The Lancet ~ January 31st, 2009 Volume 373 Number 9661 Pages 353 - 432
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
353
Melamine and food safety in China
The Lancet
In May, 2007, when several dogs and cats had died in the USA from kidney damage after eating melamine-contaminated pet food from China, Chinese authorities promised measures to restore confidence in the safety of its food and drugs. China’s State Council added that high production standards would be imposed, corruption addressed, and baby food would be tested. The announcement coincided with the trial of Zheng Xiaoyu, former head of the State Food and Drug Administration (SFDA), who was later found guilty of corruption and executed.
354
Appointment of PEPFAR head should be merit based
The Lancet
Last week saw the sudden departure of Mark Dybul as the US Global AIDS Coordinator, in charge of the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the largest and most successful bilateral HIV/AIDS programme worldwide and considered one of President Bush’s greatest achievements. The reauthorisation of this US$50 billion initiative to support HIV/AIDS, tuberculosis, and malaria over the next 5 years makes the position of coordinator one of the most important jobs in global health.
354
Over-the-counter medicines: in whose best interests?
The Lancet
Last week, the European union (EU) approved the anti-obesity drug, orlistat, for sale over-the-counter (OTC). Going by the trade name Alli, orlistat is already available OTC in the USA and Australia. The EU decision means that this drug can now be sold by pharmacists throughout Europe to people with a body-mass index over 28 in 60 mg tablets—half the recommended daily dose—after consultation.
Comment
355
The global financial crisis: an acute threat to health
Richard Horton
As the global economy enters a sharp and severe recession, desperate financiers are turning to astrology for inspiration.1 But last week, WHO convened something rather different: a high-level consultation on the financial and economic crisis and global health. Margaret Chan, WHO’s Director-General, sought to build awareness and identify actions. Her concern is that while governments grapple with fiscal meltdown, health may be neglected. Worse, if the evidence of past recessions is anything to go by, the impact on health will be worse than we think.
356
Measles in Europe—there is room for improvement
Jacques R Kremer, Claude P Muller
In The Lancet today, the EUVAC.NET group1 have compiled measles data for 2006–07 from 32 European countries, in the context of eliminating measles in the WHO-European Region (WHO-EURO) by 2010. It seems good news that only half as many (3909) measles cases occurred in 2007 as in 2006 (8223). However, preliminary data suggest that measles incidence was about three times higher during the first half of 2008 than in the same period in 2007.2,3
358
Laparoscopic versus open pyloromyotomy
Aydin Yagmurlu
Since the initial report of laparoscopic pyloromyotomy in 1991,1 several studies have compared outcomes after open and laparoscopic operations,2–4 including two randomised trials.5,6 These studies concluded that there was no significant difference in the complication rates and that both techniques were equally safe in experienced hands. Most of these studies are models for the various situations paediatric surgeons must consider. The subtleties are often lost in the style and flamboyance of study results.
360
Societal transition and health
Martin Bobak, Michael Marmot
The fall of communism in the 1990s and the ensuing profound societal transition in central and eastern Europe and the former Soviet union is a unique social experiment. Social, economic, and political changes affected all aspects of people’s lives, which resulted in changes in mortality, morbidity, and fertility rates.1 The experiment offers a rare opportunity to investigate societal factors that drive the health of a population.
362
Mental-health stigma: expanding the focus, joining forces
Beate Schulze
Despite ample international efforts, stigma against people with mental-health problems persists. This finding is underlined by Graham Thornicroft and colleagues’ INDIGO study, in The Lancet today.1 The results reveal high rates of discrimination on a global scale and show that many mentally ill people anticipate negative reactions even in the absence of discriminatory behaviours. This landmark study encourages us not only to continue fighting stigma in a global coalition,2 but also to step up our efforts.
363
Trade agreements and health in developing countries
Joseph E Stiglitz
Politicians champion free trade for bringing an era of high and stable growth, although the evidence supporting such claims is ambiguous. Studies that associate increases in trade with increases in gross domestic product often leave open questions of causality: high growth, the result for instance of strong industrial policies, typically leads to more trade. China and India’s growth spurts preceded trade liberalisation. A study by UN Development Programme showed little relation between trade liberalisation and growth.
365
Dietary fibre: an agreed definition
JH Cummings, JI Mann, C Nishida, HH Vorster
On Nov 4, 2008, the 30th Session of the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) met in South Africa, and agreed a definition of dietary fibre.1 Does this matter? Yes, because this Codex Committee sets global food standards and this definition will be used as the basis for measurement, food labelling, setting reference nutrient values, and health claims.
World Report
367
New hopes for US health pinned on Daschle’s nomination
Todd Zwillich
South Dakota Democrat Tom Daschle, nominated to be the next Secretary of Health and Human Services, will have his work cut out for him in reforming US health care. Todd Zwillich reports.Former US Senator Tom Daschle seemed to be sailing towards easy confirmation as the next Secretary of Health and Human Services (HHS).
368
UK doctors hail research excellence results
Emma Wilkinson
The results of the Research Assessment Exercise were welcomed by many UK universities, which were found to be punching well above their weight internationally. Emma Wilkinson reports.Much of UK academia had cause for celebration last month as they digested the outcome of the 2008 Research Assessment Exercise (RAE)—the mammoth peer-review process that decides which universities get a share of limited government funds (see panel).
Perspectives
371
Assessing the National Children’s Study
Rosalind L Smyth
Many people are uneasy about the health effects of hazards that they cannot control. The more governments seek to reassure us about the lack or risk of any environmental agent to our health, the more cynical we become. This month the European Parliament’s draft law to limit the use of pesticides provoked fierce opposition from British farmers and calls for tougher legislation from environmental groups. Controversy reigns about whether, or to what extent, these agents are hormonal modifiers, cause birth anomalies, or malignant disease.
372
A little of a lot of history
Elizabeth Leyland
There have always been good doctors and bad doctors, and patients have always favoured good doctors. With this in mind, William Bynum starts The History of Medicine: A Very Short Introduction, and explores, in five neat sections, how medical progress changes perceptions of what constitutes a good doctor. From the Hippocratic ideal of patient-centred control of symptoms, to the notion of seeking understanding of disease in a laboratory, he more or less covers the history of medicine from beginning to end.
373
Ian Gilmore: President of the Royal College of Physicians
Geoff Watts
Thus far into his presidency of the Royal College of Physicians of London, Professor Ian Gilmore seems to be enjoying the job. “It’s hard work, but also a privilege that few people get. It’s the opportunity not only to have insight into, but also to influence, the way that health care is delivered.” Gilmore became President in July, 2006, and his delight also reflects a long-standing enthusiasm for the College. “I believe it’s seen as an honest broker, as impartial, as being able to argue the case for quality of care to patients without getting sucked into trade union issues.
374
Plague and theatre in ancient Athens
Robin Mitchell-Boyask
As the Athenian historian Thucydides first pointed out in his account of the great plague of Athens during the late 5th century BCE, the social effects of epidemics can be at least as important as their biological impact. There have certainly been many plagues throughout recorded human history, but perhaps none arrived at such a pivotal moment in the affairs of a centre of western civilisation. Yet only recently have we been able to assess the true effect of the plague that first struck Athens in 430 BCE and continued intermittently for several years.
Obituary
376
Jacob Katz
Nellie Bristol
Leader in development of biomedical ethics. Born in Zwickau, Germany, on Oct 20, 1922, he died of heart failure on Nov 17, 2008, in New Haven, CT, USA, aged 86 years.
Correspondence
377
Response to medical students’ letter of solidarity with Gaza
Rebecca Braunstein, David Faleck, David Stern, on behalf of 805 medical students, 503 doctors, 236 health professionals , 275 other concerned individuals
In a Correspondence letter (published online Jan 12),1 medical students in Boston, MA, USA implicate Israel in perpetrating a “disproportionate assault” that underlies the humanitarian disaster in Gaza. Although these doubtlessly well intended individuals seek the moral high ground in calling for “an immediate cessation of hostilities”, they unfortunately ignore the realities of the situation. As fellow medical students, we would be remiss if we did not attempt to provide a clearer picture of the reality in Gaza and address some of the troubling points of our colleagues.
378
N-3 polyunsaturated fatty acids and statins in heart failure
George Davey Smith, Marie-Jo Brion, Jonathan AC Sterne
The cover of The Lancet Oct 4 issue confidently declares that “Supplementation with N-3 polyunsaturated fatty acids should join the short list of evidence-based life-prolonging therapies for heart failure”. However, the GISSI-HF trial, on which this statement is based (p 1223),1 does not support such a strong conclusion.
378
N-3 polyunsaturated fatty acids and statins in heart failure
Lorna M Gibson
The GISSI-HF investigators provide evidence that n-3 polyunsaturated fatty acid (PUFA) supplements are safe in patients with heart failure,1 but their conclusions about the supplements’ benefits on survival and admission to hospital might be limited because the trial could be confounded by dietary n-3 PUFA intake.
378
N-3 polyunsaturated fatty acids and statins in heart failure
Heinz Rupp, Thomas P Rupp, Peter Alter, Bernhard Maisch
In the GISSI-HF study,1 there were fewer first hospital admissions for ventricular arrhythmia in patients treated with n-3 polyunsaturated fatty acids (PUFA) than in the placebo group. A major risk underlying arrhythmias is cardiac dilatation. Dilatation was the cause of heart failure in 30·1% of patients taking n-3 PUFA versus 27·9% of those on placebo.
379
N-3 polyunsaturated fatty acids and statins in heart failure
Amitabh Parashar
The results of the GISSI-HF study1 are noteworthy indeed. However, although the presence of diabetes was similar in the two groups, the degree of glycaemic control and the medications used for diabetes management were not reported.
379
N-3 polyunsaturated fatty acids and statins in heart failure
Christopher Florkowski, Sarah Molyneux, Peter George, Michael Lever, Mark Richards
In the GISSI-HF trial (Oct 4, p 1231),1 rosuvastatin failed to show a reduction in clinical outcomes in patients with chronic heart failure of any cause. One explanatory factor might be a reduction in the concentration of coenzyme Q10 or ubiquinone, which is known to be caused by statins.
380
N-3 polyunsaturated fatty acids and statins in heart failure
Vincenzo Solfrizzi, Cristiano Capurso, Gianluigi Vendemiale, Antonio Capurso, Francesco Panza
The GISSI-HF trial1 found that rosuvastatin had no effect on clinical outcomes in patients with heart failure. Similar results were seen in the CORONA trial.2 These two studies differed in some aspects of the populations enrolled (proportion with ischaemic heart failure, age, and class of heart failure symptoms), and in primary and secondary outcomes, but both trials tested rosuvastatin at 10 mg per day, and sample size, follow-up period, and mean overall reduction in the primary outcome (about 15%) were very similar.
380
N-3 polyunsaturated fatty acids and statins in heart failure – Authors’ reply
Luigi Tavazzi, Gianni Tognoni, on behalf of the GISSI-HF Steering Committee
George Davey Smith and coauthors feel that we overstated the results of the n-3 PUFA study by highlighting the results of the adjusted analysis. Actually, they conclude that the trial showed a “modest estimated effect of fish oil”, lower than those expected according to the published protocol. We share this conclusion and this is what we wrote in the paper.
381
Sure Start in England
Jay Belsky, Alastair Leyland, Jacqueline Barnes, Edward Melhuish
In her Comment (Nov 8, p 1610)1 on our second phase of evaluation of Sure Start local programmes in England,2 Penny Kane makes several points with which we could not agree more. Like her, we would have much preferred to see a randomised controlled trial done, since this would have afforded much stronger causal inferences than the quasi-experimental investigation we undertook. We also agree that the fact that we drew on data collected by two different research teams raises questions about the confidence that can be placed in conclusions drawn.
381
Sure Start in England
Anna Eleri Livingstone
The UK’s system of general practice, based on the long-term registered population, is one of the most popular, successful, and efficient ways of delivering primary health care. It allows for continuity of care, a multidisciplinary approach, and a systematic integration of individual and family acute health care with risk management, preventive interventions, and care of long-term disorders. How tragic that the potential of this horizontal approach, so often shown to be successful, has been ignored by the vertical approach in relation to health care embodied in children’s centres and the Sure Start programme.
382
Clinical use of exhaled nitric oxide measurements
D Robin Taylor, Andrew Bush
Stanley Szefler and colleagues’ conclusion that measurement of exhaled nitric oxide (FENO) does not improve asthma outcomes compared with standard care (Sept 20, p 1065)1 could dissuade clinicians from using FENO. However, the study population and FENO management protocol substantially affected the conclusions.
382
Clinical use of exhaled nitric oxide measurements – Authors’ reply
Articles
383
Measles in Europe: an epidemiological assessment
Mark Muscat, Henrik Bang, Jan Wohlfahrt, Steffen Glismann, Kåre Mølbak, for the EUVAC.NET group
The suboptimum vaccination coverage raises serious doubts that the goal of elimination by 2010 can be attained. Achievement and maintenance of optimum vaccination coverage and improved surveillance are the cornerstones of the measles elimination plan for Europe.
390
Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial
Nigel J Hall, Maurizio Pacilli, Simon Eaton, Kim Reblock, Barbara A Gaines, Aimee Pastor, Jacob C Langer, Antti I Koivusalo, Mikko P Pakarinen, Lutz Stroedter, Stefan Beyerlein, Munther Haddad, Simon Clarke, Henri Ford, Agostino Pierro
Both open and laparoscopic pyloromyotomy are safe procedures for the management of pyloric stenosis. However, laparoscopy has advantages over open pyloromyotomy, and we recommend its use in centres with suitable laparoscopic experience.
399
Mass privatisation and the post-communist mortality crisis: a cross-national analysis
David Stuckler, Lawrence King, Martin McKee
Rapid mass privatisation as an economic transition strategy was a crucial determinant of differences in adult mortality trends in post-communist countries; the effect of privatisation was reduced if social capital was high. These findings might be relevant to other countries in which similar policies are being considered.
408
Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey
Graham Thornicroft, Elaine Brohan, Diana Rose, Norman Sartorius, Morven Leese, for the INDIGO Study Group
Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness.
Series
416
Bridging the divide: global governance of trade and health
Kelley Lee, Devi Sridhar, Mayur Patel
The main institutions responsible for governing international trade and health—the World Trade Organization (WTO), which replaced the General Agreement on Tariffs and Trade (GATT) in 1995, and WHO—were established after World War 2. For many decades the two institutions operated in isolation, with little cooperation between them. The growth and expansion of world trade over the past half century amid economic globalisation, and the increased importance of health issues to the functioning of a more interconnected world, brings the two domains closer together on a broad range of issues.
Department of Ethics
423
Principles for allocation of scarce medical interventions
Govind Persad, Alan Wertheimer, Ezekiel J Emanuel
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems.
Case Report
432
A fisherman who could not row
Abhijit Das, Ajith Cherian, Thomas Chemmanam
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