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[Perspectives] Rachel Clarke: writing life

“When I was really little”, says Rachel Clarke, looking back to her days at primary school, “we had to write a book called All About Me. Mine has a picture of me at a desk saying ‘When I grow up, I am going to be a writer of books.’” Clarke has more than fulfilled her childhood ambition and is the author of four books. The Story of a Heart, her account of a cardiac transplant from one child to another, won the UK's 2025 Women's Prize for Non-Fiction. Clarke divides her time equally between writing and work as a palliative care specialist in the UK.

[Comment] Offline: Watching the watchers (part 5)

Global Health Watch 7 (GHW7) is an important intervention in the theory and practice of global health, especially at a time of upheaval and uncertainty. (I am writing these words as I listen to the news that US forces have bombed Venezuela's capital, Caracas, and captured, arrested, and indicted the country's dictator-President Nicolás Maduro and his wife, Cilia Flores: the prospects for a rules-based world order have just swerved sharply towards danger.) The co-editors of GHW7, Ron Labonté and Chiara Bodini, have succeeded in offering alternative narratives to challenge prevailing beliefs and assumptions in global health—a discipline that rarely challenges the political and economic foundations of its work.

[Comment] Climate change, migration, displacement, and health: past, present, and future

The history of human health and migration, the human story, is deeply intertwined with the natural environment. As described by Anthony McMichael,1 pioneering scholar of health and environmental change, the climate is not merely a backdrop to human life, it is embedded in who we are and how we live. Modern human civilisation has been facilitated by the remarkably stable climatic conditions of the Holocene: the past 11 000 years during which century-to-century global average temperatures varied by no more than 1°C.

[Comment] Is proton therapy a new standard of care for oropharyngeal cancer?

The study by Steven J Frank and colleagues1 in The Lancet is the first randomised, phase 3 trial comparing intensity-modulated proton therapy (IMPT) with intensity-modulated radiotherapy (IMRT) in patients with oropharyngeal cancer. Support for the role of proton radiotherapy for head and neck cancer has previously come from dosimetric studies,2 as well as retrospective and case–control clinical reports.3–5 A study with early experience from the MD Anderson Cancer Center compared 50 patients treated with IMPT with 100 patients treated with IMRT, finding a significant reduction in acute gastrostomy tube use and severe weight loss with IMPT, but no difference in tumour control.

[Comment] A step forward in the treatment of relapsed or refractory follicular lymphoma

Follicular lymphoma remains an incurable malignancy characterised by successive relapses. Despite favourable initial responses to front-line therapy, most patients eventually relapse, and lymphoma or treatment-related complications remain the leading cause of death.1 Accumulating evidence shows that the duration of response shortens with each subsequent line of therapy, resulting in progressively reduced progression-free survival and overall survival after each line of treatment.2,3

[Comment] A new standard for relapsed or refractory follicular lymphoma

Despite progress since 2020, including the approval of immunotherapy as third-line treatment, relapsed or refractory follicular lymphoma remains a clinical challenge, particularly among patients with early progression or resistance to anti-CD20-based regimens. Although the combination of lenalidomide and rituximab is a well established, chemotherapy-free option endorsed by international guidelines, outcomes remain suboptimal in high-risk populations, underscoring the need for novel therapeutic strategies.

[Comment] Zoliflodacin shows benefit as an oral treatment for uncomplicated gonorrhoea

Neisseria gonorrhoeae inexorably develops resistance to antimicrobials used for treatment. The discovery of novel antimicrobials to treat gonorrhoea is a global priority and antimicrobial-resistant N gonorrhoeae has been identified as an urgent public health threat.1,2 Ceftriaxone remains the primary recommended regimen for gonorrhoea treatment globally. However, reports from China, Cambodia, Viet Nam, and the UK, among other countries, signal a rising threat to the preeminent place of ceftriaxone within the gonococcal treatment armamentarium due to decreased susceptibility to ceftriaxone and periodic ceftriaxone treatment failures, highlighting the importance of enhanced global antimicrobial surveillance to monitor resistance trends.

[Editorial] Responding to declining global fertility rates

The levying of a 13% tax on condoms sold in China from Jan 1 is the country's latest policy aimed at reversing its falling total fertility rate (TFR; the average number of children a woman might expect to have in her lifetime); additionally, couples can claim cash payments of 3600 yuan (US$500) a year for each child younger than 3 years, as part of a scheme announced in July, 2025. China is one of more than half of all countries where the TFR is below 2·1 births per woman, the level required to keep the population stable.

The US Food and Drug Administration’s Regulation of Mifepristone

This qualitative analysis uses information from US Food and Drug Administration (FDA) documents obtained through a Freedom of Information Act request to characterize the FDA’s decision-making with respect to the regulation of mifepristone, especially the agency’s rationale for establishing, maintaining, or modifying key components of its regulatory approach over time.

[Articles] Identifying undiagnosed HIV infected individuals in a community-based door to door testing initiative in outbreak affected areas of Larkana and surrounding districts, Pakistan

More than five years since the nosocomial HIV outbreak in Ratodero, undiagnosed HIV infections persist in the community. The undiagnosed HIV infection is common among children in Ratodero, and among both adults and children in surrounding areas. Self-reported HIV risk exposures point to reuse of needles and syringes as the predominant mode of transmission. The situation warrants urgent need to address unsafe injection practices and safety in healthcare facilities.

[Articles] Household SARS-CoV-2 transmission during Omicron wave in Chiang Mai, Thailand: a prospective observational study

Despite widespread vaccination, household transmission of SARS-CoV-2 remained common. Prior immunity in contacts and lower viral load in index cases reduced risk. These findings underscore the central role of households in ongoing spread and highlight the value of booster vaccination and genomic surveillance to clarify transmission pathways and inform prevention policies.

[Personal View] Expanding the neurological spectrum of HTLV-1 beyond HAM/TSP: a contemporary perspective

Human T-lymphotropic virus type 1 (HTLV-1) has long been linked mainly to HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, four decades of research show that the virus causes a much broader range of neurological conditions. In Latin America and the Caribbean—regions with high prevalence but limited awareness, diagnostic capacity, and treatment—its burden is especially severe. Misdiagnosis or neglect often delays care, leading to increased disability and emotional distress.

[Viewpoint] Ethical challenges and opportunities for integrating predictive analytics in community-based overdose prevention

As predictive analytics become more widely integrated into local public health responses to the United States overdose epidemic, community-based substance use service providers have begun to adopt machine learning-based predictive tools to guide the allocation and delivery of overdose prevention services. While these tools hold promise for anticipating community overdose risk and enhancing the efficiency of overdose prevention resource distribution, outreach, and education efforts, their use in community settings raises substantial ethical and practical challenges.

[Correspondence] Inclusion of incarcerated individuals in wildfire exposure registries

One year after wildfires tore through Los Angeles in January 2025, public health experts continue to examine the effects of this major wildland–urban interface (WUI) event on surrounding medically vulnerable communities.1 These are communities characterized by disproportionate exposure to poor air quality, elevated burdens of chronic illness, limited access to medical care, and a constrained ability to evacuate. Such vulnerabilities are heightened within jails and prisons, and yet the carceral population has been largely excluded from scrutiny despite their WUI fire exposure in the region.

[Comment] An undeniable public health urgency, but an incomplete response: centering racial and ethnic equity in Canada's “Strategic approaches to reducing the substance use-related burden of disease”

The recent article published in The Lancet Regional Health—Americas by Fischer and colleagues1 provides an important and useful appraisal of the burden of disease attributable to substance use in Canada, rightly emphasizing the urgency of effective public action. The authors pointed out three essential points. First, the scale and acceleration of the overdose crisis clearly demonstrate an imperative to act. Since 2016, tens of thousands of deaths from opioid toxicity have constituted a sustained public health crisis, with a strong predominance of fentanyl and other synthetic opioids in the illicit drug supply in Canada.