Medical Journal News

A recent Lancet Editorial asserts that philanthropy in health is here to stay.1 Are these private actors altering the evolution of global and national institutions in ways that undermine planetary health equity—the equitable enjoyment of good health in a stable system?

During the COVID-19 pandemic, many states failed to meet their human rights obligations and commitments to equity, as Lawrence O Gostin and colleagues elaborate.1 Surprisingly, the authors omit rights violations related to border closures. One of the clearest cases is that of Australia.

We thank Diego S Silva and Oliver Razum and for the thoughtful and thorough analysis arguing that Australia's border closing to its own citizens during much of the COVID-19 pandemic was indeed a violation of their right to enter their own country.1 Given our focus on inequality and discrimination,2 we appreciate the emphasis on the unequal impact of Australia's border closing and mention of Australia's policy on asylum seekers, which pre-dated COVID-19. We would add that border closures to asylum seekers during COVID-19 (as in many high-income countries, such as the USA)3 were violations of the rights of some of the world's most vulnerable people—violations that should never be repeated in future health emergencies, or ever.

José Manuel Pérez-García and colleagues reported updated results from PHERGain, a randomised, phase 2 trial in patients with HER2-positive breast cancer.1 This trial investigated a chemotherapy-free treatment approach based on a dual HER2 blockade with trastuzumab and pertuzumab, with treatment decisions made based on early response on 18fluorine-fluorodeoxyglucose (18F-FDG)-PET during neoadjuvant therapy, then further adapted treatment according to pathology findings at surgery. With this strategy, the 3-year invasive disease-free survival was 94·8%, and about a third of patients could avoid chemotherapy.

We appreciate the Correspondence from Elif Hindié and David Groheux highlighting two important points from our PET-based, pathological complete response-adapted PHERGain strategy.1 This study met its two primary endpoints: the proportion of PET responders in group B with a pathological complete response (37·9%), and the 3-year invasive disease-free survival rate for the entire adaptive group (94·8%), which was similar to standard neoadjuvant treatment with chemotherapy, trastuzumab, and pertuzumab (HP), despite around 30% of patients completely omitting chemotherapy and a delay in chemotherapy administration for the remaining patients.

The Lancet. Cancer registries: the bedrock of global cancer care. Lancet 2025; 405: 353—In this Editorial, the spelling of Michel P Coleman's name has been corrected. This change has been made to the online version as of March 27, 2025.

Bowman SJ, Fox R, Dörner T, et al. Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sjögren's syndrome: a randomised, double-blind, placebo-controlled, phase 2b dose-finding trial. Lancet 2022; 399: 161–71—In figure 2E of this Article, the least-squares mean change from baseline in ESSPRI scores of the placebo group and the ianalumab 300 mg group were plotted incorrectly. In figure 2F, the percentages for ianalumab 50 mg at baseline, ianalumab 50 mg at week 24, and ianalumab 300 mg at week 24 were incorrect.

Ageing is a scientifically fascinating and complex biological occurrence characterised by morphological and functional changes due to accumulated molecular and cellular damage impairing tissue and organ function. Ageing is often accompanied by cognitive decline but is also the biggest known risk factor for Alzheimer's disease, the most common form of dementia. Emerging evidence suggests that sedentary and unhealthy lifestyles accelerate brain ageing, while regular physical activity, high cardiorespiratory fitness (CRF), or a combination of both, can mitigate cognitive impairment and reduce dementia risk.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

An error in ranking applicants for radiology specialty training programmes has led to job offers for some doctors being retracted.Resident doctors who applied for radiology were sent the outcomes of their applications on 24 March. They later received an update telling them that the offers had been made in error, as only one component of the multistage selection process had been taken into account. Offers based on the correct rankings were reissued two days later.Ahmed Mohamed had applied for radiology for the second time, having failed to secure a job offer last year. He told The BMJ that he was “so, so happy and excited” when he got an email telling him that he had been successful this time. But, after calling his family to celebrate, he had to tell them hours later that his offer was in question. He then spent two days constantly checking his emails. When the...

The latest YouTube craze?Thankfully not. Instead, this is good news. Surgeons have linked the move to a cashless society to a dramatic drop in children needing operations for accidentally swallowing small items such as coins.Cash isn’t king?Researchers reviewed hospital episode statistics (HES) between 2000 and 2022 for procedures to remove foreign bodies from the alimentary tract, respiratory tract, and nasal cavity in 0-14 year olds. The study, published in the Annals of the Royal College of Surgeons of England, found the total number of procedures fell from 2405 in 2012 to 1716 in 2022—a 28% reduction.1 Lead study author Akash Jangan, an ear, nose, and throat registrar, said, “Our research shows that using cashless payment methods instead of coins has potentially helped keep children safe and reduced the need for surgery.”The penny dropsThere are likely to be fewer lying around the house. Contactless payments were first introduced in the UK...

“What has happened has the potential to bring about massive retrogression. I’m very, very scared for the future,” Deborah Ikeh, executive director of the Debriche Health Development Centre, a non-governmental organisation (NGO) that supports community led monitoring of tuberculosis (TB) in Nigeria, says about US cuts to foreign aid.On 20 January President Donald Trump signed an executive order pausing foreign development assistance, including the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR), for 90 days, pending a programme by programme review.A brief respite came a week later when the US State Department signed a waiver preserving funding for “life saving humanitarian assistance.” But then in late February the Trump administration added further confusion by terminating nearly 10 000 contracts, including some with organisations that had previously been covered under the waiver.The result is panic and uncertainty. Johns Hopkins University is reportedly being...

In the past two years we have been involved in an expert panel convened by the Royal Society of Canada and the Canadian Academy of Health Sciences on Canada’s past and future global health role. Our report, published on 27 March 2025, aims to provide strategic insights and advice on Canada’s role in global health for the next two decades.1 The need for global leadership in health is clear: growing economic and climate threats, divisive politics, backlash against human rights, and powerful waves of misinformation threaten past gains in global health and cooperation. As we enter a new era shaped by isolationist geopolitics and the US retreating in global affairs, Canada’s role as a middle power, actively engaged in multilateralism, is more important than ever.2Greater clarity around Canada’s global health role is also relevant to current domestic affairs. The new leader of the Liberal party, Mark Carney, was appointed as...

Vaccination has been so successful in protecting whole populations from disease that it is now an often-repeated phrase that vaccines are victims of their own success. As vaccination rates rise, vaccine-preventable diseases become less common within society, creating the illusion that vaccination against these diseases is no longer necessary. This means that the more successful vaccines are, the harder health authorities must work to make their value apparent. During the covid-19 pandemic the need to vaccinate against SARS-CoV-2 was paramount, but uptake was nevertheless a challenge. It would be wrong, however, to view vaccination failures as being only the fault of those who do not want to vaccinate. Government failings should also be considered.These failings have been highlighted by the ongoing UK covid inquiry. Module four, which focused on vaccines and treatments, concluded in January 2025.1 The inquiry emphasised that the covid-19 vaccination is a success story from the pandemic,...

AbstractIdentifying patients with chest pain that is of cardiac origin is crucial owing to the high mortality and morbidity of cardiovascular diseases. History, electrocardiogram, and cardiac biomarkers are the core elements of the assessment. High sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers for diagnosing acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury. However, elevations in hs-cTn can occur in patients who are not experiencing acute myocardial infarction. Therefore, it is important for clinicians to recognize how to integrate hs-cTn levels into their clinical decision making process. Structured risk assessments, using evidence based diagnostic protocols, should be employed to estimate the risk of acute coronary syndrome and adverse events in patients with chest pain. Clinical decision pathways should be used routinely in emergency departments. Patients at intermediate or high risk of obstructive coronary artery disease might benefit from cardiac imaging and further testing. Patients should be involved in decision making, with information provided about risks, radiation exposure, costs, and alternative options to facilitate informed decision making.

Unlike true experiments that are conducted by researchers for scientific purposes, natural experiments occur when infrastructure, policies, or services are introduced or changed by governments or healthcare systems. Interventions of this kind are sometimes amenable to randomised controlled trials, for example, if the advantages of randomisation can be negotiated with policy makers or providers at the planning stage and the findings are likely to be transferable across several contexts. Although the randomised controlled trial remains an important method, there are occasions when a trial will not be appropriate or feasible for answering questions about infrastructure, policy, or service changes. However, provided that the intervention divides a population into groups that are otherwise similar, researchers can evaluate the health effects of the changes in a natural experimental evaluation. Natural experiments therefore generate valuable opportunities for evaluating population health, health systems, and other interventions, including those that are, for practical or ethical...