The National Institutes of Health Task Force on Research Standards for Chronic Low-Back Pain has released a set of standards for clinical back pain research aimed at producing more reliably designed research and better treatment solutions for those affected by back pain. The recommendations include a standard set of data collection questions intended to increase consistency between studies.
Last week brought renewed interest in the worldwide antimicrobial resistance crisis, which has a potentially devastating effect on human beings, livestock, and the global economy. This interest was stimulated by the publication on Dec 11, 2014, of Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations, from the Review of Antimicrobial Resistance, led by economist Jim O'Neill and informed by two reports prepared by consultants KPMG and RAND Europe; and by the first annual progress and implementation report on antimicrobial resistance by the UK Government, following their 2013 5-year strategy plan.
The Ebola outbreak in west Africa has taken a substantial toll on health-care workers in Guinea, Liberia, and Sierra Leone—not only doctors and nurses, but also other cadres including ambulance drivers, hospital cleaners, and burial team members. More than 600 of the nearly 17 000 cases of Ebola virus disease have been in health-care workers, more than half of them fatal. In today's issue of The Lancet we pay tribute to several of the health workers who have lost their lives to the disease since the outbreak began a year ago.
The Indian Government has announced that it will overturn Section 309, a controversial law criminalising suicide. The announcement follows a 2008 report from the Indian Law Commission that recommended repeal of the “anachronistic” statute, mandating that people attempting suicide would be presumed to be suffering from mental illness and thus not liable for punishment.
The 2014 update from the International Agency for Research on Cancer1 is a sombre reminder of the burden of morbidity and mortality resulting from cancer worldwide. Many cancer therapeutics are small, hydrophobic molecules, characterised by poor water solubility, rapid biodegradation, non-specific biodistribution, and off-target toxicities. As a result, these agents often show problematic dose-limiting toxicities, narrow therapeutic indices, and provide limited clinical benefit. These shortcomings underscore the need for alternative drug delivery systems that can offer advantages over traditional formulations and overcome such obstacles.
The Lancet asked authors in July, 2005, to present their clinical trials within the context of previous research findings and to explain how their findings affect the summary of evidence.1 5 years later, Michael Clarke and colleagues2 assessed how five major general medical journals (Annals of Internal Medicine, BMJ, JAMA, The Lancet, and The New England Journal of Medicine) had implemented a CONSORT requirement3 requesting authors to take into account the totality of evidence when reporting trial data.
β blockers have revolutionised the treatment of patients with heart failure and reduced ejection fraction. In quick succession, the results of three pivotal trials showed a reduction in relative risk of about a third in death from any cause with these drugs.1–3 Based on the highest level of evidence, β blockers are strongly recommended in clinical guidelines for the management of heart failure and reduced ejection fraction.4,5 These guidelines state that β blockers are indicated in all patients, except those with atrioventricular block, bradycardia, and asthma.
Earlier this year we invited readers to submit entries for the 2014 Wakley Prize Essay. We were rewarded by a rich selection of submissions that ranged from memorable encounters with patients to personal experiences of illness. The winning essay, “On seeing Roses”, by Johanna Riesel, a Paul Farmer Global Surgery Research Fellow in the Program in Global Surgery and Social Change at Harvard Medical School and a General Surgery Resident at Massachusetts General Hospital, is published in this issue.
At one of the first meetings of the UN Mission for Ebola Emergency Response, someone is reported to have said that if anyone present wanted to use Ebola as a reason to strengthen health systems they should leave the room. The Ebola response was about one goal and one goal only—getting to zero cases. How times have changed. Last week, WHO convened a High-Level Meeting on Building Resilient Systems for Health in Ebola-Affected Countries. What seems clear now is that Ebola in west Africa is not (only) about Ebola.
Neil Bennet looks back at the major medical, health, and humanitarian stories from 2014—a year in which Ebola took hold in west Africa and transplantation doctors celebrated advances.
It was difficult to select only 12 winners from the excellent submissions we received to this year's Highlights photography competition—the many entries were varied and often surprising.
The Ebola outbreak in west Africa has had a devastating effect on health workers in the three countries most affected by the virus. Of the nearly 17 000 cases of Ebola virus disease in Guinea, Liberia, and Sierra Leone, at least 600 have been among health-care providers. More than half of them have died. The outbreak has also claimed the lives of doctors, nurses, and technicians from Mali, Nigeria, Spain, and the USA.
In October 2014, during heightened news coverage about cases of Ebola in the USA, anecdotal observations suggested that many Americans were anxious about Ebola. Given the negligible risk of infection, their anxiety was arguably driven by perceived rather than actual risk. Exaggeration or reassurance from the media can inflame or subdue people's perceived risk of Ebola infection.1 Fear can also be acquired by observation of other people's experiences, as expressed on social media.2 Thus, social media amplified fear about the imported Ebola case.
The failure of the international response to the Ebola outbreak in Africa is sadly obvious. Without denying the commitment or the goodwill of non-governmental organisations, international agencies, and governments, or the substantial funding available, the results have clearly fallen short because the methods being used are not suited to the problem posed by this epidemic.1 Indeed, with an informed population and an effective health-care system, Ebola is not very contagious, as shown by the swift control of cases in Nigeria, Europe, and the USA.
The Lancet Editorial (Oct 25, p 1477)1 on the Ebola epidemic concluded that “the military seem set to play a greater part in global civilian health in the future”. This is challenging and deserves comments.
Despite rough agreement in global estimates of maternal mortality in 2013, results from the WHO1 and Global Burden of Disease (GBD) 20132 collaborations differed by 147 000 deaths for 1990, diverged by at least 20% in 120 countries in 2013, and provided very different narratives on progress toward Millennium Development Goal 5. The differences are crucial for global monitoring as well as national policy formulation and programme planning.
Nicholas Kassebaum and colleagues' Article (Sept 13, p 980)1 provides maternal mortality estimates. These data probably rely on death certifications, which have often revealed consistent under-reporting.2
We believe that maternal mortality in Greece was considerably overestimated in Nicholas Kassebaum and colleagues' Article.1 In Greece, the official data for maternal mortality are provided exclusively by the Hellenic Statistical Authority, who have followed the International Classification of Diseases (ICD)-9 (codes 630-676) classification since 1979. Therefore, despite the official data for 1990 reporting only one maternal death in Greece that was attributable to direct causes, we were surprised that Kassebaum and colleagues reported ten maternal deaths for that year.
Nicholas Kassebaum and colleagues1 noted that maternal deaths have decreased less rapidly worldwide between 1990 and 2010 than reported by the UN agencies. They attribute this difference partly to higher UN estimates of all-cause reproductive-age mortality, especially in west Africa. They state that the UN estimates almost exclusively uses child mortality to predict adult mortality in west Africa, whereas their estimates are based on actual data. However, this is not the case. UN adult mortality estimates for all 16 west African countries use all empirical evidence available, as publicly documented.
There is substantial evidence that doctors, including those in high-income countries, misdiagnose maternal deaths, whether deliberately or otherwise. In our study,1 we use generic correction algorithms to statistically correct for this misdiagnosis. All countries should periodically undertake scientific enquiries like that described by Serena Donati, not only to identify misdiagnosed maternal deaths, but also to identify more general systematic miscoding.2 We agree that adequate identification of pregnancy-related mortality and severe morbidity should be a focus even in high-income settings, as should accurate reporting of late maternal deaths.