Lancet

Referred to as “cause for national shame” by the Health Secretary, Wes Streeting, maternity services in the UK have been the focus of repeated national scandals, with shocking reports of gross negligence and avoidable deaths in units across the UK. The largest maternity review in National Health Service (NHS) history, involving more than 2000 families, is now underway at Nottingham University Hospitals Trust. The government has promised the biggest reimagining of the NHS since its inception with the 10-year Health Plan, due this spring—in doing so, the government must deliver on long overdue pledges to improve maternity services.

The treatment landscape for first-line oncogene driver-negative metastatic non-small-cell lung cancer (NSCLC) has remained largely unchanged in recent years. Since the 2016 approval of the anti-PD-1 immune checkpoint inhibitor (ICI) pembrolizumab for front-line treatment of patients with metastatic NSCLC with PD-L1 expression of 50% or greater,1 numerous ICI monotherapies and combination regimens have followed. With an abundance of treatment options already available in the first-line setting, the HARMONi-2 trial—the results of which are presented by Anwen Xiong and colleagues in The Lancet2—raises critical questions: does ivonescimab, a novel bispecific antibody targeting VEGF and PD-L1, offer meaningful clinical advantages over existing PD-1 or PD-L1 inhibitors? And is there a compelling need for another therapeutic option in this space?

Germany's likely new Chancellor inherits a series of plans for health reform and must deal with an ageing population and underinvestment in infrastructure. Ferry Biedermann reports.

More than 300 cases have been reported, which experts have linked to infection with Campylobacter jejuni. Samaan Lateef reports from Mumbai.

The government is investing in a new single-dose vaccine as São Paulo state declares a state of emergency. Lise Alves reports.

Founded 5 years ago, the Institute of HIV Research and Innovation works with communities to answer the research questions that matter most to them. Sima Barmania reports from Bangkok.

Libby Sallnow is Associate Professor in Palliative Care in the Marie Curie Palliative Care Research Department at University College London, UK, and a consultant at the Central and North West London NHS Foundation Trust. She is also a lead author of the 2022 Lancet Value of Death Commission. “I really don’t believe in one answer, and I practise that in medicine”, she tells me. “I’ve always lived in the grey, I think.”

“Littlewoods. Doyens, please”, I call as I perform a caesarean section. “Spencer Wells. Green-Armytages, please.” Obstetricians and scrub nurses will recognise these names—surgical instruments we use every day to operate on women, all named after men. During a recent laparoscopic salpingectomy for an ectopic pregnancy, my colleague remarked, “They’re called uterine tubes now, not Fallopian. We really should stop naming body parts after people.” As I gripped a surgical instrument clearly designed for hands much larger than mine, I was reminded of how much needs to change.

Amsterdam, the Netherlands, is known for its museums. Amid the museums dedicated to Dutch masters such as van Gogh and Rembrandt, it is easy to miss a gem. Tucked away in the quieter Amsterdam Zuidoost on the grounds of the Amsterdam Universitair Medisch Centrum is Museum Vrolik (Museum of the human body), and the city's oldest anatomical collection still in Amsterdam. Museum Vrolik contains human and non-human animal models, illustrations, and wet, dried, and wax-injected specimens and skeletons and is named after two professors of anatomy Gerard (1775–1859) and Willem (1801–63) Vrolik.

Neurosurgeon who pioneered deep brain stimulation in Parkinson's disease. Born in Dacca, East Pakistan (now Dhaka, Bangladesh) on Nov 9, 1956, he died of oesophageal cancer in Oxford, UK, on Oct 25, 2024.

In the Chief Medical Officer for England's 2018 independent annual report, we called for the creation of a Composite Health Index (CHI)1,2 to track and inform efforts to improve the nation's health. The UK Office for National Statistics (ONS) responded by developing a beta Health Index3 followed by three updates, the latest covering 2015–21, which was published in June, 2023.4 We commend the ONS for their work, although funding constraints have since halted updates. With the new Secretary of State prioritising health-driven economic growth, we believe a renewed CHI should play a key part in tracking and informing these efforts over the coming years.

Gene therapy for hearing disorders is a promising advancement in the treatment of genetic hearing loss, particularly OTOF-related deafness. Mutations in OTOF disrupt synaptic transmission in cochlear inner hair cells, leading to profound congenital deafness and being a major cause of autosomal recessive non-syndromic auditory neuropathy (DFNB9). For individuals affected, cochlear implants restore partial hearing but cannot fully replicate natural hearing, with limitations in sound quality and speech recognition, especially in noisy environments.

The increase in Alzheimer's disease worldwide1 poses an urgent need for a collaborative approach to use imaging data for enhanced diagnostic, predictive, and therapeutic strategies. Inspired by the success and mission of the European Federation for Cancer Images (EUCAIM), we urge the Alzheimer's research community to consider establishing a similar federated infrastructure specifically focused on Alzheimer's disease.

Early in epidemics of emerging infections, health agencies often restrict testing criteria to people who fit within a case definition or who have had a high-risk exposure. In the recent avian influenza A(H5N1) outbreak in the USA, the US Centers for Disease Control and Prevention recommended that H5N1 testing be limited to patients meeting epidemiological criteria, including those having close contact with birds or other animals known to be infected, those having contact with surfaces contaminated with infected animal products (eg, faeces, organs, or unpasteurised dairy products), or those visiting a live bird market with confirmed cases.

Low-income and middle-income countries (LMICs) host nearly 85% of the world's population and bear a disproportionate burden of critical illness. Yet, knowledge generation and dissemination in critical care remain dominated by academics from high-income countries (HICs). A key tool of this dominance is medical journals. The structural biases within the current publishing system prioritise the visibility of work from HIC-based academics, marginalising contributions from LMICs.1 This academic divide has historical roots in colonialism.

We read with interest the study by Peter A Campochiaro and colleagues on RGX-314 for neovascular age-related macular degeneration (AMD),1 which suggests that gene therapy could reduce the need for frequent intravitreal anti-vascular endothelial growth factor (VEGF) injections. However, some methodological concerns warrant further attention.

We thank Huixun Jia and Xiaodong Sun for their perspective on our study.1 The goals of this first-in-human trial were to identify safe doses of RGX-314 and an optimised protocol for advanced studies. Doses in cohorts 1 and 2 were very low, resulting in little expression of anti-vascular endothelial growth factor (VEGF) protein, and, reassuringly, supplemental anti-VEGF injections were needed (these cohorts were vector-treated controls). In cohorts 3–5, there was good expression of anti-VEGF protein: most participants had good control of exudation and many of those with persistent exudation did not improve with monthly supplemental injections.

We read with great interest the Article by Victor Tumukunde and colleagues on kangaroo mother care (KMC).1 The authors conducted a meta-analysis pooling the results from the OMWaNA trial with the WHO iKMC trial2 and eKMC trial in The Gambia. We strongly believe this pooling is unjustified because the OMWaNA study is not comparable with the iKMC trial in terms of participants, intervention, comparisons, and outcomes.

We read with considerable interest the Article by Victor Tumukunde and colleagues1 on the effectiveness of kangaroo mother care (KMC) before clinical stabilisation in sub-Saharan Africa. Although we commend the authors for their extensive research, we believe that their findings necessitate a deeper examination of the practicality and universal applicability of KMC in resource-constrained settings.2

We thank these colleagues for their letters regarding our OMWaNA trial.1 First, in response to Harish Chellani and colleagues from WHO's Immediate Kangaroo Mother Care (iKMC) trial,2 we welcome their insights on our meta-analysis pooling neonatal mortality effects of the OMWaNA trial with similar trials in sub-Saharan Africa, where neonatal mortality is highest. This meta-analysis was important in showing a significant relative reduction in 28-day mortality of 14% across the African sites of all three trials to date, with consistency across five of the six sites,1 all lower than the effect at the iKMC Indian site.