Type: research

[World Report] Prospects for dementia research
After Pfizer's withdrawal from the market, some predicted a mass exodus of pharmaceutical companies' interests in Alzheimer's disease drug research. Geoff Watts reports. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Geoff Watts Tags: World Report Source Type: research

[World Report] FGM in Sierra Leone
Three years after a 2014 ban against the practice of female genital mutilation in Sierra Leone, Sharmila Devi reports on the progress towards its eradication. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Sharmila Devi Tags: World Report Source Type: research

[Comment] Offline: Adolescent health —vulnerable and under threat
There is no other group in society more emblematic of the Anthropocene than the adolescent —defined as a person between the ages of 10 and 24 years. The irreversible harm we are inflicting on our planet today will hurt the lives of young people most of all. During the past decade, one of the most remarkable achievements in global health has been the emergence of a new movement for adole scent health. When Ban Ki-moon's signature Every Woman Every Child initiative was launched in 2010, the young person was absent. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] The global fight against cancer: challenges and opportunities
By 2030, the number of cancer cases is projected to increase to 24 ·6 million and the number of cancer deaths to 13 million.1 Worldwide, health systems, especially in low-income and middle-income countries (LMICs), are ill prepared to manage the increasing cancer burden.2 Globally, there is a shortfall in coverage of cancer services for prevention, screening, trea tment, and palliative care.3–5 If cost-effective interventions for cancer screening, prevention, and treatment were delivered through strengthened health systems, they could help largely avoid many premature deaths, unnecessary suffering, and unaccep...
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Rifat Atun, Franco Cavalli Tags: Comment Source Type: research

[Comment] Should basic science matter to clinicians?
We have observed declining interest in discovery science by our medical colleagues. Across a range of top medical journals, the number of basic science articles decreased by 40 –60% from 1994 to 2013,1 while a major North American university recorded a 60% decrease in clinician-investigator trainees pursuing basic science training between 1987 and 2016.2 The decline of basic science research in the medical literature and a disregard for it in continuing education program mes3 are allowing mastery of science to be lost by practising clinicians. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Niall C Filewod, Jane Batt, Andras Kapus, Katalin Szaszi, Gregory D Fairn, Arthur S Slutsky, Warren L Lee Tags: Comment Source Type: research

[Editorial] Editing the human genome: balancing safety and regulation
The international race to bring human genome editing into widespread use in clinical medicine is moving fast. On Jan 23, the National Institutes of Health Common Fund launched its Somatic Cell Genome Editing programme, committing approximately US$190 million of funding over the next 6 years to propel development of genome editing into medical practice. A worthy effort, but the USA and Europe still trail behind China. As many as 86 patients in China have already had their genes altered as part of clinical trials to treat a range of diseases, including solid cancers. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Yellow fever: a major threat to public health
The world's largest fractional-dose vaccination campaign for yellow fever started on Jan 25 in Brazil, with the support of WHO. The campaign attempts to avoid the urban transmission cycle, not seen in the country since 1942. 33 people have died due to yellow fever between Jan 14 and 23, while the number of confirmed cases in the country has reached more than 130. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Changing culture to end FGM
When Ellen Johnson Sirleaf retired last month after 12 years in office in Liberia, she signed an executive order banning female genital mutilation (FGM) in the country for girls younger than 18 years. Her profile as Africa's first female president and a recipient of the Nobel Peace Prize for efforts to advance women's rights and peace ensured her executive order got international media attention, thus shining needed light on a devastating practice. Globally, a staggering 200 million women and girls have undergone FGM, and UNICEF estimates that more than one in three girls between 15 and 19 years of age are currently affected. (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Correspondence] Turkish Medical Association central council detained for demanding peace
On Jan 24, 2018, the central council of the Turkish Medical Association (TTB) issued a short statement to express its opinion against the ongoing military operations by the Turkish army in northern Syria and to call for an end to the war by demanding peace.1 In its short announcement, TTB underscored the validity of its professional oath and duty to defend human lives.1 (Source: LANCET)
Source: LANCET - February 2, 2018 Category: General Medicine Authors: Caghan Kizil Tags: Correspondence Source Type: research

[Department of Error] Department of Error
Robinson L. Successful ageing. Lancet 2018; 391: 300. In this Perspectives, the surname of the patient in the second and fifth paragraphs should have been Shuler and the book title should have read Enlightened Aging in the third and fifth paragraphs. This correction has been made to the online version as of Feb 8, 2018. (Source: LANCET)
Source: LANCET - January 31, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Department of Error] Department of Error
Sinharay R, Gong J, Barratt B, et al. Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants older than 60 years with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study. Lancet 2017; 391: 339 –49—In this Article (published online first on Dec 5, 2017), the corresponding author has been corrected, the middle initial for Frank Kelly has been added, the role of the funding source has been updated, and author initials have been updated throughout. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Underestimation of the global burden of schistosomiasis – Authors’ reply
Charles King and Alison Galvani cite three specific concerns in their commentary regarding the Global Burden of Disease (GBD) Study1 2016 and we respond briefly to them. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Ellen M Goldberg, David Pigott, Shreya Shirude, Jeffrey Stanaway, Simon I Hay, Theo Vos Tags: Correspondence Source Type: research

[Correspondence] Underestimation of the global burden of schistosomiasis
The Global Burden of Disease (GBD) Study aims to determine the cumulative global disability that is attributable to diverse diseases, the knowledge of which is essential in targeting public health responses, prioritising funding, and guiding research. The 2016 GBD study (Sept 16, 2017, p 1211)1 suggested that, of all 328 diseases considered, schistosomiasis showed the most pronounced reduction in age-standardised years lived with disability (YLD) between 2006 and 2016. Schistosomiasis was ranked in the top ten for YLDs in six sub-Saharan countries but was now reported to account for only 1 ·496 million YLD worldwide...
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Charles H King, Alison P Galvani Tags: Correspondence Source Type: research

[Correspondence] Great expectations – Authors’ reply
Non-ST-segment elevation myocardial infarction (NSTEMI) is associated with relevant mid-term mortality and might be associated with poorer long-term prognosis compared with ST-segment elevation myocardial infarction.1 All-cause mortality is the most objective and clinically meaningful endpoint regarding data quality of randomised controlled trials and patient prognosis. However, as pointed out by Gilles Lemesle and colleagues, all-cause mortality is unlikely to be an appropriate endpoint to power a randomised controlled trial funded by a government agency and investigating the optimal timing of invasive coronary angiograph...
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Alexander Jobs, Steffen Desch, Holger Thiele Tags: Correspondence Source Type: research

[Correspondence] Great expectations
We congratulate Alexander Jobs and colleagues1 (Aug 19, 2017, p 737) for their meta-analysis of trials addressing the optimal timing of an invasive strategy in acute coronary syndromes (ACS), using individual or standardised tabulated data. Their analysis did not support a mortality benefit of an early strategy compared with a delayed strategy. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Gilles Lemesle, Marc Laine, Mathieu Pankert, Etienne Puymirat, Laurent Bonello Tags: Correspondence Source Type: research

[Correspondence] Atezolizumab and bladder cancer: facing a complex disease
Cytotoxic chemotherapy has been the first choice treatment for advanced or metastatic bladder cancer for many years, without substantial insights despite the advent of targeted therapies. Following the enthusiasm for cancer immunotherapy, several trials have investigated checkpoint inhibitors for the treatment of bladder cancer. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Carlo Cattrini, Francesco Boccardo Tags: Correspondence Source Type: research

[Correspondence] The updated Physician's Pledge and Chinese junior physicians
On Oct 14, 2017, a newly revised version of the Physician's Pledge1 was approved by the World Medical Association, including several important amendments that are in accordance with the needs of the modern medical profession. Among the Chinese medical community, additional focus and consideration need to be directed towards the revised Physician's Pledge given that the current occupational environment is not ideal, particularly for junior physicians. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Liming Lu, Menghan Gao, Tian Yang, Xiao Gong Tags: Correspondence Source Type: research

[Obituary] Gian Franco Bottazzo
Researcher on diabetes and autoimmunity. Born in Venice, Italy, on Aug 1, 1946, he died there of bacterial endocarditis on Sept 15, 2017, aged 71 years. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] Successful ageing
Increased longevity in many high-income countries has transformed old age. Life expectancy in the UK continues to increase by 2 years per decade, although recent data reveal this is not the case in more socio-economically deprived areas nationally. Between 1991 and 2011, life expectancy for men in the UK increased from 77 ·9 years to 82·6 years and for women, from 81·5 years to 85·6 years. Unfortunately, these extra years do not seem to be spent in better health, with morbidity and dependency increasing over the past 20 years. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Louise Robinson Tags: Perspectives Source Type: research

[World Report] Senior WHO appointments are praised but raise questions
WHO Director-General Tedros Adhanom is making progress towards his pledge to transform the global body, but some say that this comes at the cost of transparency. John Zarocostas reports. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: John Zarocostas Tags: World Report Source Type: research

[World Report] Mega-crisis in DR Congo
The UN fears the humanitarian crisis in DR Congo will further deteriorate in 2018, putting in jeopardy the lives of over 13 million people. John Zarocostas reports. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: John Zarocostas Tags: World Report Source Type: research

[Comment] Offline: Why we must learn to love economists
George Bernard Shaw once remarked that, “If all economists were laid end to end, they'd never reach a conclusion.” Since the global financial crisis of 2007–08, economists have suffered a sharp loss of intellectual confidence. Some critics have rejoiced. Yet the fact remains that economics is the discipline that orders our world. It s locus of influence is the national Treasury. It is finance ministers who have the most decisive say about a country's priorities. For health advocates, we have two choices. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Editorial] Institutional and coercive mental health treatment in Europe
Images of people incarcerated, unkempt and kept in chains, mocked, and uncared for dominate the history of psychiatry, particularly from the middle ages to the early 20th century. Locked up for years, and forcibly sedated or sterilised, those with mental ill health were subject to inhumane conditions and removed from society, often under the supervision of doctors. What of now? How have things improved for those with mental illnesses? (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Facial injuries
Patients, surgeons, and other health-care professionals met to discuss life after facial injuries at an event on Jan 22 organised by the Royal Society of Medicine and Saving Faces, the facial surgery research foundation. A large proportion of facial injuries result from interpersonal violence, in which the maxillofacial region is frequently targeted. In domestic violence, damage can be very severe due to extreme violence and protracted uninterrupted attacks. In trauma cases, facial injuries are often a sign of extensive injuries and many patients experience associated head injury. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] The health of a president: an unnecessary distraction
The respected New York Times physician-journalist, Lawrence K Altman, often wrote about the personal health of US presidential candidates and other elected leaders in high office. He argued that the medical records of each president should be made publicly available and that the public have a right to know that their president is fit to fulfil the role. Last week, the health of President Donald Trump became the subject of sometimes wild political speculation after the release of his first physical examination results since he took office. (Source: LANCET)
Source: LANCET - January 26, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Comment] Amid US funding cuts, UNRWA appeals for health and dignity of Palestinian refugees
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) faces a major challenge in upholding its mandate and preserving key services such as education and health care for Palestinian refugees. On Jan 16, 2018, the US Government announced a contribution of US$60 million for 2018 so far,1,2 in support of UNRWA's efforts to keep our schools open, health clinics running, and emergency food and cash distribution systems functioning. Although important, this funding is dramatically below past levels. (Source: LANCET)
Source: LANCET - January 22, 2018 Category: General Medicine Authors: Akihiro Seita, Amelia Goldsmith, Majed Hababeh, Yousef Shahin Tags: Comment Source Type: research

[Correspondence] The definition of acute kidney injury – Authors' reply
We thank John A Kellum and Norbert Lameire for their letter in response to our Comment.1 An acute increase in serum creatinine (sCr) is caused by direct injury to kidney cells (ie, pathophysiological processes resulting from ischaemia, sepsis, medications, metals, or enzymes) or a compromise in cardiovascular homoeostasis (ie, substantial volume depletion,2 congestive heart failure,3 or portal hypertension4). Hence, we appreciate that an acute rise in sCr can indicate several pathophysiological processes with worsened patient population outcomes. (Source: LANCET)
Source: LANCET - January 19, 2018 Category: General Medicine Authors: Jonathan Barasch, Richard Zager, Joseph V Bonventre Tags: Correspondence Source Type: research

[Correspondence] The definition of acute kidney injury
We read with interest the Comment in The Lancet by Jon Barasch and colleagues (Feb 25, 2017, p 779)1 with its controversial title “Acute kidney injury: a problem of definition”. We appreciate the opportunity to clarify what is written in the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline on acute kidney injury (AKI),2 in the hope that clinicians will read beyond the headlines. The guideline cl early states that AKI is a clinical diagnosis and stresses the importance of clinical judgment: “While the definitions and classification system discussed in Chapter 2.1 provide a frame...
Source: LANCET - January 19, 2018 Category: General Medicine Authors: John A Kellum, Norbert Lameire Tags: Correspondence Source Type: research

[Correspondence] A public health approach to opioid addiction in North America – Author's reply
I agree with Mohammad Karamouzian and Thomas Kerr that “restricting access to prescription opioids for opioid-naive populations should be included in the primary strategies” in response to the epidemic of opioid overdose and addiction, as discussed in my Comment.1 Karamouzian and Kerr are also correct to note that people currently taking opioids wil l require different clinical and policy strategies. For example, some people with chronic pain conditions will need to remain on their medication indefinitely because the net costs and benefits of doing so are favourable. (Source: LANCET)
Source: LANCET - January 19, 2018 Category: General Medicine Authors: Keith Humphreys Tags: Correspondence Source Type: research

[Correspondence] A public health approach to opioid addiction in North America
Keith Humphreys' Comment in The Lancet (July 29, 2017, p 437)1 describes the main drivers of the opioid crisis in the USA and advocates for global restriction of prescription opioids as an effective public health response to addressing the overdose epidemic. We argue that although the dominant narrative about the opioid crisis circulating around careless prescribing and unscrupulous pharmaceutical companies has some merit, it does not tell the whole story of the epidemic of opioid addiction in North America because it occurs among medical and non-medical opioid users. (Source: LANCET)
Source: LANCET - January 19, 2018 Category: General Medicine Authors: Mohammad Karamouzian, Thomas Kerr Tags: Correspondence Source Type: research

[Correspondence] A new era for medical education in Colombia
During Nov 1 –3, 2017, most of the Deans of Medicine who belong to the Colombian Association of Faculties of Medicine (ASCOFAME)—a nationwide network of higher education institutions or universities with medical faculties—met in Monteria, Colombia. Their objective was to develop a consensus on medical educ ation.1 (Source: LANCET)
Source: LANCET - January 19, 2018 Category: General Medicine Authors: Alfonso J Rodr íguez-Morales, Carlos J González-Colonia, Julio C Gutiérrez-Segura, Eduardo Ramírez-Vallejo, Guillermo J Lagos-Grisales Tags: Correspondence Source Type: research

[Perspectives] Peter Robert Mason
Clinical microbiologist with a commitment to Zimbabwe. Born in Aldridge, UK, on July 9, 1948, he died of prostate cancer in Amsterdam, the Netherlands, on Sept 28, 2017, aged 69 years. (Source: LANCET)
Source: LANCET - January 19, 2018 Category: General Medicine Authors: Geoff Watts Tags: Perspectives Source Type: research

[Perspectives] Health care as a cultural borderland
As a clinician, how do you best care for patients from a wide variety of backgrounds? Cultural diversity is not merely a matter of pluralism or multiculturalism; it is often accompanied by unequal or inadequate health care. Very often, cultural diversity and health disparity go hand in hand. As a response to such inequities, various forms of cultural competence training are now viewed as an essential curriculum component in medical education programmes and a key element of effective practice. However, these educational innovations have also come under fire. (Source: LANCET)
Source: LANCET - January 19, 2018 Category: General Medicine Authors: Cheryl Mattingly Tags: Perspectives Source Type: research

[Perspectives] Encounters with Indian medicine
In 1911, an Indian-born medical doctor called Paira Mall was recruited by Henry Wellcome's Historical Medical Museum in London, UK. Overseen by its curator, C J S Thompson, Mall was sent to collect objects from the south Asian subcontinent; artifacts that would capture the art and science of healing throughout the ages, as well as medicinal plants for Wellcome's chemical research labs in the UK. Mall was well travelled, having served as an army surgeon in the Russo –Japanese War. A linguist and an expert in Asian cultures, he was by then fluent in German, French, Italian, Sanskrit, Persian, Hindi, Punjabi, and Arabic...
Source: LANCET - January 19, 2018 Category: General Medicine Authors: Aarathi Prasad Tags: Perspectives Source Type: research

[Perspectives] Type 1 diabetes
Writing in 1649, the English herbalist Nicholas Culpeper despaired of his patients with diabetes: their “continual pissinge” was resistant to all treatment, and their deaths were rapid and certain. No longer: type 1 diabetes is a striking example of the transformation of the meaning of a diagnosis by application of clinical research. Its history reflects the trajectory of medicine away from heroic interventions and towards long-term treatment, from cure to care. (Source: LANCET)
Source: LANCET - January 19, 2018 Category: General Medicine Authors: Richard Barnett Tags: Perspectives Source Type: research