The Lancet Vol 5

For readers of Being Mortal and Modern Death, an ICU and Palliative Care specialist offers a framework for a better way to exit life that will change our medical culture at the deepest level In medical school, no one teaches you how to let a patient die. Jessica Zitter became a doctor because she wanted to be a hero. She elected to specialize in critical care—to become an ICU physician—and imagined herself swooping in to rescue patients from the brink of death. But then during her first code she found herself cracking the ribs of a patient so old and frail it was unimaginable he would ever come back to life. She began to question her choice. Extreme Measures charts Zitter’s journey from wanting to be one kind of hero to becoming another—a doctor who prioritizes the patient’s values and preferences in an environment where the default choice is the extreme use of technology. In our current medical culture, the old and the ill are put on what she terms the End-of-Life Conveyor belt. They are intubated, catheterized, and even shelved away in care facilities to suffer their final days alone, confused, and often in pain. In her work Zitter has learned what patients fear more than death itself: the prospect of dying badly. She builds bridges between patients and caregivers, formulates plans to allay patients’ pain and anxiety, and enlists the support of loved ones so that life can end well, even beautifully. Filled with rich patient stories that make a compelling medical narrative, Extreme Measures enlarges the national conversation as it thoughtfully and compassionately examines an experience that defines being human.

The global response to the COVID-19 pandemic is the greatest science policy failure in a generation. We knew this was coming. Warnings about the threat of a new pandemic have been made repeatedly since the 1980s and it was clear in January that a dangerous new virus was causing a devastating human tragedy in China. And yet the world ignored the warnings. Why? In this short and hard-hitting book, Richard Horton, editor of the medical journal The Lancet, scrutinizes the actions that governments around the world took – and failed to take – as the virus spread from its origins in Wuhan to the global pandemic that it is today. He shows that many Western governments and their scientific advisors made assumptions about the virus and its lethality that turned out to be mistaken. Valuable time was lost while the virus spread unchecked, leaving health systems unprepared for the avalanche of infections that followed. Drawing on his own scientific and medical expertise, Horton outlines the measures that need to be put in place, at both national and international levels, to prevent this kind of catastrophe from happening again. Were supposed to be living in an era where human beings have become the dominant influence on the environment, but COVID-19 has revealed the fragility of our societies and the speed with which our systems can come crashing down. We need to learn the lessons of this pandemic and we need to learn them fast because the next pandemic may arrive sooner than we think.

Inspired by a hugely successful series entitled Treating Individuals, originally published in The Lancet, this volume will become essential reading for any professional involved with performance and evaluation of trials and systematic reviews or clinical patient care. There are many books explaining the importance of evidence-based medicine and how randomised clinical trials (RCTs) and systematic reviews should be performed. However, this is the first book to tackle the apparent conflict between the importance of evidence-based decision making and the widely-held view that it is often very difficult to apply the overall results of RCTs and systematic reviews to decisions about individual patients in routine clinical practice. The book brings together experienced clinicians, statisticians and trialists to focus on the two key questions that are most frequently asked by clinicians. Is the evidence relevant to my clinical practice? How can I judge whether the probability of benefit from treatment in my current patient is likely to differ substantially from the average probability of benefit reported in the relevant trial or systematic review? These questions are addressed from methodological and clinical perspectives, and potential approaches to improving the targeting of treatment are considered, with detailed reviews of several areas of medicine and surgery where useful progress has been made.

Excerpt from The Lancet, Vol. 5: Oct. 9, 1824 So faithfully and humbly has mr. Tvaun'u. Transcribed our pages in the book, which this conscientious person asserts to be the only authentic and correct copy of sir astle\'-'s Lectures, that we will next week entertain our readers with an instance in which he has been caught in the snare of his own cupidity. He has actually transcribed a passage of considerable length, which, from a circumstance which we will hereafter explain, sir as1 ley Coorsn. Never uttered. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.

'I couldn't imagine a better guidebook for making sense of a tragic and momentous time in our lives. Covid by Numbers is comprehensive yet concise, impeccably clear and always humane' Tim Harford How many people have died because of COVID-19? Which countries have been hit hardest by the virus? What are the benefits and harms of different vaccines? How does COVID-19 compare to the Spanish flu? How have the lockdown measures affected the economy, mental health and crime? This year we have been bombarded by statistics - seven day rolling averages, rates of infection, excess deaths. Never have numbers been more central to our national conversation, and never has it been more important that we think about them clearly. In the media and in their Observer column, Professor Sir David Spiegelhalter and RSS Statistical Ambassador Anthony Masters have interpreted these statistics, offering a vital public service by giving us the tools we need to make sense of the virus for ourselves and holding the government to account. In Covid by Numbers, they crunch the data on a year like no other, exposing the leading misconceptions about the virus and the vaccine, and answering our essential questions. This timely, concise and approachable book offers a rare depth of insight into one of the greatest upheavals in history, and a trustworthy guide to these most uncertain of times.

Recounting the fenoterol epidemic—a major medical controversy that took place more than 15 years ago—this narrative explores the involvement of the asthma drug that caused numerous asthma deaths. Although the epidemic occurred in New Zealand, its shocking discoveries and subsequent consequences attracted worldwide attention in medical journals and conferences. Neil Pearce, the researcher who discovered that fenoteral was the cause of the epidemic, tells this personal story while raising concerns about drug safety internationally and analyzing the battle between money and science in medical research.

​The goal of this open access book is to develop an approach to clinical health care ethics that is more accessible to, and usable by, health professionals than the now-dominant approaches that focus, for example, on the application of ethical principles. The book elaborates the view that health professionals have the emotional and intellectual resources to discuss and address ethical issues in clinical health care without needing to rely on the expertise of bioethicists. The early chapters review the history of bioethics and explain how academics from outside health care came to dominate the field of health care ethics, both in professional schools and in clinical health care. The middle chapters elaborate a series of concepts, drawn from philosophy and the social sciences, that set the stage for developing a framework that builds upon the individual moral experience of health professionals, that explains the discontinuities between the demands of bioethics and the experience and perceptions of health professionals, and that enables the articulation of a full theory of clinical ethics with clinicians themselves as the foundation. Against that background, the first of three chapters on professional education presents a general framework for teaching clinical ethics; the second discusses how to integrate ethics into formal health care curricula; and the third addresses the opportunities for teaching available in clinical settings. The final chapter, "Empowering Clinicians", brings together the various dimensions of the argument and anticipates potential questions about the framework developed in earlier chapters.

Tuberculosis is an ancient disease, but it's not a disease of history. With more than a million victims every year - more than any other disease, including malaria - and antibiotic resistance now found in every country worldwide, tuberculosis is once again proving itself to be one of the smartest killers humanity has ever faced. But it's hardly surprising considering how long it's had to hone its skills. Forty-thousand years ago, our ancestors set off from the cradle of civilisation on their journey towards populating the planet. Tuberculosis hitched a lift and came with us, and it's been there ever since; waiting, watching, and learning. In The Robber of Youth, Kathryn Lougheed, a former TB research scientist, tells the story of how tuberculosis and humanity have grown up together, with each being shaped by the other in more ways than you could imagine. This relationship between man and microbe has spanned many millennia and has left its mark on both species. We can see evidence of its constant shadow in our genes; in the bones of the ancient dead; in art, music and literature. Tuberculosis has shaped societies -- and it continues to do so today.The organism responsible for TB, Mycobacterium tuberculosis, has had plenty of time to adapt to its chosen habitat - human lungs - and has learnt through natural selection to be an almost perfect pathogen. Using our own immune cells as a Trojan Horse to aid its spread, it's come up with clever ways to avoid being killed by antibiotics. But patience has been its biggest lesson -- the bacterium can enter into a latent state when times are tough, only to come back to life when a host's immune system can no longer put up a fight. Today, more than one million people die of the disease every year and around one-third of the world's population are believed to be infected. That's more than two billion people. Throw in the compounding problems of drug resistance, the HIV epidemic and poverty, and it's clear that tuberculosis remains one of the most serious problems in world medicine. The Robber of Youth follows the history of TB through the ages, from its time as an infection of hunter-gatherers to the first human villages, which set it up with everything it needed to become the monstrous disease it is today, through to the perils of industrialisation and urbanisation. It goes on to look at the latest research in fighting the disease, with stories of modern scientific research, interviews doctors on the frontline treating the disease, and the personal experiences of those affected by TB.

The monumental life of Benjamin Rush, medical pioneer and one of our most provocative and unsung Founding Fathers FINALIST FOR THE GEORGE WASHINGTON BOOK PRIZE • AMERICAN LIBRARY ASSOCIATION NOTABLE BOOK OF THE YEAR By the time he was thirty, Dr. Benjamin Rush had signed the Declaration of Independence, edited Common Sense, toured Europe as Benjamin Franklin’s protégé, and become John Adams’s confidant, and was soon to be appointed Washington’s surgeon general. And as with the greatest Revolutionary minds, Rush was only just beginning his role in 1776 in the American experiment. As the new republic coalesced, he became a visionary writer and reformer; a medical pioneer whose insights and reforms revolutionized the treatment of mental illness; an opponent of slavery and prejudice by race, religion, or gender; an adviser to, and often the physician of, America’s first leaders; and “the American Hippocrates.” Rush reveals his singular life and towering legacy, installing him in the pantheon of our wisest and boldest Founding Fathers. Praise for Rush “Entertaining . . . Benjamin Rush has been undeservedly forgotten. In medicine . . . [and] as a political thinker, he was brilliant.”—The New Yorker “Superb . . . reminds us eloquently, abundantly, what a brilliant, original man Benjamin Rush was, and how his contributions to . . . the United States continue to bless us all.”—The Philadelphia Inquirer “Perceptive . . . [a] readable reassessment of Rush’s remarkable career.”—The Wall Street Journal “An amazing life and a fascinating book.”—CBS This Morning “Fried makes the case, in this comprehensive and fascinating biography, that renaissance man Benjamin Rush merits more attention. . . . Fried portrays Rush as a complex, flawed person and not just a list of accomplishments; . . . a testament to the authorial thoroughness and insight that will keep readers engaged until the last page.”—Publishers Weekly (starred review) “[An] extraordinary and underappreciated man is reinstated to his rightful place in the canon of civilizational advancement in Rush. . . . Had I read Fried’s Rush before the year’s end, it would have crowned my favorite books of 2018 . . . [a] superb biography.”—Brain Pickings