The Lancet ~ Jan 24, 2009 Volume 373 Number 9660 Pages 271 - 352
by: Elsevier
About The Lancet medical journal History
The Lancet’s prestigious heritage as one of the world’s leading medical journals continues to inspire our authors and editors today as they strive for medical excellence in all that they publish.
When Thomas Wakley founded The Lancet in 1823, he announced “A lancet can be an arched window to let in the light or it can be a sharp surgical instrument to cut out the dross and I intend to use it in both senses”. This philosophy remains at the heart of the journal today.
The Lancet first appeared on Oct 5, 1823. From the beginning, Wakley’s aim was to entertain, instruct, and reform. Instruction came in the form of transcribed medical lectures from the London teaching establishment; entertainment in the early days of the journal came in the form of theatre reviews and piquant political comment. The Lancet has been, first and foremost, a reformist medical newspaper known for its campaigns, for example, our focus on child survival in recent years. Thomas Wakley and his successors aimed to combine publication of the best medical science in the world with a zeal to counter the forces that undermine the values of medicine, be they political, social, or commercial.
The journal was, and remains, independent, without affiliation to a medical or scientific organisation. More than 180 years later, The Lancet is an independent and authoritative voice in global medicine. We seek to publish high-quality clinical trials that will alter medical practice; our commitment to international health ensures that research and analysis from all regions of the world is widely covered. Critical appraisal of research and reviews is ensured by strong Comment and Correspondence sections; The Lancet’s opinion and personality is communicated by three editorials every week; fast dissemination of priority issues is delivered by online first publication through thelancet.com; and the continued success of our monthly specialty titles ensures that The Lancet delivers in-depth knowledge in key medical disciplines Between our first online publication in 1996 and today, 1.8 million users have registered at thelancet.com.
From those few hundred copies in London in 1823, The Lancet’s global reach has extended to the point where today it delivers the latest medical news and clinical research to every country in the world.
Whether clinical specialist or student doctor, all health professionals will find something at The Lancet online medical journals of interest to them. No longer just the printed word either: audio medical content is now an increasingly popular feature of all The Lancet medical journals.
Editorial
271
A dismal year for human rights abuses
The Lancet
The global community still has much work to do in the field of human rights. Such rights stretch from: the right to life and the rights to health, water, and food; to prohibition against torture and inhumane or degrading treatment or punishment; and to crimes against humanity. All these factors are of concern to health professionals, who have to deal with the consequences.
272
Investment in health systems—a priority for health and wealth
The Lancet
The interdependence of health systems, health, and wealth was recognised and accepted by European health ministers at a WHO conference in Tallinn, Estonia, in June, 2008. By signing the Tallinn Charter, health ministers from the 53 nations of WHO’s European region committed their countries to strengthen health systems because they accepted the principle that such investment improves health, boosts economic development in its own right, and leads to social wellbeing. A Viewpoint by Martin McKee and colleagues in this week’s issue discusses the research background to the triangular relationship between health systems, health, and wealth, and outlines the basis for the Charter in more detail.
272
A NICE adaptation
The Lancet
Last week, the UK’s National Institute for Health and Clinical Excellence (NICE) reconsidered its advice on four drugs for renal cell carcinoma, which it last year deemed not cost effective for the National Health Service (NHS). NICE’s decision will be made public in March but many experts expect that the drugs will now be approved because they meet new criteria set by the Institute.
Comment
273
Trade and health: time for the health sector to get involved
Rhona MacDonald, Richard Horton
There is no denying that trade is a political issue. It is perhaps for this reason, and because many health professionals perceive trade as a complex, unrelated, or remote factor in their practice and busy working lives, that the health sector has traditionally avoided getting involved in trade debates. But the fact that trade directly and indirectly affects the health of the global population with an unrivalled reach and depth undoubtedly makes it a key health issue that the global-health community can no longer ignore.
274
Radiotherapy in locally advanced prostate cancer
Alex Tan, Chris Parker
Long-term hormonal therapy has long been regarded as the mainstay of treatment for men with locally advanced prostate cancer.1,2 Four key randomised controlled trials3–6 have shown that early use of hormonal therapy leads to improved overall survival. There has been no consensus about whether or not radical local treatment should be used in addition to hormonal therapy,7,8 and SPCG-7/SFUO-3, reported in The Lancet today,9 is the first randomised trial to address this issue.
276
Clopidogrel in acute coronary syndrome: to genotype or not?
Robert F Storey
ADP has an important role in platelet activation.1 The molecule can be released by damaged cells but a major source is platelet dense granules, from which it is released on platelet activation.2 ADP initiates platelet activation via the P2Y1 receptor, while binding of ADP to the P2Y12 receptor amplifies this response such that sustained ADP-induced platelet aggregation depends on continuing activation of the P2Y12 receptor. P2Y12 also has an important role in amplifying the responses to other agonists—ADP is released from platelet dense granules regardless of the activating stimulus, be that thrombin, collagen, thromboxane A2, or other agonists.
278
Intimate-partner violence and fetal loss
Claudia Garcia-Moreno
Violence against women by their male intimate partners is an important public-health problem worldwide. Such violence is associated with a wide range of negative physical and mental-health outcomes among women, including injuries, unwanted pregnancies, and other sexual and reproductive health problems.1 The violence often continues—and at times starts—during pregnancy, and is negatively associated with maternal and fetal health outcomes, including low birthweight,2 preterm labour,3 smaller gestational weight-gain,4 and reduced levels of breastfeeding.
280
Safeguarding children: a call to action
Albert Aynsley-Green, David Hall
Since Kempe’s description, almost 50 years ago, of the “battered baby”, we have become all too familiar with sexual and emotional abuse of children, neglect, fabricated illness, bullying, and exposure to domestic violence. In many countries the catalogue of abuse and exploitation also includes female genital mutilation, child trafficking and prostitution, sweatshop labour, and coercive enrolment into military service. The Lancet’s Series on child maltreatment describes the progress that has been made in recognising maltreatment and its effects in the short and long term, and in evaluating interventions once abuse has occurred.
281
Reforming China’s health care: for the people, by the people?
Yuanli Liu
On Oct 14, 2008, the Chinese Government published a draft of its Healthcare Reform Plan, to solicit comments from the public.1 Inviting people to participate in the development of public policies is unprecedented in China. The invitation reveals signs of how far the world’s largest developing country has gone and where it might be going, and indicates open-mindedness in the current leadership or at least shows that they want to be perceived as being good listeners.
283
Paper of the year 2008: results
William Summerskill
On Dec 19, The Lancet1 posted the papers of the six finalists for paper of the year 2008 on our website and published Profiles from each research team.2–7 After 25 days of voting, during which 21 556 votes (each from a unique IP address) were cast, three papers have proved clear favourites with readers (panel). Among these, the editors’ choice was Werner Hacke and colleagues’ study of alteplase for ischaemic stroke8 and the people’s choice was the PEACE study of carbocisteine in chronic obstructive pulmonary disease (COPD) by Nan-Shan Zhong and associates.
World Report
285
South Africa heads into elections in a sorry state of health
Clare Kapp
South Africa’s ruling African National Congress has singled out health as one of the top five priorities for the next government. With good reason. Clare Kapp reports from Cape Town.President-in-waiting Jacob Zuma addressed 60 000 adoring supporters at the launch of the African National Congress’ (ANC) election manifesto on Jan 10, vaunting the social progress that has been made since the party came to power. He said that 88% of the population had access to running water, up from 62% in 1996; 12·5 million received social grants, up from 3 million; free primary health care was expanded, 1600 more clinics were built, and more than half the 400 public hospitals were refurbished.
287
Old problems still mar fight against ancient disease
Talha Burki
On the eve of World Leprosy Day, Talha Burki, reviews progress in the global fight against the disease, and finds that far from nearing eradication, much remains to be done to control leprosy.Jan 25 marks World Leprosy Day—an event that aims to publicise an ancient disease that still affects thousands of people worldwide.
Perspectives
289
The wonders of Romantic science
Steven Rose
Richard Holmes is best known for his biographies of the Romantic poets of the late 18th and early 19th centuries, notably Samuel Taylor Coleridge and Percy Bysshe Shelley. In The Age of Wonder he turns his attention to a group of men (and one woman) whom to 21st-century eyes would seem initially very far removed from these poets: explorers, adventurers, and scientists—although the latter word had not yet been invented. But as his account proceeds, the affinities between this seemingly disparate group and the poets becomes clearer.
290
The asbestos industry
Barry Castleman
Last year as chrysophiles and chrysophobes prepared to do battle once more over UN plans to restrict the worldwide asbestos trade, Defending the Indefensible put the ruthless tactics of global asbestos industry into a historical context. By chronicling the evolution of knowledge about, and the corporate response to, asbestos, Jock McCulloch and Geoffrey Tweedale explain the inexplicable: why most of the world’s people live in countries where asbestos products are still used.
291
Barbara Hogan: South Africa’s Minister of Health
Clare Kapp
Rarely has a South African Cabinet reshuffle been greeted with such enthusiasm and expectation as the appointment last September of Barbara Hogan to Minister of Health, when she took over from her discredited predecessor Manto Tshabalala-Msimang. Hogan has faced a baptism of fire, having to confront the spread of cholera from Zimbabwe over the South African border, which has added to the already daunting challenges facing the country’s health system. Many think she has passed the 100-day test with flying colours.
292
Caregiving: the odyssey of becoming more human
Arthur Kleinman
“Let the more loving one be me.”W H Auden, The More Loving OneI lead her across the living room, holding her hand behind my back, so that I can navigate the two of us between chairs, sofas, end tables, over Persian rugs, through the passageway and into the kitchen. I help her find and carefully place herself in a chair, one of four at the oval-shaped oak table. She turns the wrong way, forcing the chair outward; I push her legs around and in, under the table’s edge. The sun streams through the bank of windows.
Obituary
294
Raymond Adams
Alison Snyder
Leading neuropathologist. Born on Feb 13, 1911, in Portland, OR, USA, he died from complications of congestive heart failure on Oct 18, 2008, in Boston, MA, USA, aged 97 years.
Correspondence
295
In solidarity with Gaza
Rami Abdou, Iyah Romm, Davida Schiff, Kirsten Austad, Sam Dubal, Simeon Kimmel, Eugene Schiff, on behalf of 753 other medical students
With sadness and urgency we, medical students, express our outrage at the brutal Israeli attacks and subsequent humanitarian disaster that is occurring in Gaza. As we write, more than 600 Palestinians have been killed and more than 2700 wounded in Israel’s disproportionate assault that began on Dec 27, 2008. Not just as medical students, but as Christians, Jews, and Muslims; as Arabs, Americans, Israelis, and Palestinians, we write in solidarity with the people of Gaza as they suffer yet another major humanitarian disaster.
295
Health and human rights in the Palestinian West Bank and Gaza
David Worth, Su Metcalfe, John Boyd, Adrian Worrall, Paola Canarutto
Palestine is split geographically into the West Bank and the Gaza strip. Gaza is the most densely populated area on earth: after first being crippled by blockade of its borders since 2007, Gaza is currently being bombed by the Israeli armed forces.1
296
Neglected tropical diseases and the Global Fund
David H Molyneux, Peter J Hotez, Alan Fenwick, Robert D Newman, Brian Greenwood, Jeffrey Sachs
There is a recognised need to scale up malaria interventions rapidly if the international community is to meet the targets established in the Global Malaria Plan,1 which include improved access to artemisinin-based combination therapy, intermittent preventive treatment for pregnant women, and universal coverage with long-lasting insecticidal bednets.
297
Alma-Ata addresses cultural, economic, and political issues too
David G Legge, Wim DeCeukelaire, Fran E Baum, David McCoy, David Sanders
The Lancet Series on the renaissance of primary health care (Sept 13, 2008) is welcome. However, from our perspective, it has significant weaknesses and omissions.The call for a New International Economic Order, prominent in the Declaration of Alma-Ata but omitted from the abbreviated version provided by Joy Lawn and colleagues,1 highlighted the effect of an unfair global economic regime on health. This relation is also clearly articulated in the report of the WHO Commission on Social Determinants of Health.
298
Bias in WHO report on the social determinants of health
Philip Stevens
In your Nov 8 Editorial (Nov 8, p 1607),1 you endorse the recommendations of WHO’s Commission on Social Determinants of Health, thereby adding to the consensus that the report is a vital contribution to future health policy.
298
Governments, civil society, and social determinants of health
Wim De Ceukelaire, Pol De Vos
In The Lancet’s special issue on social determinants of health, Erik Blas and colleagues (Nov 8, p 1684)1 conclude that governments and civil society can have important positive roles in addressing health inequity if political will exists.
299
Health-care equity—for all generations?
Aishling Murray, Desmond O’Neill
The report of the Commission on Social Determinants of Health (Nov 8, p 1661)1 represents a formidable achievement. However, in a world where most older people live in the developing world, the prominent emphasis given to factors linked to inequity including gender, education, occupation, income, ethnicity, and place of residence, seems to miss out on the pervasive nature of ageism. Where later life figures in the full report, it is largely related to social protection issues such as pensions, but not to other forms of ageism which restrict access to a wide range of services including health care.
299
Green space, psychological restoration, and telomere length
Jean Woo, Nelson Tang, Eddie Suen, Jason Leung, Moses Wong
In his Comment (Nov 8, p 1614),1 Terry Hartig explores the health-promoting properties of exposure to the natural environment, independent of socioeconomic factors. He points out that determining whether the effect is mediated through psychological restoration or increased physical activity could be difficult, in view of the paucity of data on psychological restoration compared with that for physical activity. We believe that our data on geographical variation in telomere length could contribute to answering this question.
300
2009: a crucial year for progress on the health workforce crisis
Sigrun Møgedal, Mubashar Sheikh
Articles
301
Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial
Anders Widmark, Olbjørn Klepp, Arne Solberg, Jan-Erik Damber, Anders Angelsen, Per Fransson, Jo-Åsmund Lund, Ilker Tasdemir, Morten Hoyer, Fredrik Wiklund, Sophie D Fosså, for the Scandinavian Prostate Cancer Group Study 7 , the Swedish Association for Urological Oncology 3
In patients with locally advanced or high-risk local prostate cancer, addition of local radiotherapy to endocrine treatment halved the 10-year prostate-cancer-specific mortality, and substantially decreased overall mortality with fully acceptable risk of side-effects compared with endocrine treatment alone. In the light of these data, endocrine treatment plus radiotherapy should be the new standard.
309
Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study
Jean-Philippe Collet, Jean-Sébastien Hulot, Anna Pena, Eric Villard, Jean-Baptiste Esteve, Johanne Silvain, Laurent Payot, Delphine Brugier, Guillaume Cayla, Farzin Beygui, Gilbert Bensimon, Christian Funck-Brentano, Gilles Montalescot
The CYP2C19*2 genetic variant is a major determinant of prognosis in young patients who are receiving clopidogrel treatment after myocardial infarction.
318
Spousal violence and potentially preventable single and recurrent spontaneous fetal loss in an African setting: cross-sectional study
Amina P Alio, Philip N Nana, Hamisu M Salihu
Spousal violence increases the likelihood of single and repeated fetal loss. A large proportion of risk for recurrent fetal mortality is attributable to spousal violence and, therefore, is potentially preventable. Our findings support the idea of routine prenatal screening for spousal violence in the African setting, a region with the highest rate of fetal death in the world.
Series
325
Managing the pursuit of health and wealth: the key challenges
David P Fidler, Nick Drager, Kelley Lee
This article forms part of a six-part Series on trade and health, and sets the stage for this Series by analysing key aspects of the relationship between trade and health. The Series takes stock of this relation and provides timely analysis of the key challenges facing efforts to achieve an appropriate balance between trade and health across a diverse range of issues. This introductory article reviews how trade and health have risen and expanded on global policy agendas in the past decade in unprecedented ways, describes how trade and health issues are respectively governed in international relations, examines the ongoing search for policy coherence between the two policy spheres, and highlights the topics of the remaining articles in the Series.
332
Promotion of children’s rights and prevention of child maltreatment
Richard Reading, Susan Bissell, Jeffrey Goldhagen, Judith Harwin, Judith Masson, Sian Moynihan, Nigel Parton, Marta Santos Pais, June Thoburn, Elspeth Webb
In medical literature, child maltreatment is considered as a public-health problem or an issue of harm to individuals, but less frequently as a violation of children’s human rights. Public-health approaches emphasise monitoring, prevention, cost-effectiveness, and population strategies; protective approaches concentrate on the legal and professional response to cases of maltreatment. Both approaches have been associated with improvement in outcomes for children, yet maltreatment remains a major global problem.
Viewpoint
344
Medical ethics and torture: revising the Declaration of Tokyo
Steven H Miles, Alfred M Freedman
Because of the duty to promote and protect prisoners’ wellbeing, physicians who work in prisons should monitor human rights during their medical work.1,2 They can discern signs of abuse even when they have not witnessed the abuse. Also, they can see prisoners who have been concealed from customary monitors, such as delegates of the International Committee of the Red Cross. Furthermore, they belong to national and international communities that include advocates for humane prison health care and for stopping torture.
349
Health systems, health, and wealth: a European perspective
Martin McKee, Marc Suhrcke, Ellen Nolte, Suszy Lessof, Josep Figueras, Antonio Duran, Nata Menabde
Countries from WHO’s European region met in Tallinn, Estonia in June, 2008, to discuss a new way of thinking about health systems. For the past three decades, much of the debate on health care in Europe has been dominated by cost containment. Informed by detailed background analyses,1,2 a 2 year consultation process began by asking “what is a health system actually for?” The answer depends on who is asking the question. For some, a health system is a means of redistributing society’s resources—from healthy to sick and from rich to poor.
Case Report
352
Amnesia, political ambition, and canned tuna
Roger CM Ho, Stanley YW Lam, Evangeline SL Tan, Pamela MY Ng, Anselm Mak
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