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[Comment] Strategic approaches to reducing the substance use-related burden of disease in Canada

Substance use is a primary risk factor for premature mortality and morbidity, and Burden of Disease (BoD) in the populations of high-income countries.1 The reduction of this substance use-related BoD requires effective public health intervention strategies. In Canada, a recent primary focus has been on responses to the ‘overdose death crisis’ which has claimed >52,000 lives since 2016, through acute drug toxicity fatalities—mostly from synthetic, toxic opioids.2 In 2023, this toll involved 8,623 fatalities (population rate: 21.5/100,000) of mostly young/middle-aged adults, making it the leading cause of unnatural deaths and a measurable driver of reduced life-expectancy in the Canadian population.

JAMA Neurology Editorial Fellowship

We are pleased to announce that JAMA Neurology is again offering a 1-year editorial fellowship position for a qualified individual. The fellow will receive hands-on training in the editorial processes and policies of a neurology journal, and will be well prepared to take an editorial role in a peer-reviewed publication at the end of the fellowship.

[Series] Challenges and opportunities in developing integrated sexual and reproductive health programmes

Sexual and reproductive health and rights are fundamental to both human and societal wellbeing and sustainable development, and encompass a broad array of sociocultural and clinical issues that affect all people across the life course. In 2018, the Guttmacher–Lancet Commission described sexual and reproductive health as a state of physical, emotional, mental, and social wellbeing in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction, or infirmity.

[Series] Who pays and what pays off in sexual and reproductive health? A review of the cost and cost-effectiveness of interventions and implications for future funding and markets

This Series paper provides a summary of what is known about the funding, cost, and cost-effectiveness of sexual and reproductive health and rights interventions, interrogates the likely impacts of increasing or reducing future sexual and reproductive health and rights funding, and provides recommendations for policy and regulatory changes from an economic perspective. Interventions that target HIV and sexually transmitted infections, contraceptive interventions, and abortion care are among the most cost-effective health interventions worldwide, but their funding is under severe duress.

[Series] Innovations in the biomedical prevention, diagnosis, and service delivery of HIV and other sexually transmitted infections

The interconnectedness of the global HIV and sexually transmitted infection (STI) epidemics necessitates integrated strategies to address both. This Series paper highlights the biological link between HIV and STIs, and describes the successful progress in HIV response versus STI response over the past decades. The concept of undetectable=untransmissible (U=U) in HIV treatment has revolutionised HIV prevention by reducing stigma and promoting early treatment. In line with this approach, we discuss the role of chronic suppressive therapy for herpes simplex virus type 2 and the importance of the accurate diagnosis and treatment of curable STIs to prevent transmission between sexual partners.

[Series] Biomedical innovations in contraception: gaps, obstacles, and solutions for sexual and reproductive health

Contraception and family planning are vital aspects of sexual and reproductive health and rights. Despite major advances in modern contraception over the past 60 years many gaps remain, and the rate of unplanned pregnancies and abortions remains high. These issues have given rise to a new era in contraception research with great opportunities and many challenges. These opportunities include new innovations, particularly in the areas of male contraception, non-hormonal female contraception, and multipurpose prevention methods that provide contraception in combination with protection against leading sexually transmitted pathogens; fast tracking new inventions currently in the pipeline by intensifying support from government, non-profit, and industry entities; the provision of new methods, services, and messaging for underserved populations including men, marginalised women, and transgender individuals; and better understanding the needs of diverse populations.

[Series] Partial progress in sexual and reproductive health and rights: the influence of sociocultural, behavioural, structural, and technological changes on epidemiological trends

The concept of sexual and reproductive health and rights has evolved in the 21st century from previous narrower conceptualisations. In 2018, the Guttmacher–Lancet Commission proposed a broader and integrated defining framework, together with a package of essential health service elements. Despite this, progress on the sexual and reproductive health agenda has been inconsistent, with progress in some areas and considerable gaps in others. Even in areas that have seen breakthroughs in biomedicine and technology, progress has been partial owing to inadequacies in funding, policy, and implementation.

[Department of Error] Department of Error

Cousins S. The neglect of melioidosis. Lancet 2025; 406: 1550–51—In this World Report, the quote from Prasanta Mohapatra should have read: “Only in the last 10–15 years have studies from states like Kerala, Karnataka, Tamil Nadu, Odisha, and West Bengal using proper diagnostic methods revealed that melioidosis is endemic…”. This correction has been made to the online version as of Oct 22, 2025

[Department of Error] Department of Error

Xiong A, Wang L, Chen J, et al. Ivonescimab versus pembrolizumab for PD-L1-positive non-small cell lung cancer (HARMONi-2): a randomised, double-blind, phase 3 study in China. Lancet 2025; 405: 839–49—In the third paragraph of the Introduction of this Article, the penultimate sentence should have read “In the LEAP007 study,18 pembrolizumab plus lenvatinib did not significantly improve PFS and overall survival compared with pembrolizumab alone.” In figure 2, all the numbers censored have been updated and corrected.

[Correspondence] Stratifying IL-2 therapy in ALS: integrating biomarkers

In the MIROCALS trial, Gilbert Bensimon and colleagues1 showed that low-dose interleukin-2 (IL-2) added to riluzole did not significantly reduce mortality in an unadjusted analysis of patients with early-stage amyotrophic lateral sclerosis (ALS). However, in patients with low levels of cerebrospinal fluid-phosphorylated neurofilament heavy chain (CSF-pNFH), IL-2 significantly increased regulatory T cells (Tregs) and reduced mortality after covariate adjustment, suggesting a potential benefit in this subgroup.

[Correspondence] Population screening for Helicobacter pylori to reduce gastric cancer

We read Raghav Sundar and colleagues’ Seminar on gastric cancer with interest.1 The optimal approach to managing any disease with a burden as high as gastric cancer will probably be, where possible, primary prevention. As Sundar and colleagues correctly point out, gastric cancer is the fifth most common cancer worldwide.2 The International Agency for Research on Cancer (IARC) classified Helicobacter pylori as a human carcinogen more than 30 years ago,3 and there have been numerous randomised controlled trials (RCTs) of eradication therapy that have been conducted in populations at high risk of gastric cancer since the 1990s.

[Correspondence] A system under transformation, not collapse

The World Report1 by Dinesh C Sharma on the corruption scandal in Indian medical education brings to attention a serious episode involving regulatory malpractice that is currently under investigation by India's Central Bureau of Investigation. Allegations of bribery, misuse of inspection schedules, and deployment of ghost faculty in a few institutions rightly raise concern. Such incidents should be met with transparency, firm accountability, and structural introspection. However, it is essential to distinguish between a breach in regulatory integrity and a collapse of educational credibility.

[Correspondence] A medical unemployment crisis in a desperate NHS

Recently published competition ratios for specialty training expose the unfolding unemployment crisis in the medical industry. There were 33 108 applicants for only 9479 training posts in the first round of recruitment for post-foundation training in the UK National Health Service, and competition is at an all-time high in the second round.1 The British Medical Association reported that 52% of foundation year 2 doctors were unemployed in August, 2025, without substantive posts or regular locum work.

[Correspondence] Striving for free health education in Greece after a financial crisis

Generations of medical students and trainee doctors in Greece have benefited from free education in public institutions, from textbooks to clinical training and doctoral degrees. Tuition fees have been restricted to specific postgraduate programmes.1 However, this free education is often subsidised by students themselves via unpaid overtime, uncompensated clinical rotations, voluntary research, and out-of-pocket expenses for conferences and external courses.

[Correspondence] Health safeguards under the UN's reimposition of sanctions on Iran

On Sept 28, 2025, the UN Security Council snapback under Resolution 2231 reinstated multilateral sanctions on Iran related to insufficient compliance in international oversight of its nuclear programme.1 This Correspondence does not take a position on the UN Security Council decision to reimpose multilateral sanctions. We focus on the implications of these geopolitical decisions for Iran's population, against the backdrop of devastating impacts on at-risk populations under previous sanctions.