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[Seminar] Peripartum cardiomyopathy

Peripartum cardiomyopathy is increasingly recognised and diagnosed in clinical practice. Over the past two decades, a substantial amount of new knowledge on this condition has been accrued, including a better understanding of the pathophysiology, genetic predisposition for a proportion of patients, diagnostic tools, management with a disease-specific therapy, and predictors of outcome. Peripartum cardiomyopathy occurs globally in all ethnic groups and should be suspected in any women who are peripartum presenting with symptoms and signs indicative of heart failure towards the end of pregnancy or in the months following delivery.

[Articles] Effectiveness of high-dose influenza vaccine against hospitalisations in older adults (FLUNITY-HD): an individual-level pooled analysis

In this prespecified pooled analysis, HD-IIV demonstrated superior protection compared with SD-IIV against hospitalisation for influenza or pneumonia and also reduced the incidence of the secondary endpoints of cardiorespiratory hospitalisation, laboratory-confirmed influenza hospitalisation, and all-cause hospitalisation. Given wide eligibility for influenza vaccination, implementing HD-IIV could result in substantial public health benefits.

[Department of Error] Department of Error

Philpott C, Beard DJ, Saeedi E, et al. The clinical effectiveness of clarithromycin versus endoscopic sinus surgery for adults with chronic rhinosinusitis with and without nasal polyps (MACRO): a pragmatic, multicentre, three-arm, randomised, placebo-controlled phase 4 trial. Lancet 2025; 406: 926–39—In the appendix of this Article, the wider team involved in the MACRO trial has been added on page 34. This correction has been made to the online version as of Nov 20, 2025.

[Correspondence] Treatments for unresectable hepatocellular carcinoma: insights from CheckMate 9DW – Authors' reply

We thank Akhil Santhosh and Nihanthy D Sreenath and Liting Zhang and colleagues for their interest in our trial. The CheckMate 9DW trial showed clinically significant overall survival benefit for nivolumab plus ipilimumab versus lenvatinib or sorafenib (median overall survival, 23·7 vs 20·6 months; hazard ratio 0·79) in unresectable hepatocellular carcinoma.1 We concur with Akhil Santhosh and Nihanthy Sreenath that further investigation of biomarkers could refine patient selection, given that some patients with hepatocellular carcinoma do not benefit from currently available therapies.

[Correspondence] Treatments for unresectable hepatocellular carcinoma: insights from CheckMate 9DW

The CheckMate 9DW trial by Thomas Yau and colleagues1 reveals a key paradox: nivolumab plus ipilimumab delivers unprecedented durability (38% 3-year overall survival) yet carries statistically significant early mortality risk. The initial overall survival disadvantage (hazard ratio 1·65 [95% CI 1·12–2·43] within 6 months) raises concerns over early toxicity. 12 treatment-related deaths occurred in patients who received nivolumab plus ipilimumab versus three deaths in patients who received tyrosine kinase inhibitors, primarily due to hepatic failure and immune-mediated hepatitis.

[Correspondence] Treatments for unresectable hepatocellular carcinoma: insights from CheckMate 9DW

Thomas Yau and colleagues’ CheckMate 9DW trial has yielded unprecedented results, with nivolumab plus ipilimumab reaching an overall response rate of 36%, a median progression-free survival of 9·1 months, and a median overall survival of 23·7 months.1 The outcomes of IMbrave1502 appear less compelling when contrasted with CheckMate 9DW, which excluded patients with main portal vein invasion (Vp4) and enrolled a cohort with comparatively more favourable disease biology. More patients in CheckMate 9DW had earlier-stage disease (Barcelona Clinic Liver Cancer [BCLC] stage A/B: 27%) compared with IMbrave150, where 82% had BCLC stage C.

[Correspondence] Addressing the consequences of conflict in Sudan

The Lancet's Editorial and related commentary about Sudan's health catastrophe raises immediate concern regarding public health, increasingly aggressive gender-based violence, and the diminished global response.1,2 We agree that the crisis cannot be overlooked, and that Sudanese lives are not expendable. With famine afflicting 24·6 million people and 80% of hospitals in conflict areas dysfunctional, it is imperative to highlight the essential and challenging work undertaken by humanitarian organisations in direct response to this crisis.

[Correspondence] Research integrity is undoubtedly in crisis

Richard Horton's view that there is not a research integrity crisis1 contradicts the initiation of the Lancet Commission on Research Integrity, which states “There is clearly a crisis in research integrity that needs urgent action.”2 This divergence might be because Horton focuses on researcher misconduct, a relatively small contributor to compromised publication integrity, when other explanations are more commonly at play. This misstep shifts focus from the question most important to the scientific community and the public—is the research reliable—to the less important secondary one—why is it unreliable? Focusing primarily on the reliability of research will improve the consistency and timeliness of resolution of concerns about publication integrity.

[Correspondence] Centralised ethics review of clinical trials in a public health emergency in the EU

The COVID-19 pandemic caused major excess mortality worldwide. Although many innovations originated in the EU, pivotal vaccine, diagnostic, and therapeutic trials largely occurred outside the EU. Unlike the more centralised approaches in the USA and UK, the EU's fragmented clinical trial system—particularly the complex trial application (CTA) and approval processes across 27 member states and European Economic Area countries—slowed research response.

[Correspondence] El Fasher crisis: over 500 days under siege amid global inaction

Sudan's ongoing nationwide conflict has triggered one of the world's worst humanitarian crises, displacing 13·9 million people,1 including more than 4 million individuals who have fled across borders. Yet El Fasher, the capital of North Darfur and the historic centre of the Darfur region, has endured more than 500 days of siege by the Rapid Support Forces (RSF) since April, 2024.2 Despite the scale of the catastrophic humanitarian crisis in the city, it remains largely absent from international headlines.

[Perspectives] Non-communicable diseases of poverty: what's in a name?

In recent decades, there has been increasing focus on individual responsibility for health. The emphasis for non-communicable diseases (NCDs) has long been on screening, early diagnosis, and timely treatment, with prevention tied to behavioural measures, such as avoidance of smoking and sedentary living, limited consumption of alcohol, and the promotion of physical activity and a healthy diet. These public health messages frequently characterise NCDs as “lifestyle diseases” best prevented through individual action.

[Perspectives] Adekemi Adeniyan: bringing oral health to communities in Nigeria

Adekemi Adeniyan is founder and Executive Director of Dentalcare Foundation, a non-profit organisation focused on oral health equity in Nigeria. 38-year-old Adeniyan, who describes herself as a rural dentist, was the recipient of the Institute for Health Metrics and Evaluation's 2025 Roux Prize, in recognition of her innovative and data-driven solutions to address health disparities in oral health among underserved communities. “The Roux Prize elevated the fact that the work we are doing in oral health really matters”, Adeniyan says, “and being a global award, getting recognised is a win for the communities, for the children we are advocating for.

[Comment] Offline: A reservoir of illusions (part 2)

Emily Bender is a Professor of Linguistics at the University of Washington in Seattle. Her book, The AI Con: How to Fight Big Tech's Hype and Create the Future We Want (2025), written with Alex Hanna, is a compelling antidote to the techno-optimism paraded by Marc Andreessen and other cyber-futurists. Artificial intelligence (AI), Bender and Hanna argue, is nothing but a marketing term. AI tools do not think. They do not understand. They are not sentient. They do not possess consciousness. They cannot empathise.

[Comment] Delivering Nigeria's COP26 commitments on climate and health: health and climate financing needed to match our ambition

At the 2021 UN Climate Change Conference COP26 in Glasgow, UK, Nigeria was one of many African countries that committed to build a climate resilient and sustainable health system.1 Considering the compounding pressures on Nigeria's health sector and competing priorities for limited resources, this was not a commitment that was made flippantly. In Nigeria we are already seeing the health impacts from climate change, the daily disruption this causes to lifesaving health services, and the part the health sector must play in adapting to tackle the devastating toll of climate change on our people.

[Comment] Kidney disease must be counted everywhere

History was made on May 23, 2025, when the resolution submitted by Guatemala on “Reducing the burden of noncommunicable diseases through promotion of kidney health and strengthening prevention and control of kidney disease” was adopted at the 78th World Health Assembly.1 All countries now acknowledge that kidney disease is an important public health concern. Speaking to nephrologists from low-income settings, one understands unequivocally that the burden of kidney disease is high, patients present late, and morbidity and mortality are high.