Lancet Editorial Research Articles

Introduction to the special issue “Higher education during and after COVID in Central and Eastern Europe”

Is there a need for more research on the effects of COVID-19 on education? While there is research suggesting that the impacts and “the troubling effects of the pandemic on research and higher education… might be felt for years to come” (The Lancet Editorial, 2020), there is also discernible pandemic fatigue, not only among the population, but researchers and subjects of research as well (Patel, Webster, Greenberg, Weston, & Brooks, 2020). Indeed, there has been an overabundance of published research articles in nearly all disciplines about the pandemic. The purpose of the current special issue is not to repetitively take stock of what happened during the pandemic but rather explore how the pandemic transformed the education system while rethinking certain practices and strategies engrained in the education system. To some extent, then, taking stock of what we know about the pandemic should help us prepare for the era some call the “new normal post-COVID-19 era” (Cahapay, 2020).

The Spread of the Epidemic Among Vulnerable Groups and Related Epidemic Prevention Issues

The COVID-19 pandemic has highlighted the adverse health, economic and social consequences of longstanding social inequality on various communities, groups, and individuals. Because they lack sufficient access to health and social resources, vulnerable groups affected by lower incomes, geographic remoteness, and/or low awareness of disease prevention and control measures are more susceptible to infection (McDonald, 2022; Mein, 2020; Moghanibashi-Mansourieh, 2021). According to The Lancet (2020) editorial board, vulnerable groups are defined as segments of the population disproportionately exposed to risk. People not considered vulnerable at the start of the pandemic may become vulnerable afterward due to pandemic-related effects such as loss of income and lack of access to social support. Thus, during the COVID-19 pandemic, vulnerable groups include not only traditionally vulnerable populations (e.g., older adults, infants, immuno-compromised individuals) but socioeconomic groups that may be financially, mentally, or physically struggling to cope. In addition, schools of all levels around the world have adopted remote online synchronous or asynchronous teaching methods to avoid pandemic-related school closures and interruptions in student learning (Dreesen et al., 2020). However, issues such as the accessibility, availability, acceptability, and applicability of online learning equipment for vulnerable students should be comprehensively considered by the government. Governments encounter multiple challenges related to the above-mentioned issues, including (1) dealing with the public health effects of the pandemic crisis; (2) dealing with related economic and social impacts such as social and economic depression due to isolation, tax reductions, increased payments, subsidies, compensation, and the provision of unemployment insurance (Moghanibashi-Mansourieh, 2021); and (3) reforming education teaching methods and providing appropriate information and equipment of vulnerable groups. In responding to COVID-19, policymakers should consider the risks of exacerbating the inequalities faced by vulnerable groups. Moreover, vulnerable groups should be clearly identified to limit the long-term consequences of the pandemic. Governments must continually identify vulnerable / at-risk populations and provide equitable support to those most at risk.

Permission to Narrate a Pandemic in Palestine

Permission to Narrate a Pandemic in Palestine

Misleading and Biased Lancet Editorial on Kashmir: What are the Authors Hiding?

Misleading and Biased Lancet Editorial on Kashmir: What are the Authors Hiding?

Fear and uncertainty around the Lancet's editorial

Fear and uncertainty around the Lancet's editorial

Invisible smoke: third-party endorsement and the resurrection of heat-not-burn tobacco products

BackgroundTobacco companies are introducing new ‘heat-not-burn’ cigarettes in dozens of countries. Historically, these products failed commercially, and independent researchers contested their health claims. The most prominent early heat-not-burn cigarette was...

21st century telemetry

Despite having been around in one incarnation or another since the early 20th century, as recently as 1995 the full potential of telemedicine—electronic dissemination of medical information over a distance—was still very much underappreciated. A Lancet editorial on the topic asked the question whether this was a fad or the future, and opined on what effect, if any, telemedicine would have on medical practice in the year 2000.1The LancetTelemedicine: fad or future?.Lancet. 1995; 345: 73-74Crossref PubMed Scopus (91) Google Scholar Of course, such discussions could not have even begun to factor in the incalculable boost to be gained from improvements in telecommunications networks and computer-based applications that were just around the corner, leading to an expansion of the landscape of teleconsultation, tele-education, and even telediagnosis, that would be unrecognisable to even the most techno-savvy commentator back then.2Larner AJ Teleneurology: an overview of current status.Pract Neurol. 2011; 11: 283-288Crossref PubMed Scopus (41) Google Scholar Some specialties and more visual disciplines, such as radiology and pathology, lend themselves better to telemedicine than others; accordingly, neurology is a natural fit with the advantages of telemedicine and has even coined its own subspecialty: teleneurology. While teleneurology has been applied to many neurological disorders, such as headache, dementia, movement disorders, and multiple sclerosis, it is in stroke that teleneurological applications have predominated;2Larner AJ Teleneurology: an overview of current status.Pract Neurol. 2011; 11: 283-288Crossref PubMed Scopus (41) Google Scholar, 3Fassbender K Balucani C Walter S Levine SR Haas A Grotta J Streamlining of prehospital stroke management: the golden hour.Lancet Neurol. 2013; 12: 585-596Summary Full Text Full Text PDF PubMed Scopus (194) Google Scholar however, with new interface technologies comes more potential for telemedical applications in epilepsy.4Holmes D Can technology reveal the ecology of epilepsy?.Lancet Neurol. 2014; 13: 347-348Summary Full Text Full Text PDF Scopus (3) Google Scholar But as the initial problems based on the limitations of the technology platforms have been negated, a whole new tranche of obstacles to the wider adoption of telemedicine seem to have supplanted them, including the questions about the standards used to assess the economic benefits, the socioeconomic effects, the factors that promote uptake, the qualitative methods used, and the design of some of the reported studies.5Ekelend AG Bowes A Flottorp S Methodologies for assessing telemedicine: a systematic review of reviews.Int J Med Inform. 2013; 81: 1-11Summary Full Text Full Text PDF Scopus (121) Google Scholar However, reiteration of the requirements still needed can only be for the good and make the wider integration of telemedicine achievable.

Italian guidelines on thrombolysis indications in ischemic stroke have been revised after IST-3 trial and Cochrane revision: cons

One of the milestones of evidence-based medicine is the critical appraisal [1]. Critical appraisal shifts clinical practice from eminence-based medicine (medicine based on authority) to evidence-based medicine (medicine based on the proof and the judgment of the proof). Clinical practice guideline recommendations should be based on the best available evidence. Therapeutic recommendations should be developed upon randomized controlled trials (RCTs) with clinically relevant (defined as ‘‘hard’’) primary end points, low risk of bias, rigorous internal validity and good external validity [2]. The Italian guidelines on thrombolysis indications in ischemic stroke [3] have been revised after the IST-3 trial [4]. Does IST-3 satisfy the above-mentioned RCT characteristics providing the best evidence on which a clinical practice guideline should be modified? When the IST-3 trial was published many considered it the end of the struggle between ‘‘pros’’ and ‘‘cons’’ about thrombolysis [5–7]. Indeed IST-3 is the largest trial on this topic. The Lancet editorial accompanying the IST-3 trial claims ‘‘The role of stroke and emergency physicians is now not to identify patients who will be given rt-PA, but to identify the few who will not’’ [5]. An authoritative IAEM editorial [8] commenting on the IST-3 trial concludes ‘‘We have no longer to ask the age, but just the onset time!’’ However, some weaknesses should be considered [9] and we suggest that there are still some reasons to introduce some notes of caution. If a large trial has some biases, it should not be considered as the ‘‘best’’ evidence and used to change the recommendations of clinical practice guidelines. The aim of this paper is not a comprehensive critical appraisal of the IST-3 trial, already published [10]. We would like just to highlight some major criticisms indicating that maybe the IST-3 trial results are not adequate to change clinical practice.

New Data on Aspirin and Colorectal Cancer Brings Calls for New Guidelines, More Research

T hree large studies in the past 14 months have reopened a longstanding issue in colorectal cancer: Can aspirin prevent it? Or more precisely, is the evidence for preventive benefit in people at average risk strong enough to outweigh the known risks of regular aspirin use? Up to now, the committees that draw up cancer prevention guidelines have concluded that the evidence for aspirin ’ s benefi ts was insuffi cient when weighed against the risk of gastrointestinal bleeding, a common side effect that can be severe; aspirin can also cause hemorrhagic stroke. But the new studies, though not perfect, could tip the scales in favor of aspirin, say some experts. The accumulated data now “arguably support more general recommendations to consider aspirin for prevention of colorectal cancer in the context of individualized risk-benefi t assessments,” wrote Andrew Chan, M.D. Harvard Medical School, Boston, and Scott Lippman, M.D. at the M.D. Anderson Cancer Center in Houston, in their Lancet editorial on December 17 th . “We ’ re in a situation where no single study will settle all the questions for everyone,” Chan said in an interview. “But a lot of evidence is in and we’ve reached a point where there is a suffi cient body of evidence for us to no longer question if aspirin can prevent colorectal cancer, but to decide what kind of risk stratifi cation we need.” Others argue that the evidence is still not strong enough, pointing to weaknesses in the new studies. Nevertheless, it seems certain that guideline committees will revisit the issue in 2012 and that ongoing research on aspirin ’ s risks and benefi ts in cancer prevention has taken on new visibility.

The NHS IT project: more than just a bad dream

There is much in The Lancet's Editorial (Aug 13, p 542)1 on England's National Programme for Information Technology (NPfIT) in the National Health Service (NHS) that it is difficult to argue with. Our assessment of the implementation of NHS electronic health records revealed the problems faced by hospitals in implementing NPfIT systems which, more often than not, failed to benefit clinicians or patients.2,3

An Invitation to Our Medical Colleagues: Work with Us

I read your June 26-July 2, 2010 issue, dedicated to diabetes, cover-to-cover, reviewed the cited references, and carefully studied The Lancet editorial. To my amazement, there was not one mention of metabolic/ bariatric surgery, the only proven method of resolving the clinical and laboratory manifestations of type 2 diabetes in about 80% of patients [1–4]. Though this technology is not suitable or available to all type 2 diabetics, it is an alternative for millions of people and, most importantly, metabolic/bariatric surgery is a clinical laboratory for diabetes research.

Type 2 Diabetes in Oman: Can we learn from the Lancet editorial.

more than 75% of the disease burden in Oman is attributable to non-communicable diseases (NCDs) with the distribution of chronic diseases and related risk factors among the general population being similar to that of industrialized nations; 12% of the population have diabetes, 30% are overweight, 20% are obese, 41% have high cholesterol, and 21% have the metabolic syndrome. The findings related to diabetes from the above recent review article, 2 does not paint a good picture regarding diabetes control, since Omanis have high rates of diabetes-related complications; more than 14% were found to have diabetic retinopathy, 27% had microalbuminuria, and more than 50% of amputations are attributed to diabetes mellitus. Another review also noted that as Oman continues through the epidemiological transition and socioeconomic development, the burden of NCDs, particularly cardiovascular diseases and diabetes, can only be expected to increase. 3 Higher prevalence rates of diabetes have been identified in more urbanized areas of the country (18%) relative to more rural areas (11%). 4 An earlier study found that only one-third of people with diabetes knew that they had the condition. 5 There are concerns about the financial implications of diabetes in the Arab countries. A recent conference on health economics proposed to issue the ‘Riyadh Declaration’ as a guiding framework to address the challenges of diabetes particularly from an economic standpoint. 6 Some of the objectives of the conference were in fact in tune with what the Lancet editorial is now proposing. These include shedding light on all aspects of economics of diabetes including the medical and social issues at the international, regional and gulf level; illuminate the immense challenges imposed by diabetes on the heath systems and healthcare costs (whether direct or indirect); propose and present responses to confront these challenges, with presentation of effectiveness models; involve key stakeholders in the management of Diabetes and impart significance to their role in combating diabetes; increase the knowledge of governmental officials and others concerned with and interested in the economic aspects of diabetes; and present outstanding international

Significant fall in hormone replacement therapy prescription in general practice

Hormone replacement therapy (HRT) in the past has been used in one of five women but not without significant short-term and long-term consequences. Objective. The aim of the study is to assess the prescription of HRT in general practice to women consulting with menopausal symptoms, before and after publication of the Women's Health Initiative (WHI) study (2002), the Million Women Study and the Lancet Editorial (2003), and to correlate these with co-morbidity, co-medication and frequency of GP consultation. Methods. The study was performed using data collected by a Dutch Continuous Morbidity Registration. We selected women who presented with menopausal symptoms for the first time during the period 1999-2007 (n=341). Women who were prescribed HRT between 2002 and 2007 were compared with women presenting with menopausal symptoms without HRT prescription and women who did not consult for menopausal symptoms. Both control groups were matched for age, socio-economic status and general practice. Results. HRT prescription decreased considerably: from 37% in all women who present with menopausal symptoms at the GP 2002 to 14% in 2003 and 4% in 2004. Women who consulted for menopausal symptoms, irrespective of HRT prescription, presented with nervous functional complaints more often, were prescribed more tranquillizers and visited the GP more frequently than women who did not consult for menopausal symptoms. Conclusions. These GPs were very quick to implement new recommendations on HRT prescription. The decision to prescribe HRT was not correlated with specific emotional or psychiatric problems of the menopausal women.

Body Mass Index and Weight Distribution

It has been accepted for many years that being overweight or obese, as indicated by a body mass index (BMI) of 25 or over for the former and 30 or over for the latter, is associated with impairment of long term health and prognosis. The World Health Organisation (WHO) has indicated that, in Caucasians, waist measurements of 94 cm or more in men, and 80 cm or more in women have similar adverse effects on health, with increased risks at 102 cm or more in men and 88 cm in women. The role of waist-hip ratio (W/H) and whether it represents a better index than waist (W) measurement alone is being debated; many papers favour waist measurement alone. But two papers in 2005 discussing 27,098 subjects, 12,461 of whom had myocardial infarction and 14,637 controls, come down firmly in favour of W/H and were followed by a Lancet Editorial entitled 'Farewell to Body Mass Index?' Life assurance companies at medical examination usually request height and weight measurements (and therefore BMI). Most ask for waist measurements and a few hip measurements in addition (and therefore W/H). The authors have reviewed the data in 816 consecutive subjects for life assurance examination in whom BMIs, Ws and W/Hs were all recorded. In these the evidence supports the use of W as the best indicator of risk in men (634 cases), but not in the relatively small number of women (182 cases) in whom H appeared better. We believe that BMI, W and W/H should be recorded in every subject at life assurance examination so that the insurance companies in the long term will be able to reach valid conclusions about their individual and collective value.

WITHDRAWN: HIV-AIDS hypothesis out of touch with South African AIDS - A new perspective

This Article-in-Press has been permanently withdrawn. The editorial policy of Medical Hypotheses makes it clear that the journal considers "radical, speculative, and non-mainstream scientific ideas", and articles will only be acceptable if they are "coherent and clearly expressed." However, we received serious expressions of concern about the quality of this article, which contains highly controversial opinions about the causes of AIDS, opinions that could potentially be damaging to global public health. Given these important signals of concern, we commissioned an external expert panel to investigate the circumstances in which this article came to be published online. The panel recommended that the article should be externally peer-reviewed. Following a peer-review process managed by The Lancet editorial team, all five external reviewers recommended rejection, as a result of which the expert panel recommended permanent withdrawal. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

WITHDRAWN: Aids denialism at the ministry of health

This Article-in-Press has been permanently withdrawn. The editorial policy of Medical Hypotheses makes it clear that the journal considers "radical, speculative, and non-mainstream scientific ideas", and articles will only be acceptable if they are "coherent and clearly expressed." However, we received serious expressions of concern about the quality of this article. Given these important signals of concern, we commissioned an external expert panel to investigate the circumstances in which this article came to be published online. The panel recommended that the article should be externally peer-reviewed. Following a peer-review process managed by The Lancet editorial team, all five external reviewers recommended rejection, as a result of which the expert panel recommended permanent withdrawal. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Thank you to all our clinical and statistical peer reviewers!

At the end of last year, we launched a faster and much improved website. As promised, we are continuing to expand the service off ered by TheLancet.com and our users can now set up tailored search alerts. The latter allow a user to be notifi ed of each new instance of Lancet content that matches personally selected keywords. Search alerts provide an opportunity not only for faster and more targeted access to our content but also for more targeted advertising. We were therefore approached by colleagues in our advertising department and asked whether we would allow drug-company advertisements that matched users’ preferred search terms to be displayed alongside the search results. Much debate surrounds the appearance of drug advertisements in medical journals—in print and, increasingly, online. All Lancet editorial decisions are made strictly and entirely independently of advertising. We have agreed that such advertising might appear. However, we have stipulated that advertising sponsors may select keywords based only on clinical specialties (eg, “oncology”) or disease conditions (eg, “breast AND cancer”)—they cannot select keywords based on a drug name or drug class. We were also concerned that there might be occasions when a user’s search alert contains only one matching article. Were an advertisement for a drug mentioned in the article to appear in the alert, the coincidence might erroneously be perceived to be a link between editorial and advertising decisions. To avoid any such misperceptions, we have also specifi ed that such advertisements may appear only if a search result contains at least three items of content. We welcome readers’ views on this new arrangement and will continue to strive to be transparent on all similar editorial policies.

Editorial

Editorial

Mental health in the Syrian Arab Republic

The following view was espoused in a 1903 Lancet editorial describing psychiatric services in the East: 'The treatment of lunatics in the East has not yet fully emerged from the clouds of ignorance and barbarism which have surrounded it for ages.' One of the first reformers was 'Mr. Theophilus Waldmeier, a gentleman resident in Syria, who commenced in the spring of 1896 the work of helping and providing for the numerous sufferers from mental disease in Syria and Palestine.' He attempted to introduce the methods of humanity and science in this field. In 1939 Bernstein described his visit to the Maristan Arghoum, a psychiatric hospital, in the city of Aleppo. He observed the complete lack of medical supervision, 'bad' patients being chained and the despotic rule of the 'keeper' of the hospital.

Treatment of hypertensive emergencies: blood pressure cosmetics or outcome evidence?

For almost half a century, the standard approach to the treatment of hypertensive emergencies has been based on the evidence from a case series by Gifford. In this study, the blood pressure was promptly reduced with either reserpine, the drug of first choice at the time, or sodium nitroprusside.1 In 1991, the Lancet stated, ‘Clearly the immediate goal of treatment should be a reduction in pressure that begins quickly and continues gradually.’2 At that time, some of the preferred drugs to be used for achieving blood pressure control were sublingual captopril or nifedipine. Interestingly, the Lancet editorial also stated emphatically, ‘In case of doubt, nifedipine will be the safer option.’2 We, since then, have learned that this dictum was not necessarily true.