Lancet

The story of child and adolescent health over the past 25 years is one of clear but sometimes stalled progress, followed by the catastrophically negative impact of COVID-19, from which many children's lives have not recovered. It started with a focus on reducing mortality in children younger than 5 years, which almost halved, from 9·9 million deaths in 2000, to 5·3 million in 2019. It then expanded to include ensuring that children and adolescents fulfil their cognitive developmental potential through tackling poverty, providing nurturing care (ie, health, nutrition, responsive caregiving, safety and security, and early learning), and focusing on a life-course approach.

For men with low-volume de novo metastatic castration-sensitive prostate cancer, radiotherapy to the prostate is a standard of care option due to the significant improvement in overall survival reported in the STAMPEDE trial.1 The HORRAD trial2 similarly investigated prostate radiotherapy in men with bone-only metastatic disease, but did not find a significant improvement in overall survival for patients with up to five bone metastases, likely because the trial overall was underpowered (low numbers in the group of patients with low-volume metastatic disease specifically)was underpowered.

“War destroys the present in order to alter the future. Genocide destroys the present and the past in order to abort the future.” Ghassan Abu-Sittah is a British-Palestinian professor of surgery and a plastic and reconstructive surgeon. He has worked in conflict zones in Yemen, Iraq, Syria, Lebanon, and Gaza. In April, 2024, students elected him Rector of Glasgow University. He was speaking at the London School of Hygiene and Tropical Medicine (LSHTM) last week at an event organised by the Health in Humanitarian Crises Centre—“The Role of Public Health Institutions in Ethical Reconstruction”.

The 2024 Access to Medicine Index shows that some manufacturers are increasingly prioritising LMICs, but broader interest in equitable access is waning. Udani Samarasekera reports.

“'Here is a story’, my grandmother used to begin her best tales, 'That is and isn't true,’” writes Patricia J Williams in The Miracle of the Black Leg: Notes on Race, Human Bodies, and the Spirit of the Law. Her grandmother's caveat captures Williams’ realised goal of balancing legal and factual discussion with an awareness of the narrative truths embedded in mythologies. Williams is known as the author of The Nation's revelatory Diary of a Mad Law Professor column and of superb, genre-traversing books such as Seeing a Color-Blind Future: The Paradox of Race and The Alchemy of Race and Rights that encompass law, social medicine, race, and culture.

Early in Amitav Ghosh's 2008 novel, Sea of Poppies, one of the central characters, Deeti, laces her mother-in-law's food and drink with opium. The more she gives the drug to the older woman, the more Deeti comes to admire its power: “how frail a creature was a human being, to be tamed by such tiny doses of this substance!”. Farming poppies near the East India Company's opium factory in Ghazipur, India, in the 1830s, Deeti considers the possibilities of having more opium at her disposal, “why should she not be able to seize kingdoms and control multitudes?”.

New medical students file into the Yale University Art Gallery and follow two senior facilitators to the contemporary art section. Most have no idea what a museum trip has to do with medical training; some of the students probably think this is yet another ice-breaker activity. The students settle around a large, vivid painting. A facilitator invites them to take a short time to silently observe the details of the artwork. Then she asks them to describe—not interpret—what they see: to paint a picture with words for someone who is not there with them.

Surgeon and pioneer of endoscopy. He was born in Szeged, Hungary, on March 14, 1921 and died in Thousand Oaks, CA, USA, on Aug 30, 2024 aged 103 years.

The UN has declared November 24 as World Conjoined Twins Day,1 an initiative led by Saudi Arabia to raise global awareness about the medical and societal challenges faced by conjoined twins and their families. This rare condition occurs in approximately one in every 75 000 births, often resulting in miscarriage, stillbirth, or early death due to severe congenital disabilities.2 For those who survive, the challenges are immense, as some conjoined twins share vital organs such as the heart, brain, or liver.

The Abyei Area Administration (Abyei) is disputed between Sudan and South Sudan, having experienced conflict and tensions over the last 18 years. Despite international efforts, this dispute remains unresolved. In June, 2011, an agreement was made to establish joint administration,1 but this has not yet materialised. Currently, Khartoum (Sudan) manages the north region and Juba (South Sudan) oversees the south region. Both of these administrations face challenges in providing services to their communities, which are affected by humanitarian crises, drought, infectious disease outbreaks, armed conflicts, and population displacement.

In September, 2024, WHO announced a partnership between its Fides network of health influencers and the social media platform TikTok to promote science-based health information and encourage positive health dialogues to counter misinformation.1

For the first time since 1964, the revised Declaration of Helsinki provides an ethical framework for medical research and explicitly states that its provisions apply to all research participants, “whether patients or healthy volunteers”.1 This statement is important since, alongside patients, healthy people participating in biomedical research greatly contribute to advancing science. Globally, every year, thousands of healthy volunteers participate in clinical trials that include phase 1 first-in-human studies and studies that fulfil other research and regulatory needs that cannot be addressed by patients alone.

The recent update to the World Medical Association's Declaration of Helsinki,1 adopted at the 75th World Medical Association General Assembly in October, 2024, signals yet another milestone in the ongoing effort to safeguard ethical standards in medical research involving human participants. As with previous revisions, this update aims to reflect contemporary challenges, but it raises questions about the extent of its novelty and efficacy in addressing the evolving landscape of medical research.

We read with great interest the results from the ENGOT-cx11/GOG-3047/KEYNOTE-A18 trial reported by Domenica Lorusso and colleagues.1 The improvement in progression-free survival is exciting but difficult to interpret without additional radiation details and sites of progression. The total equivalent dose in 2 Gy fractions is reported as 87 Gy (IQR 83–92), which suggests that 25% of patients received less than 83 Gy. Data from EMBRACE-1 show that the minimum dose that covers 90% of the target volume of 85 Gy is required to offer a 95% chance of local control at 3 years for squamous cell cancers, and an even higher dose is needed for adenocarcinomas.

We read with interest the Article by Domenica Lorusso and colleagues about the ENGOT-cx11/GOG-3047/KEYNOTE-A18 trial.1 This phase 3 study showed that pembrolizumab, when administered in combination with chemoradiotherapy, resulted in a statistically significant improvement in progression-free survival, compared with chemoradiotherapy alone, for patients with locally advanced cervical cancer. However, the results are difficult to interpret.

We commend Domenica Lorusso and colleagues for their Article1 reporting a phase 3 clinical trial that analysed the comparison between pembrolizumab or placebo combined with chemoradiotherapy in the treatment of newly diagnosed, high-risk, locally advanced cervical cancer. However, the strength of evidence in this study could be enhanced by further discussion of some issues.

Regarding the Article by Domenica Lorusso and colleagues on ENGOT-cx11/GOG-3047/KEYNOTE-A18,1 this trial finally shows the long-awaited progress in patients with high-risk locally advanced cervical cancer: addition of pembrolizumab to chemoradiation statistically significantly improved progression-free survival at 24 months. We do not want to question the results of a randomised controlled trial or the potential role of pembrolizumab, but we would like to focus attention on the central treatment component, which is chemoradiotherapy, including brachytherapy.

We thank our colleagues for their interesting comments on our Article1 and the chance to expand on several study details. Mitchell Kamrava and Sushil Beriwal note that our patients received a lower total cervix equivalent dose in 2 Gy fractions than that reported in EMBRACE-I.2 Correspondence from Maximilian P Schmid and colleagues suggests an unused radiotherapy potential after adjusting the EMBRACE-I cohort to the high-risk definition in ENGOT-cx11/GOG3047/KN-A18. Such cross-study comparisons are challenging due to differences in endpoints, population risk, enrolment periods, and number of study sites and might yield misleading results.

Combining radiotherapy with standard of care plus abiraterone improves radiographic progression-free survival and castration resistance-free survival, but not overall survival in patients with low-volume de novo metastatic castration-sensitive prostate cancer. Radiotherapy reduces the occurrence of serious genitourinary events, regardless of metastatic burden and without increasing the overall toxicity, and could become a component of standard of care in patients with both high-volume and low-volume de novo metastatic castration-sensitive prostate cancer.

A 23-year-old woman with a 1-week history of a rash, fever, diffuse arthralgia, sore throat, and oral oedema attended our hospital. The patient had previously been fit and well; she had no medical history and was prescribed no medications.