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[Editorial] The devastating impact of Trump's global gag rule

Sab, 15/06/2019 - 00:00
About 56 million abortions are done annually, and almost half (25 million) are unsafe, of which 97% occur in developing countries. An estimated 8% of all maternal deaths are due to abortion, leaving a massive unmet global need for access to safe abortion services. Despite this situation, the USA, the world's largest global health donor, takes a hardline stance against abortion both at home and abroad. On June 5, the International Women's Health Coalition launched Crisis in care: year two impact of Trump's global gag rule, detailing the direct effect of anti-abortion policies and the broader ways in which they are threatening the work of non-governmental organisations (NGOs) that support women and vulnerable groups around the world.

[Editorial] Recognising physicians with impairment

Sab, 15/06/2019 - 00:00
The Ethics, Professionalism, and Human Rights Committee of the American College of Physicians (ACP) published a position paper on June 4, Physician impairment and rehabilitation: reintegration into medical practice while ensuring patient safety. Opening with the words “physician impairment, the inability to carry out patient care responsibilities safely and effectively, is a problem of functioning”, the paper explores the difference between illness and impairment.

[Editorial] Venezuela: food and medicines used as weapons

Sab, 15/06/2019 - 00:00
When Nicolás Maduro was first elected in April, 2013, he ambitiously aimed for “zero poverty” by 2019. Now, Venezuela's economy is collapsing, with people becoming even more impoverished. Those living without access to food and medicine display the reality of an unprecedented humanitarian emergency in the country. On June 7, the UN stated that more than 4 million people have already left Venezuela, while a further 7 million need humanitarian assistance. Maduro's strategy in the face of such a catastrophe includes the control of food production and distribution, and subsidising food handouts as a political weapon.

[Comment] Offline: A Chief Medical Officer—unplugged

Sab, 15/06/2019 - 00:00
“We have very little power.” Professor Dame Sally Davies, England's Chief Medical Officer (CMO) for the past 9 years, was giving her final evidence last week to the House of Commons Science and Technology Committee. Her encounter before politicians who independently scrutinise government policies on all aspects of science was unexpectedly revealing. A CMO sits in an unusual position. She is the principal adviser to government on all medical and public health matters. That role would seem to make her extremely powerful.

[World Report] Health targeted in Sudan's political transition

Sab, 15/06/2019 - 00:00
As the country organises after its former leader's decade-long rule was ended, violence has been rife, with up to 113 people killed at a civilian protest in early June. Sharmila Devi reports.

[World Report] Trump administration limits fetal tissue research

Sab, 15/06/2019 - 00:00
The move could threaten medical research advances, say scientists, as acquisition of new fetal tissue for research is substantially hindered. Susan Jaffe reports.

[World Report] Pharma blockchains AI for drug development

Sab, 15/06/2019 - 00:00
The venture would allow AI to be trained on millions of datapoints across databases from several drug companies without threatening the ownership and privacy of the data. Talha Burki reports.

[Perspectives] Making women equally visible

Sab, 15/06/2019 - 00:00
Caroline Criado Perez is a feminist probably most famous in the UK for successfully campaigning to have a woman depicted on Bank of England notes and a statue of suffragist Millicent Fawcett erected in Parliament Square. Her book Invisible Women: Exposing Data Bias in a World Designed for Men describes the avoidable adversities women experience when they inhabit a world designed by default to fit men.

[Obituary] John Lennard-Jones

Sab, 15/06/2019 - 00:00
Pioneering gastroenterologist. He was born in Bristol, UK, on Jan 29, 1927, and died in Woodbridge, UK, on March 29, 2019, aged 92 years.

[Correspondence] Ongoing pregnancy as the primary outcome for the inSIGHT study

Sab, 15/06/2019 - 00:00
The inSIGHT study1 was a randomised controlled trial investigating the effect of routine hysteroscopy before the first in-vitro fertilisation (IVF) or intracytoplasmic sperm injection treatment on livebirth rate. The trial included 750 subfertile women, who were randomly allocated to either hysteroscopy with treatment of detected intracavity abnormalities before IVF or immediate start of IVF at 22 centres in the Netherlands between May, 2011, and August, 2013. The results showed that routine hysteroscopy before IVF did not improve the rate of livebirths.

[Correspondence] Alcohol and the global burden of disease

Sab, 15/06/2019 - 00:00
We read with interest the systematic anlysis of the global burden of alcohol use by the Global Burden of Disease (GBD) 2016 Alcohol Collaborators.1

[Correspondence] Alcohol and the global burden of disease

Sab, 15/06/2019 - 00:00
The 2016 Global Burden of Disease (GBD) Alcohol Collaborators1 corroborate that alcohol is a leading risk factor for the global burden of disease; however, limitations in the methods have led to the unfounded conclusion that, at the individual level, no amount of alcohol consumption benefits health.

[Correspondence] Alcohol and the global burden of disease

Sab, 15/06/2019 - 00:00
We read the paper by the GBD 2016 Alcohol Collaborators1 with great interest. However, we are surprised that, on the basis of mainly ecological data and predominantly mathematical models, the authors suggest the need for a revision of alcohol control policies worldwide.

[Correspondence] Alcohol and the global burden of disease

Sab, 15/06/2019 - 00:00
The Global Burden of Disease (GBD) Alcohol Collaborators1 estimate the burden of alcohol consumption on populations from 195 locations and conclude that drinking alcohol leads to health loss regardless of the quantity consumed and question the need for revising alcohol control policies worldwide.

[Correspondence] Alcohol and the global burden of disease – Authors' reply

Sab, 15/06/2019 - 00:00
We synthesised data from 694 surveys and 592 prospective and retrospective studies to estimate the global burden of disease attributable to alcohol use. As part of that analysis, we calculated a theoretical minimum risk exposure level (TMREL) of alcohol use.1 We found that risk increases monotonically with dose and the minimal exposure to risk was zero drinks per day. Although we reached this conclusion using a new method, our results are consistent with those of other studies.2–4 These findings are further bolstered by results in mendelian randomisation trials, which have not found a protective effect between alcohol use and ischaemic heart disease.

[Correspondence] ABSORB IV: will the low rate of scaffold thrombosis persist?

Sab, 15/06/2019 - 00:00
Gregg Stone and colleagues1 reported the results of the ABSORB IV randomised trial, which including non-inferiority testing for the primary endpoint of target lesion failure at 30 days. The rate of scaffold thrombosis was 0·7% at 1 year.

[Correspondence] ABSORB IV: will the low rate of scaffold thrombosis persist? – Authors' reply

Sab, 15/06/2019 - 00:00
We thank Ruben Tijssen and colleagues for their interest in our work.1 We agree with most of their comments. Specifically, we note in our Article that more careful patient selection and greater attention to procedural technique in ABSORB IV compared with ABSORB III were associated with lower stent thrombosis rates after implantation of metallic drug-eluting stents as well as bioresorbable vascular scaffolds. Despite these efforts, thrombosis events have not been eliminated (with either device), especially in complex lesions, as seen in every large stent study in which careful clinical follow-up was done.

[Correspondence] Dyspnoea in the GLOBAL LEADERS trial

Sab, 15/06/2019 - 00:00
Pascal Vranckx and colleagues1 reported that extended ticagrelor monotherapy was not superior to the standard dual antiplatelet therapy after stenting. Although we agree that the results do not support a change from current practice, we are concerned about the high incidence of discontinuation due to dyspnoea during the study period.

[Correspondence] Dyspnoea in the GLOBAL LEADERS trial – Authors' reply

Sab, 15/06/2019 - 00:00
We thank David Martí and Marcelo Sanmartín for their interest in GLOBAL LEADERS.1 Dyspnoea was reported in 1642 (13·8%) of 11 936 patients ever treated with ticagrelor after 2 years of follow-up in GLOBAL LEADERS versus 1270 (11·4%) of 9235 patients after 1 year of follow-up in the PLATO study2 and 1205 (17·2%) of 6988 patients allocated to ticagrelor 90 mg twice daily in the PEGASUS trial, after a median follow-up of 33 months.3 Discontinuation of ticagrelor because of dyspnoea was reported in only 79 patients in the PLATO study after 1 year of follow-up.

[Correspondence] How can we avoid making universal health coverage a white elephant?

Sab, 15/06/2019 - 00:00
When Irene A Agyepong1 discussed the potential risk of universal health coverage (UHC) becoming a white elephant in low-income and low-income and lower-middle-income countries, she also demonstrated how, from 1945 to 2019, global dominant ideologies have been alternating between vertical and horizontal approaches to UHC, with the exception of Ghana.