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[Correspondence] Rethinking atherosclerotic disease prevention

The Lancet Commission on rethinking coronary artery disease1 offers important advances in cardiovascular disease (CVD) prevention. The Commission argues, correctly in our opinion, that identification of adequate management of people with high blood pressure is more important than finding the optimal CVD risk threshold for its pharmacological treatment. A large (n=3 337 314) cross-sectional study of people aged 45–74 years in Australia2 showed that 41% of individuals with low CVD risk and blood pressure of more than 140/90 mm Hg were not managed with antihypertensive medications.

[Correspondence] Plant-based diets for coronary artery disease prevention

We read with interest the Lancet Commission1 on rethinking coronary artery disease, which shifts focus from ischaemia to atherosclerosis. The prominence of diet as a risk factor for atherosclerotic coronary artery disease (ACAD) is rightfully highlighted in the Commission. However, we believe greater emphasis could have been placed on the importance of plant-based diets given their great potential in atherosclerosis prevention.

[Correspondence] Loans dominated COVID-19 funding: it's time to adjust

As the US foreign assistance architecture faces unprecedented dismantling, lessons from past crises take on urgent significance. Our new analysis of COVID-19 donor funding1 reveals a profound disconnect between the rhetoric of global solidarity and the reality: most official development assistance was issued as loans, and direct support to partner governments was minimal.

[Correspondence] Naegleria fowleri in Kerala, India: prevention over panic

Kerala, India, is confronting a rare but deadly cluster of primary amoebic meningoencephalitis caused by Naegleria fowleri, with about 69 confirmed cases and 19 deaths reported in 2025.1 Although uncommon, the disease is almost uniformly fatal and can progress over days. Because primary amoebic meningoencephalitis frequently mimics bacterial meningitis or viral encephalitis, diagnosis and treatment are often delayed. In some instances, it has also been mistaken for cerebral toxoplasmosis, cryptococcal meningitis, or tuberculous meningitis.

[Perspectives] Cinematic portrayals of euthanasia and ageing across the decades

Cinema can be enormously instructive in reflecting and informing public consciousness on societal issues. It is especially illuminating for exploring perceptions of ageing, a complex, diverse, and heterogeneous social experience. An early scene in Michael Anderson's 1976 film Logan's Run depicts a ceremony in which people at the age of 30 years ascend to a crystal maze where only those “strong enough” are “renewed”. Little do citizens of the underground utopia in Logan's Run realise that they will all perish upon ascension, irrespective of perceived strength.

[Perspectives] The cost of diagnosis

“It is a truth universally acknowledged”, Meghan O’Rourke writes in her memoir The Invisible Kingdom (2022), “that a young woman in possession of vague symptoms like fatigue and pain will be in search of a doctor who believes she is actually sick.” O’Rourke, who spent years struggling to name her illness, captures the essence of the diagnostic quest—the longing for a label that makes sense of suffering. A diagnosis offers not only an explanation but also a language to translate pain into meaning.

[Perspectives] The troubled birth of aerobiology

“FACT: #COVID19 is NOT airborne”, declared a tweet from WHO in March, 2020. WHO did not officially accept until almost 2 years later that infection by SARS-CoV-2 could after all be caused by long-range airborne transmission. Throughout the worst ravages of the disease, WHO continued to insist that viral transmission happened either by fomites or by relatively large droplets emitted by people coughing and sneezing. Instead of focusing on ventilation, we (some of us) solicitously observed the 2 m distancing rule and, at least in the early days of the COVID-19 pandemic, assiduously washed the mail and groceries delivered at our door.

[Comment] Offline: “People have died”

The World Health Summit has proved itself the premier global health event of the year. Under the banner “Taking responsibility for health in a fragmenting world”—symbolised by a giant stage globe cracking during a flamboyant evening “signature event”—summiteers, despite facing their biggest financing catastrophe for a generation, were remarkably upbeat. Perhaps they were all in denial. Or enjoying euphoric freedom from American hegemony. The star political guest was Germany's Federal Minister of Health, Nina Warken.

[Comment] Accelerating progress on essential medicines: a new Lancet Commission

There is no equity in access to basic health care. The latest biennial report on universal health coverage reported that in 2021 4·5 billion people—about half the world's population—had no access to basic health services, and progress has stalled since 2019.1 The percentage of people facing catastrophic out-of-pocket expenditure for health care has risen from 11·9% in 2005 to 16·7% in 2019, with high expenditure on medicines being a major contributor.1

[Comment] Documenting atrocity: child malnutrition in Gaza

Since the egregious civilian massacre on Israeli civilians by Hamas on Oct 7, 2023, there have been grave concerns about the conduct of Israeli military operations in Gaza with regard to proportionality and breaches of humanitarian protocols, which a recent UN commission concluded met the legal definition of genocide.1 The most recent Integrated Food Security Phase Classification (IPC) report, issued in August, 2025, declared famine in the governorate of Gaza City (one of five governorates), comprising a quarter of the population, and stated that the remainder of the Gaza Strip is facing critical or emergency conditions,2 assessments that the Israeli Government continues to deny.

[Comment] Drug therapy for obstructive sleep apnoea: promises and challenges

Obstructive sleep apnoea (OSA) affects up to 1 billion people worldwide and is defined by repeated upper airway collapse during sleep, leading to intermittent hypoxaemia and disrupted sleep. Although severity is measured by the Apnoea–Hypopnea Index (AHI), and OSA has been associated with many adverse cardiometabolic and neurocognitive outcomes, treatment indications primarily reflect proven benefits: improving symptoms—especially daytime sleepiness—and lowering blood pressure.1 Continuous positive airway pressure is the first-line therapy and effectively prevents airway collapse, but long-term discontinuation rates can be substantial.

[Comment] The use of IPD meta-analysis in maternal health prognostics

For decades, evidence guiding the diagnosis of postpartum haemorrhage has been constrained by traditional aggregate data reviews that mask patient-level variation and rely on arbitrary thresholds. The WHO-led individual participant data (IPD) meta-analysis by Ioannis Gallos and colleagues represents a methodological breakthrough, assembling original, anonymised records from more than 312 000 women and reanalysing prognostic markers for adverse postpartum haemorrhage outcomes at the participant level, rather than through study-level summaries.

[Comment] Optimising treatment strategies in older patients with mantle cell lymphoma

The integration of Bruton tyrosine kinase (BTK) inhibitors into first-line treatment regimens, in combination with immunochemotherapy, constitutes the new standard of care following the recent approval of ibrutinib and acalabrutinib for transplant-eligible and transplant-ineligible patients with mantle cell lymphoma, respectively.1–3 In younger and fitter patients, ibrutinib is administered in combination with R-CHOP (rituximab–cyclophosphamide, doxorubicin, vincristine, and prednisolone) alternating with R-DHAP (rituximab, dexamethasone, cytarabine, and cisplatin) as induction, followed by optional autologous haematopoietic stem-cell transplantation and time-limited maintenance.

[Editorial] Drug pricing and pharmaceutical innovation: a false promise

The UK is facing a pharma exodus. Major pharmaceutical companies have withdrawn about £2 billion in proposed investment from the country, blaming insufficient government investment. Central to the dispute is the amount of money that the National Health Service (NHS) spends on medicines—the main argument being that without adequate reward, industry investment in research and development will evaporate. The standoff has been catalysed by Donald Trump's threats to place vast tariffs on US medicine imports if companies do not level the prices the USA pays for drugs.

[Personal View] Managing adults with screen-detected islet autoantibody positivity: a pragmatic framework

New disease-modifying therapies, such as teplizumab, offer opportunities to delay the clinical onset of type 1 diabetes but require islet autoantibody screening to identify individuals at increased risk of progression to diabetes. As type 1 diabetes screening programmes expand, clinicians will increasingly encounter a new group of people: adults who test positive for islet autoantibodies but have not yet been diagnosed with diabetes. Although international guidelines outline management for both children and adults, considerable uncertainties remain, particularly for adults.