Lancet

“Racism must be opposed by all the means that humanity has at its disposal.” Nelson Mandela1

July 4: Independence Day in the USA. And independence day in the UK: the day when voters pass judgement on the present Conservative Government and choose one of several futures on offer from an array of splintered political parties. Elections are usually fought on domestic matters. According to Statista, the most important issues facing Britain are the economy (for 49% of the population), health (46%), immigration (38%), crime (23%), and housing (22%). One cannot disagree with those anxious or angry about a cost-of-living crisis or the continuing erosion of the National Health Service (NHS).

The firing of co-founder and Executive Director Roopa Dhatt has prompted outrage from members. By Udani Samarasekera.

New members of the European Parliament should “defend health in receiving the political priority that it deserves”, experts say. By Udani Samarasekera.

Hoard, the powerful debut feature from British writer-director Luna Carmoon, is preoccupied with the contents of bins, bodies, and brains. It is a film about hoarding, a condition that has long been recognised by clinicians, but which remains mysterious. Hoarding disorder was added to the ICD-11 in 2018, described as the “accumulation of possessions that results in living spaces becoming cluttered to the point that their use or safety is compromised”. This accumulation, it adds, is “due to both repetitive urges or behaviours related to amassing items and difficulty discarding possessions due to a perceived need to save items and distress associated with discarding them”.

The place we come from and our past experiences—the unresolved relationships, the happy memories, and the choices we did not make—all coalesce into who we are today. In his novel Requiem for a Nun, William Faulkner wrote “The past is never dead. It's not even past.” As the past continues to cast a shadow on their lives, that sentence could describe the four sisters who are at the centre of Jez Butterworth's new play The Hills of California, which is directed by Sam Mendes and in production at the Harold Pinter Theatre in London, UK.

When I started writing seriously—by which I mean daily—I had no intention of dealing with medical themes or, god forbid, the experience of being a doctor. On the contrary, the decision to try to write every day, making it a part of my life, was a deliberate attempt to carve out a space that was as far away from my medical career as possible.

Leading researcher on tobacco control and treatments for smoking dependence. He was born in Bath, UK, on May 22, 1950 and died of respiratory failure in Belo Horizonte, Brazil, on April 13, 2024, aged 73 years.

History was made in March, 2024, when Nigeria became the first country to introduce the Men5CV multivalent meningitis vaccine,1 an advance that will protect its population against the meningococcal disease that is prevalent in the core northern regions of the country.1

Iran, one of the most populous countries in the Middle East, with more than 80 million people, grapples with road traffic injuries that have become the second leading cause of disability and the third leading cause of death in the country, excluding COVID-19.1,2 Despite upstream national policies aiming for an annual reduction of road deaths by 10%, there was a disconcerting 15% increase in fatalities in 2022, compared with 2019.3 This alarming change is exacerbated by a 27% rise4 in crash fatalities involving motorcycles, mostly driven by high car prices and urban traffic congestion.

My colleagues and I recently argued that citation errors are not a victimless crime.1 Such errors can deeply mischaracterise individual scientific works, inappropriately slant clinical guidelines, and even, in the striking phrase of Steven Greenberg, enable “the conversion of hypothesis into fact through citation alone”.2

Over the last year, efforts in the USA have aimed to defund diversity, equity, and inclusion (DEI) infrastructures in education and professional organisations, including efforts to defund by state legislatures of Wisconsin, Florida, Texas, and Alabama1 and the American Academy of Dermatology.2 Additionally, these measures also aim to de-legitimise gender, sexuality, religious, African American, sociological, Indigenous, and ethnic studies at public institutions, as these studies inform progress in DEI.

Representing 145 national bodies and over 250 000 members, the World Psychiatric Association promotes international collaborations across mental health. In September, 2023, the World Psychiatric Association World Congress of Psychiatry in Vienna, Austria, attracted around 4000 delegates. Yet, reports emerged from prospective participants who were unable to attend due to stringent visa requirements, including those from countries such as Iraq, Nigeria, and Pakistan. Despite an increasing emphasis towards cross-cultural diversity in global health, these accounts show how visa challenges continue to impede researcher mobility and scientific exchanges.

Richard Horton's call to action to save medical education should sound an alarm for us all.1 With the British health-care system on its knees, the definition of what it means to be a doctor (hailing from the Latin, docere, to teach) is being eroded by our neglect of medical students.

We join in Richard Horton's call to act on diminished student wellbeing and the health-care emergency that is latent within the broader definition of sustainability.1,2 The progressive destruction of nature, in part mediated by the impacts of health-care systems in high-income countries, reflects the dominant societal fixation on resource extraction, heedless of the limits of planetary—or student—capacities. The broader loss of culturally based relationships with the planet and consequent deconstruction of an ethos of intergenerational ecological custodianship is coincident with the centring of reductionist thinking (disembodiment) in medicine.

We read the study by Caitlin Jones and colleagues,1 which prompted us to raise several concerns about it. The main issue we are concerned about is that the authors’ conclusion does not match nor reflect the trial's question, design, and scope. In both the abstract and discussion, the authors use the plural form opioids and state that they should not be used for acute low back and neck pain and further claim that their trial's findings call for reconsidering the guidelines of opioid prescription for those acute pain states.

We read with interest the study by Caitlin Jones and colleagues1 and their conclusion that short-term, judicious use of opioids for acute back pain conferred no benefit over placebo. However, we have some concerns.

Caitlin Jones and colleagues1 reported that in a randomised trial, opioids were not associated with a significant reduction in acute low back or neck pain. Their study provides significant insights during this opioid overdose crisis; however, a few issues should be addressed when interpreting the results.

As a neurosurgeon, I often feel helpless for patients with hyperalgesic lumbosciatica, and I am unable to give a scientifically valid answer to the emergency physician dealing with the case regarding the proper analgesic treatment to give. Lumbosciatica and cervicobrachial neuralgia have become the 21st century plague owing to the lifestyle shift to office work or to increased professional physical constraints. They are the first and the fourth cause of disability-associated years lived, respectively,1 being accountable for major economic loss estimated at US$100 billion in the USA each year.

We thank Asaf Weisman and colleagues, and Medhat Wahba and Pamela E Macintyre for their correspondence about our study.1 We chose to use modified-release oxycodone–naloxone combination to reduce the risk of opioid-induced constipation and protect blinding.1 This regimen also allowed the medication to be taken every 12 h (rather than every 4 h with immediate-release oxycodone), to facilitate treatment adherence. Regular doses of modified-release opioid will achieve equivalent steady-state oxycodone exposure compared with dosing with an immediate-release opioid within a few days.