Medical Journal News

Over 14 years of Conservative Government in the UK—characterised by policies of austerity and deep cuts to public services—healthy life expectancy dropped, mental health worsened, and public satisfaction with the National Health Service (NHS) fell from 70% in 2010 to 24% in 2023. In September, 2024, 7·7 million people were on the waiting list for hospital treatment (>10% of the population), up from just over 2 million in 2010. UK spending on health stands at 21% below the median of 14 EU countries.

Mpox and its causative pathogen, monkeypox virus, represent a growing international public health concern following a global outbreak of monkeypox virus clade II in 2022–231 and regional outbreaks of monkeypox virus clade I centred in DR Congo beginning in late 2023.2 Epidemiological analysis of monkeypox virus, including genomic epidemiology, is crucial to understanding the expansion of the virus within and outside its historically endemic range due to increased spillover from a zoonotic host, increased human-to-human transmission, or both, and any changes in virulence.

Dr Sivakumar was a successful Consultant Psychiatrist in Maidstone, UK. He had emigrated from Sri Lanka in 1977 and was, in his words, “one of the lucky ones”. Why lucky? Because, having received a “decent English education” in his home country, Dr Sivakumar's journey through medicine as a South Asian doctor in the UK was “comfortable”. This outcome had not necessarily been his expectation. He arrived from Sri Lanka armed with letters attesting to his excellent English language skills. He did not need them.

Revolutionary new HIV drugs are being made available in 120 low-income countries, but many important populations are being left out. Sophie Cousins reports.

A contested election with allegations of vote rigging could be damaging to health NGOs in the country. Sharmila Devi reports.

Marina Romanello is the Executive Director of the Lancet Countdown: Tracking Progress on Health and Climate Change, an independent and multidisciplinary research collaboration headquartered at the Institute for Global Health, University College London, UK.

Picture the scene: an asylum for women in Claresholm, AB, Canada, in the summer of 1933. Southern Alberta was in the grip of the Great Depression, but this town was also in the midst of the Dust Bowl, so-called because the parched topsoil was easily whipped by the wind into filthy clouds that blocked out the sky. Yet at the asylum, water was still being prioritised for a specific therapeutic purpose. Three women were placed in a tub and wrapped up head to toe in saturated blankets. They stayed in these watery cocoons for 3 hours.

Leader in melanoma research and immunotherapy. Born in New York, NY, USA, on May 8, 1952, he died there of pancreatic cancer on Aug 18, 2024, aged 72 years.

The ongoing conflict in Sudan has substantially exacerbated the crisis of gender-based violence, including sexual violence, directed against women and girls, revealing crucial gaps in health services and support systems.1 Although the increase in violence against women and girls is alarming, examining additional dimensions enables a more comprehensive understanding of the crisis.

The PROTECT trial, reported by Brad H Rovin and colleagues,1 showed superior efficacy of sparsentan, a dual endothelin A and angiotensin receptor antagonist, over irbesartan in reducing urinary albumin-to-creatinine ratio and decline in estimated glomerular filtration rate in IgA nephropathy. The ZENITH-CKD trial reported similar kidney protective potential of the selective endothelin A receptor antagonist zibotentan combined with dapagliflozin, in which a marked decrease in haematocrit was noted.

Dion Groothof and colleagues have suggested that the anaemia observed in some volunteers in the PROTECT trial1 was due to endothelin A receptor antagonism increasing renal medullary blood flow and oxygenation with resultant suppressed erythropoietin secretion. Although this possibility cannot be entirely excluded, it is unlikely to contribute substantially to endothelin A receptor antagonist-induced anaemia. Every endothelin receptor antagonist, whether targeting endothelin A or both endothelin A and B receptors, can induce fluid retention,2 including zibotentan in the ZENITH-CKD trial (the 1·5 mg zibotentan dose regimen significantly increased extracellular fluid volume).

Christopher W Ryan and colleagues1 reported that adjuvant everolimus after surgery did not improve recurrence-free survival versus placebo among patients with renal cell carcinoma at high risk of recurrence, and the result did not support the adjuvant use of everolimus for these patients. Curiously, although the median follow-up time was up to 76 months, the survival data were not mature. The median recurrence-free survival was not reached in either group. Moreover, despite a large proportion of patients at very high risk being included (55%), there was a large number of dropout cases in both treatment groups.

We thank Yao-Ning Feng and colleagues for their Correspondence in response to our publication of the EVEREST trial.1 Although recurrence rates in both the everolimus and placebo groups were low, the groups were evaluated on the same schedule. EVEREST included participants with a broad range of recurrence risk as well as both clear and non-clear cell tumours, which probably contributed to the lower than anticipated recurrence rate. Notably, among the subset of patients with a very high risk disease and clear cell histology, an estimated 5-year recurrence-free survival rate of 50% was seen in the placebo group, which is similar to that reported in adjuvant trials that limited enrolment to patients at high risk.

Seung-Jung Park and colleagues1 report an important proof-of-concept study of precision medicine for so-called vulnerable plaques, which could represent a first step towards a shift in current indications for percutaneous coronary intervention with stenting.

We read with great interest the study by Seung-Jung Park and colleagues,1 regarding preventive percutaneous coronary intervention in patients with high-risk, but fractional flow reserve-negative, lesions. The results are of particular interest; however, several implications arise.

We commend the authors, Seung-Jung Park and colleagues, of the PREVENT trial1 for testing a bold hypothesis; stenting vulnerable non-flow-limiting plaques. Although the treatment effect of the primary outcome was impressive, the event rates were low. The authors assumed a major adverse cardiac event (MACE) rate of 8·5% in the intervention group and 12·0% in the medical therapy group. Actual event rates were substantially lower at 0·4% in the intervention group and 3·5% in the medical therapy group.

The necessity of additional intervention for non-flow-limiting high-risk plaques remains uncertain.1 Seung-Jung Park and colleagues’ PREVENT Trial2 offers compelling insights into the comparison of preventive percutaneous coronary intervention with optimal medical therapy for patients with non-flow-limiting vulnerable plaques. The findings unequivocally establish the superior advantages of preventive percutaneous coronary intervention, as the primary outcome at 2 years was notably lower in the percutaneous coronary intervention group.

Prevention of acute myocardial infarction in stable coronary disease has been the so-called holy grail in interventional cardiology. Numerous large randomised clinical trials, including the COURAGE1 and ISCHAEMIA2 trials, showed that percutaneous coronary intervention does not offer incremental prognostic benefit above optimal medical therapy in patients with stable angina. It is in this context we read, with great interest, Seung-Jung Park and colleagues’ PREVENT trial.3 It is the first trial, powered for clinical outcomes, which attributes prognostic benefit to percutaneous coronary intervention in addition to optimal medical therapy in patients with stable angina (84% of patients had stable angina).

We thank the authors for their interest in our trial.1

Hickey M, Hunter MS, Crandall CJ, et al. Reflections on The Lancet menopause Series. Lancet 2024; 404: 1307–08—In this Correspondence, the order of the author list and Hadine Joffe's name were incorrect. These corrections have been made to the online version as of Nov 7, 2024.