Medical Journal News

New England Journal of Medicine, Volume 391, Issue 20, Page 1870-1872, November 21, 2024.

Donald Trump's decisive re-election as US President on Nov 5 puts many aspects of health and science in a deeply concerning position. Although there is broader alarm about his openly authoritarian intentions, his imminent return to the White House has left much of the health community in particular feeling dread and uncertainty about what comes next in the USA and globally.

The treatment landscape for patients with relapsed or refractory diffuse large B-cell lymphoma has rapidly evolved, particularly with the introduction of chimeric antigen receptor (CAR) T-cell therapy as an alternative to salvage chemotherapy and autologous stem-cell transplantation (ASCT) as second-line therapy for those with primary refractory disease or early progression,1–3 even in patients older than 65 years.4 However, suitability for and access to CAR T-cell therapy remains limited due to factors such as rapid disease progression, logistical challenges, and economic or geographical barriers.

Every year more than 10 million people die unnecessarily from consuming tobacco, alcohol, and sugary beverages.1 In the wake of the COVID-19 pandemic and other crises constraining fiscal space, financing for health care and social services is stagnating or facing cuts, endangering the achievement of the Sustainable Development Goal (SDG) targets. Yet, a new report from the Task Force on Fiscal Policy for Health,1 supported by Bloomberg Philanthropies, aiming to address the growing global burden of non-communicable diseases, shows that governments globally are missing the opportunity to implement a simple solution: a one-time tax increase on tobacco, alcohol, and sugary beverages (so-called health taxes); raising prices 50% would raise US$3·7 trillion over the next 5 years—$2·1 trillion in low-income and middle-income countries and $1·6 trillion in high-income countries.

President Trump. Again. The first time around, a past editor-in-chief of an American medical journal refused to allow the President to be called “President” in his pages. A resistance, of sorts. What can we expect from Trump 2.0? Will he withdraw US membership of the World Health Organisation, as he did during the COVID-19 pandemic? Will he once more take America out of the Paris climate agreement? The trauma and grief among more liberally minded observers of US politics are palpable. But those of us who would not have voted for this man should ask ourselves why we feel this way.

If adopted into law, the legislation would make Brazil one of the few places in the world to have explicit protections against weight-based discrimination. Tony Kirby reports.

The G20 Leaders’ Summit in Rio de Janeiro on Nov 18–19 will address global health, but uncertainty over multilateralism under a new US President looms large. John Zarocostas reports.

For researcher Elizabeth Kimani-Murage, nutrition and food systems featured in life early on. As a young girl growing up in Kiambu, Kenya, she would help grow crops on the family's farm. “We undertook subsistence farming—to feed ourselves, share or exchange with neighbours, and whatever was excess was either stored for future use or sold”, she recalls. Later, her “desire to work in development” led her to complete an undergraduate degree in environmental health, followed by a master's in public health at Moi University, Kenya, and a PhD in public health nutrition from the University of the Witwatersrand, South Africa.

When I first heard, back in 2015, that the activist Caroline Criado-Perez had succeeded in her campaign against the near total disappearance of women from British bank notes, I was impressed but also a little perplexed. With problems like the gender pay gap and violence against women still crying out for solutions, the fact this wonderful feminist was electing to direct her energies here struck me as a bit niche. It wasn’t until a while later, when I found myself sharing the stage with Criado-Perez at a book festival, and heard her talk not only about the motivation for her campaign, but the awful backlash of rape and death threats it had provoked, that I realised how naive I had been.

There is a fine line that you must walk if you speak up against injustice done to marginalised people by people who hold power. Or if you fight for health equity as part of or on behalf of such marginalised people: women, people living with disability or poverty, people who are minoritised based on their sexual, gender, or racial identity, Indigenous people, people in or of the Global South, or patients who are members of marginalised groups. It is the line between lionising the marginalised and demonising the powerful; between noting the differences between groups and applying the differences to individuals; between seeing connections among people and singling out one group when you speak up; between noting the agency of people from marginalised groups and only emphasising their suffering; between recognising progress and drawing attention only to inequities; between recognising that each group is both fragile and strong and framing marginalised groups as necessarily fragile and those with power as necessarily strong; between fighting with love and fighting like a monster.

Cardiologist and coronary care unit pioneer. He was born in Rochester, NY, USA, on June 18, 1927 and died in Easthampton, MA, USA, on Sept 8, 2024 aged 97 years.

The world's first self-amplifying mRNA vaccine, or replicon vaccine, was administered in Japan to prevent SARS-CoV-2 infection.1 Similar to other infodemics related to COVID-19 vaccines,2 misinformation about replicon vaccines has spread, with some academic societies issuing statements based on misinformation and even public health centres emphasising that they have not introduced replicon vaccines in their cities.

In 2023, wars and violence displaced over 6 million people from their home countries.1 The USA is one of the primary destinations for refugees and asylees (ie, individuals who have been granted asylum status).2 The difficult asylum journey, coupled with insufficient access to health-care services, often turns treatable diseases into permanent disabilities.3 Refugees and asylees with disabilities face increasing challenges that are often overlooked by institutions, service systems, and the research community.

WHO defines female genital mutilation (FGM) as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons” and medicalised FGM as “situations in which FGM is practiced by any category of health-care provider, whether in a public or private clinic, at home, or elsewhere”.1 Female genital cosmetic surgery (FGCS)—including the most common form, labiaplasty—similarly involves partial or total removal of the external female genitalia for non-medical (ie, aesthetic) reasons and is practiced by a health-care provider, usually a medical doctor, in a public or private clinic.

In relation to the Review on hypopituitarism by Maria Fleseriu and colleagues,1 we would like to raise awareness about Nakalanga syndrome, a poorly understood condition most likely caused by hypopituitarism. This syndrome was first described in the late 1950s among the inhabitants of Mabira Forest, an onchocerciasis-endemic area in south-eastern Uganda.2 This syndrome is characterised by emaciation, stunted growth, delayed sexual development, mental impairment, facial dysmorphia, and thoracic and spinal abnormalities.

Park S-J, Ahn J-M, Kang D-Y, et al. Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial. Lancet 2024; 403: 1753–65—In table 2 of this Article, the proportion of patients in the optimal medical therapy group with target-vessel-related myocardial infarction at 4 years should have been 0·9%. This correction has been made to the online version as of Nov 14, 2024.

Glofit-GemOx had a significant overall survival benefit compared with R-GemOx, supporting its use in transplant-ineligible patients with relapsed or refractory diffuse large B-cell lymphoma after one or more previous lines of therapy.

A 13-year-old boy with a history of fatigue, facial and lower limb oedema, and an intermittent cough was seen at our institution for further evaluation and intervention.

Oesophageal cancer is the seventh leading cause of cancer mortality worldwide. Two major pathological subtypes exist: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Epidemiological studies in the last decade have shown a gradual increase in the incidence of oesophageal adenocarcinoma worldwide. The prognosis of oesophageal cancer has greatly improved due to breakthroughs in screening, surgical procedures, and novel treatment modalities. The success achieved with combined modality therapies, including surgery, chemotherapy, and radiotherapy, to treat locally advanced oesophageal cancer is particularly notable.

Cardiogenic shock is a complex syndrome defined by systemic hypoperfusion and inadequate cardiac output arising from a wide array of underlying causes. Although the understanding of cardiogenic shock epidemiology, specific subphenotypes, haemodynamics, and cardiogenic shock severity staging has evolved, few therapeutic interventions have shown survival benefit. Results from seminal randomised controlled trials support early revascularisation of the culprit vessel in infarct-related cardiogenic shock and provide evidence of improved survival with the use of temporary circulatory support in selected patients.