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[Correspondence] Reducing childhood obesity in the UK and France

Sáb, 06/01/2018 - 00:00
The Lancet's Editorial (Aug 26, 2017, p 822)1 suggested that the UK's plan for reducing childhood obesity was inadequate as Public Health England announced it will be “working closely” with the food industry in seeking voluntary calorie reductions in high-energy food sources popular with children and young people.

[Correspondence] Targeted radiotherapy for early breast cancer

Sáb, 06/01/2018 - 00:00
We congratulate Charlotte E Coles and colleagues (Sept 9, 2017, p 1048)1 on their randomised trial (IMPORT LOW) ratifying partial-breast irradiation and confirming the original hypothesis2 proposed in The Lancet 20 years ago.3 In 2010, the independent commentary accompanying the first results of the TARGIT-A trial4 of single-dose targeted intraoperative radiotherapy (TARGIT-IORT), published in The Lancet by the authors of this letter, presented partial-breast irradiation as the new standard for suitable patients.

[Correspondence] Targeted radiotherapy for early breast cancer – Authors' reply

Sáb, 06/01/2018 - 00:00
We reject the inference of a survival benefit for patients receiving partial-breast irradiation within the IMPORT LOW trial and caution against any such interpretation when the number of events reported is so small.1 There is no suggestion of a difference in disease-free and overall survival across IMPORT LOW treatment groups.1 The TARGIT trialists' claim of survival benefit in their own trial relates to non-breast cancer deaths, and the data they cite are from a selected subset of patients. In IMPORT LOW, there were nine cardiac deaths occurring 6–36 months following randomisation, four after left-sided and five after right-sided breast cancer.

[Correspondence] How does azithromycin improve asthma exacerbations?

Sáb, 06/01/2018 - 00:00
We read with interest the Article by Peter G Gibson and colleagues (July 4, 2017, p 659),1 which clearly showed the beneficial effects of macrolide therapy on the incidence of asthma exacerbations. Increasingly, asthma is recognised as a heterogeneous disease with multiple phenotypes and endotypes. By contrast with the effects of anti-inflammatory treatment with inhaled corticosteroids, leukotriene receptor antagonists, and biological therapies—for which therapeutic efficacy depends on the inflammatory profile—Gibson and colleagues showed no differential benefit in terms of eosinophilic inflammation over non-eosinophilic inflammation.

[Correspondence] How does azithromycin improve asthma exacerbations? – Author's reply

Sáb, 06/01/2018 - 00:00
Two key findings of the AMAZES trial1 are relevant to asthma management. First, the addition of low-dose azithromycin to a combination of inhaled corticosteroids and long-acting bronchodilators led to a clinically significant reduction in asthma exacerbations in adults with poorly controlled asthma. This finding provides an additional therapeutic option for these patients. Second, the effect occurred equally in both eosinophilic and non-eosinophilic asthma, by an as yet unidentified mechanism, but acting on pathways other than type 2 inflammation.

[Correspondence] Hypothyroidism and hypertension: fact or myth?

Sáb, 06/01/2018 - 00:00
We read with interest the thorough Seminar on hypothyroidism (Sept 23, 2017, p 1550),1 in which the authors implicate that hypothyroidism is a cause of hypertension. However, hypertension is not a typical sign of hypothyroidism. This misconception is more than 80 years old with Owen Thompson and colleagues2 reporting a high incidence of hypertension in myxoedema. Since then, many uncontrolled observational studies have shown that elevated blood pressure in patients with hypothyroidism returns to within normal range after thyroid hormone substitution.

[Correspondence] Hypothyroidism and hypertension: fact or myth? – Authors' reply

Sáb, 06/01/2018 - 00:00
We thank Louis Hofstetter and Franz H Messerli for their interest in our Seminar on hypothyroidism in The Lancet.1 We agree that hypothyroidism is rarely the sole underlying cause of hypertension in the general population and that hypertension should always be treated in the context of primary cardiovascular disease prevention. However, several observational studies have shown a difference in blood pressure between those with hypothyroidism (clinical or subclinical) and euthyroid individuals, even after adjusting for age.

[Department of Error] Department of Error

Sáb, 06/01/2018 - 00:00
Al-Lamee R, Thompson D, Dehbi H-M, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet 2018; 391: 31–40—In this Article (published online first on Nov 2, 2017) there were data analysis errors, including the erroneous exclusion of the final batch of 24 dobutamine stress echocardiograms. The analyses have been checked and the data corrected in table 3 under headings “SAQ-angina frequency” and “Peak stress wall motion index score”, as well as any text referring to these data in the Results and Discussion.

[Editorial] Artificial intelligence in health care: within touching distance

Sáb, 23/12/2017 - 00:00
Replacing the doctor with an intelligent medical robot is a recurring theme in science fiction, but the idea of individualised medical advice from digital assistants like Alexa or Siri, supported by self-surveillance smartphone data, no longer seems implausible. A scenario in which medical information, gathered at the point of care, is analysed using sophisticated machine algorithms to provide real-time actionable analytics seems to be within touching distance. The creation of data-driven predictions underpins personalised medicine and precision public health.

[Editorial] Our responsibility to protect the Rohingya

Sáb, 23/12/2017 - 00:00
Much has been made of the Rohingya being stateless. But how they are being treated is utterly heartless. The almost 1 million Rohingya Muslims displaced from Myanmar's Rakhine State to Bangladesh are housed in squalid camps quickly becoming reservoirs of disease and despair. A new outbreak of diphtheria comes on the heels of cholera and measles outbreaks. Insufficient food, shelter, health care, and hope add to the almost unimaginable suffering of these most disenfranchised refugees.

[Editorial] Dangerous words

Sáb, 23/12/2017 - 00:00
Medicine is underpinned by both art and science. Art that relies upon strong therapeutic relationships with patients and populations. And science that brings statistical rigour to clinical and public health practice. If allegations reported in The Washington Post on Dec 15 are credible, the Trump administration has seriously undermined both foundations by banning the words “vulnerable”, “entitlement”, “diversity”, “transgender”, “fetus”, “evidence-based”, and “science-based” from government documents for the US$7 billion budget discussions about the Centers for Disease Control and Prevention (CDC).

[Comment] Is WHO ready to improve its country work?

Sáb, 23/12/2017 - 00:00
The health status of people has changed dramatically across the world—in most cases for the better. People live longer and sometimes also healthier lives. In most countries, capacity to manage health issues has improved and health priorities have changed. However, WHO has not yet fully adjusted to these changing realities, but there is an opportunity now with a new Director-General and leadership team in place.

[Comment] 2017 Wakley Prize Essay

Sáb, 23/12/2017 - 00:00
We would like to thank the many readers who entered the 2017 Wakley Prize Essay. The winning essay published in this issue was selected by Lancet editors and is “You Don't Know Me” by Kate Rowland, an Assistant Professor at the Department of Family Medicine at Rush University, Chicago, IL, USA. Kate is board certified in family medicine and is a Fellow of the American Academy of Family Physicians. She's worked as a family physician for 10 years and her professional interests include understanding how doctors make decisions during patient care and learning about how new medical evidence is taken up in practice.

[Comment] Offline: Are China's global ambitions good for global health?

Sáb, 23/12/2017 - 00:00
A bitter argument is taking place between two nations, a dispute that could have profound effects for the future of global health. China and Australia are geographic neighbours. During the past decade, both countries have worked hard to build strong trading and diplomatic relationships. They have succeeded. But those relationships are now being torn apart. China's Xinhua News Agency last week claimed that Australia's Government was “obsessed” with “criticising China”. Xinhua argued that Australia's Government was trying “to undermine bilateral political trust”.

[This Year in Medicine] 2017: a year in review

Sáb, 23/12/2017 - 00:00
2017 was not only a year marred by conflict-driven humanitarian crises and political quagmires but also a year for biomedical innovation and women's empowerment. Farhat Yaqub looks back.

[World Report] US Children's Health Insurance Program in jeopardy

Sáb, 23/12/2017 - 00:00
Without adequate federal funding, CHIP is on the verge of collapse in several states. Susan Jaffe, The Lancet's Washington correspondent, reports.

[Highlights] Highlights 2017: health in focus

Sáb, 23/12/2017 - 00:00
The fleeting moments captured in a photograph can tell powerful stories. Earlier this year we asked readers to send us striking pictures on any health topic for The Lancet's annual photography competition, Highlights. We were delighted by the response. Lancet editors selected these ten winning pictures from the varied and interesting photographs you sent us.

[Correspondence] WHO leadership is essential for the elimination of NTDs

Sáb, 23/12/2017 - 00:00
The second director of the Department of Control of Neglected Tropical Diseases (NTDs) of WHO retired at the end of September, 2017. He was appointed in 2014 to ensure administrative stability after 9 years of innovative growth of this WHO department, which was established in 2005 after the retirement of the first director.1 Sustaining the momentum for elimination of NTDs requires a timely appointment of a new director to lead an effective Department of NTDs in WHO.

[Correspondence] Are new technologies translatable to point-of-care testing?

Sáb, 23/12/2017 - 00:00
The point-of-care testing (PoCT) market is rapidly expanding and its predicted worth by 2021 is US$36·96 billion.1 This market has many facets, one of which is tumour and cancer markers. To develop a new test for clinical use, a biomarker needs to be identified and a quick and simple detection method developed. This biomarker then goes through many steps before clinical use including the all-important step—can it detect cancer earlier than existing methods?

[Correspondence] Changes to NHS charges: what does this mean for our most vulnerable patients?

Sáb, 23/12/2017 - 00:00
August, 2017, saw the introduction of new regulations on health-care charges to migrants and overseas visitors in England.1 Patients who are unable to prove entitlement to free care will receive an estimated treatment bill, which must be fully paid before receipt of care, and might increase exponentially. Urgent treatment, as defined by the treating clinician, should be provided and billed for afterwards. These regulations are the outcome of only 418 responses obtained by the Department of Health from their consultation exploring the extension of charging overseas visitors and migrants who use the National Health Service (NHS).

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