20 years ago, The Lancet published an Editorial on reviving research into psychedelics for mental health conditions, observing that “the blanket ban on psychedelic drugs enforced in many countries continues to hinder safe and controlled investigation, in a medical environment, of their potential benefits”. The Lancet of 2006 could not have foreseen that one day a president of the USA would sign an executive order aiming to “dramatically accelerate access to new medical research and treatments based on psychedelic drugs”.
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Complicated urinary tract infections (cUTIs) and acute pyelonephritis remain major causes of hospitalisation worldwide and contribute substantially to antibiotic consumption and health-care costs.1 The increasing prevalence of antibiotic resistance among Gram-negative bacterial pathogens, particularly extended-spectrum β-lactamase (ESBL)-producing Enterobacterales and carbapenem-resistant bacteria has made effective treatment increasingly challenging.2
Vaccines remain one of the most impactful and cost-effective public health interventions. Decades of evidence from randomised controlled trials and epidemiological studies have shown the impact of vaccines on population health following the introduction and scale-up of immunisation programmes.1 As the incidence of previously debilitating vaccine-preventable childhood diseases diminishes due to vaccination efforts, the perceived importance of immunisation could become less evident to the public. Amid rising vaccine hesitancy and the spread of misinformation, it is increasingly important to continue demonstrating the tangible impact of vaccines globally.
Autologous stem-cell transplantation (ASCT) has remained central to the care of younger patients with mantle cell lymphoma since the publication of the first European Mantle Cell Lymphoma Network trial in 2005.1 Its role is now firmly challenged in The Lancet by results of the TRIANGLE study from Martin Dreyling and colleagues.2
Memories resurface. An unfamiliar virus. Deaths. A stricken cruise ship. Quarantines. Hastily arranged WHO press briefings. Scientists interviewed on radio and television about what is known—and, more importantly, not known—about disease transmission. WHO has assessed the public health risk as low. But for the families of the three passengers on the MV Hondius who died, together with those with either confirmed or suspected hantavirus infection, the news of an outbreak of a mysterious virus will be frightening.
Peru is expanding access to surgery and care for patients with cleft conditions in remote areas through intensive capacity-building led by local volunteers. Jacqui Thornton reports.
As part of a series on medicine in unusual settings, Talha Burki takes a look at medical practice in UK prisons.
“In Viet Nam, health challenges are rarely abstract”, says Thu-Anh Nguyen, Director of the University of Sydney Vietnam Institute (SVI) and Professor in Global Health at the University of Sydney, Australia. “They are visible in overcrowded clinics, in families navigating long treatment journeys, and in communities where preventable diseases persist. Building health research in this context is not simply about generating evidence. It is about creating the conditions under which evidence can be trusted, used, and sustained.”
For decades, the thymus has been regarded as a vestigial organ of childhood, essential for T-cell education early in life, but thought to lose relevance as it involutes into fatty tissue after adolescence. This dogma was challenged a few years ago when a study showed that removal of the thymus during thoracic surgery was linked to poor outcomes. More recent work, enabled by artificial intelligence (AI), brings new insights about the potential role of the thymus across the lifespan.
The use of artificial intelligence (AI) and generative AI in medicine provokes important questions about the nature of clinical work performed by human practitioners as well as the limitations and benefits of this technology. In the light of the possibilities and pitfalls of AI in clinical work, there is a need to re-examine the basic nature of the therapeutic value of human interaction in clinical medicine and to discuss some pervasive misconceptions (in practice if not in theory) about the nature of the societally embedded human mind.
Virologist and expert in influenza surveillance, pandemic preparedness, and infectious disease response. Born on July 21, 1948, in Emmetsburg, IA, USA, she died from glioblastoma on April 24, 2026, in Atlanta, GA, aged 77 years.
We read with interest Marcello Ienca and colleagues’ Review on the increasing erosion of trust in health institutions.1 We also believe that restoring emotional engagement and resonance are essential, but were surprised that the authors did not suggest youth advocacy as a scalable strategy and co-production mechanism (WHO framework) for rebuilding trust, which encompasses most aspects of their proposed solutions.2
Marcello Ienca and colleagues1 in their Review identify a trust paradox in which rigorous institutions lose credibility while unaccountable voices gain it. We argue that large language model (LLM)-based chatbots represent a qualitatively distinct escalation of this paradox, extending beyond the social media dynamics described.
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, although invaluable for global health metrics, presents concerning estimates of life expectancy at birth for Monaco.1 Monaco is a microstate typically synonymous with world-leading levels of life expectancy at birth, with official sources, such as statistics from the Monaco Government and UN reports, consistently placing Monaco's life expectancy among the highest globally.2,3 The most recent estimate from the Monegasque Demography Observatory for 2022–24 places life expectancy at birth at 87·0 years;3 however, GBD estimates are substantially lower, at 80·4 years in 2023.
Grant M A Wyper and colleagues highlight a discrepancy between the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 life expectancy estimates for the microstate of Monaco and locally published figures. We welcome engagement on small-population estimation and offer several clarifications.
I congratulate Steven J Frank and colleagues1 on the successful completion of their multi-institutional study comparing photons with protons for oropharyngeal squamous cell carcinoma, but many questions remain. One of the main differences between intensity-modulated (photon) radiation therapy (IMRT) and intensity-modulated proton therapy (IMPT) was the risk of grade 3 xerostomia, which is defined by Common Toxicity Criteria for Adverse Events (CTCAE) as dry mouth leading to the inability to adequately aliment orally, tube feeding or total parenteral nutrition indicated, or unstimulated salivary flow rate of less than 0·1 mL/min.
Trials of local therapies where progression-free survival is equivalent but overall survival is improved raise the spectre of confounding. The overall survival improvement seen in the phase 3 trial by Steven J Frank and colleagues1 of proton therapy for oropharyngeal cancer is likely an example of this issue. First, if proton therapy truly increased survival—given the crossover from photon to proton and barring extreme bias in the crossover population—the overall survival difference should be attenuated in the intention-to-treat versus per-protocol comparison, which is not demonstrated.
We thank David J Sher for the compliments on our phase 3 trial of intensity-modulated (photon) radiation therapy (IMRT) versus intensity-modulated proton therapy (IMPT) for oropharyngeal cancer.1 A key finding from the trial was that proton therapy de-intensified chemoradiation therapy, reducing the rates of high-grade toxicities and gastrostomy tube dependency to 40·2% in the IMRT group and 26·8% in the IMPT group. Sher expressed concern that the reported rate of severe xerostomia (45% IMPT and 33% IMRT) was higher than that in the RTOG 1016 trial,2 where 243 (61·5%) of 395 patients given IMRT and cisplatin required a gastrotomy tube.
Cefepime–nacubactam and aztreonam–nacubactam are potential treatment options for Gram-negative cUTI and acute uncomplicated pyelonephritis, including infections caused by antimicrobial-resistant strains.
Decisions around which vaccines to use are increasingly important in the context of Gavi's country vaccine budgets. Robust metrics that allow comparison between vaccines are thus essential to inform discussions. The vaccine impact ratios presented in this study can be used to complement other evidence to support effective planning and prioritisation in national immunisation programmes.
After a prolonged follow-up of 55 months, both ibrutinib-containing groups showed relevant improvements not only in failure-free survival—a modified form of progression-free survival—but also in overall survival. In contrast, the addition of ASCT to an ibrutinib-containing regimen had no supplementary benefit but increased toxicity. Induction treatment with ibrutinib and R-CHOP plus R-DHAP (or R-DHAOx), followed by 2 years of maintenance treatment with ibrutinib, should be considered as a new standard of care for younger patients with mantle cell lymphoma.
Brain inflammation secondary to encephalitis is an urgent global emergency and presents multiple opportunities to reduce current substantial morbidity and mortality. Aetiologies can be divided into infectious and autoimmune causes. In this Seminar, we highlight pragmatic clinical approaches to recognise and distinguish the most common pathogenic viruses and emerging range of autoantibodies encountered in routine practice. These pre-test impressions are judiciously shaped by valuable, simple investigations—particularly serum and cerebrospinal fluid nucleic acid and autoantibody testing—to identify the precise causative agent.
The Pasteur Institute of Iran sustained considerable damage from a series of airstrikes in late March, 2026.1 This historically important medical institution, founded 106 years ago, has played a key role in combating various human pathogens in the region and has responded to numerous epidemics and pandemics in its history. The Pasteur Institute of Iran houses reference laboratories, departments of vaccine research and production, pathogen surveillance, and outbreak response teams.2 WHO confirmed that, following the damage caused by the airstrikes, the institute was no longer functional and could no longer deliver health services.
Since early March, 2026, the US–Israel war with Iran has expanded to attacks on energy infrastructure, producing black plumes from burning fuel storage sites across the Arabian Gulf. Burning oil and fuel release complex mixtures of fine particulate matter, black carbon, sulphur oxides, volatile organic compounds, polycyclic aromatic hydrocarbons, and trace metals from incomplete combustion. These emissions are chemically complex and can carry greater toxicity per unit exposure than emissions from non-anthropogenic sources.
Clinical trials in stroke balance a few tensions including efficacy against safety, biology against clinical proof, and broad answers against a disease that is not really one disease. Antiplatelet therapy after intravenous thrombolysis is one such area. Platelet-mediated re-occlusion after lysis is biologically plausible, but haemorrhage risk has warranted caution against early antiplatelet use. In The Lancet, Anxin Wang and colleagues1 report results from the TAPIS trial, which reopens this question.