The Lancet

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[Comment] Astegolimab and the new era of biologics in COPD care
Chronic obstructive pulmonary disease (COPD) affects 480 million people worldwide and this is projected to increase to nearly 600 million over the next two decades.1 Long-acting beta agonists (LABA) and long-acting muscarinic antagonists (LAMA), often combined with inhaled corticosteroids (ICS), are the cornerstone of COPD management.2 However, even with maximal inhaled therapy, most patients remain symptomatic and a third continue to have multiple exacerbations.3
The Lancet8h
[Articles] Safety and efficacy of astegolimab for COPD with frequent exacerbations regardless of baseline blood eosinophil counts (ALIENTO and ARNASA): randomised, double-blind, placebo-controlled, phase 2b and 3 trials
In ALIENTO, astegolimab every 2 weeks was associated with a lower annual rate of exacerbations versus placebo in patients with COPD and a history of frequent exacerbations. In ARNASA, these findings did not meet statistical significance. Together, these findings suggest a role for targeting the ST2/IL-33 pathway to reduce the frequency of COPD exacerbations in patients with limited treatment options.
The Lancet8h
[Comment] Pan-European Commission on Climate and Health: recommendations for accelerating climate action for health
The pace of climate change has increased worldwide in the past decade.1 Europe is the fastest-heating continent, with temperatures increasing at more than twice the global average rate since the mid-1990s.2 It is increasingly possible to attribute health impacts to human-induced climate change. For example, nearly 70% of the approximately 24 000 summer heat-related deaths in 2025 in 854 European cities were attributed to climate change.3 Climate change is driving the rapid northward expansion of Aedes albopictus, the vector mosquito for dengue and chikungunya, increasing the population at risk
The Lancet2d
[Correspondence] Hantavirus outbreak on a cruise ship in the South Atlantic
On May 2, 2026, a cluster of severe respiratory illness among passengers aboard a cruise ship in the Atlantic was reported to WHO, and a suspected hantavirus outbreak was identified. The vessel departed from Ushuaia, Argentina, on April 1, 2026, carrying 147 individuals (88 passengers and 59 crew members) from 23 countries.1 This event raises concerns about surveillance, outbreak response, containment, and the potential for international spread of hantavirus. As of May 4, 2026, seven cases (two laboratory confirmed and five suspected) have been identified, including three deaths, corresponding
The Lancet4d
[Obituary] Eugene Braunwald
Leading cardiologist who changed clinical practice and research. Born on Aug 15, 1929, in Vienna, Austria, he died on April 22, 2026, in Newton, MA, USA, aged 96 years.
The Lancet4d
[Department of Error] Department of Error
Kaminski MF, Kalager M, Løberg M, et al. Long-term effects of colonoscopy screening on colorectal cancer incidence and mortality: a multicountry, population-based randomised controlled trial. Lancet 2026; 407: 1787–95—In figures 1 and 3 of this Article, the labels for the screening and no-screening groups were inverted. These corrections have been made to the online version as of May 12, 2026.
The Lancet5/12/2026
[Comment] Challenges in mitigating weight regain with incretin-based therapy
Weight regain after successful weight loss is acknowledged as one of the major challenges for long-term obesity management, whatever the mode of treatment, potentially leading to a deleterious weight cycling.1 Weight regain after stopping incretin-based therapies is especially rapid and substantial, as most patients often regain roughly two-thirds of lost weight within 1 year of cessation;2 thus, different strategies should be implemented to mitigate this risk.3
The Lancet6d
[Health Policy] Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process
Polyendocrine metabolic ovarian syndrome (PMOS), previously named polycystic ovary syndrome (PCOS), affects one in eight women. However, the term PCOS is inaccurate, implying pathological ovarian cysts, obscuring diverse endocrine and metabolic features, and contributing to delayed diagnosis, fragmented care, and stigma, while curtailing research and policy framing. Building on an international mandate for change, we outline an unprecedented, rigorous, multistep global consensus process for the name change.
The Lancet5/12/2026
[Articles] Tirzepatide for maintenance of bodyweight reduction in people with obesity in the USA (SURMOUNT-MAINTAIN): a multicentre, double-blind, randomised, placebo-controlled trial
In adults with obesity, long-term treatment is often necessary to maintain bodyweight reduction and its associated cardiometabolic benefits. In the SURMOUNT-MAINTAIN trial, continuing tirzepatide at MTD maintained bodyweight reduction and health-related benefits. Reducing to 5 mg tirzepatide might provide a valuable alternative to discontinuation, although individuals’ treatment response might vary. Together, these findings support the importance of ongoing therapy for long-term obesity management and provide evidence to inform individualised, patient-centred obesity care.
The Lancet6d
[Clinical Rounds] A case of acute necrotising encephalitis secondary to human herpesvirus 6 infection
In this Clinical Rounds, we present the case of a girl aged 11 months who developed acute necrotising encephalitis in the setting of human herpesvirus 6 infection, complicated by elevated intracranial pressure, seizures, and development of increased tone. This patient presented with common features of acute necrotising encephalitis including fever, seizures, altered level of consciousness, and focal neurological deficits. We discuss the investigations for acute necrotising encephalitis, which is extensive and includes serology, often showing thrombocytopenia and liver dysfunction.
The Lancet6d
[Comment] Meningococcal B resurgence in the UK: implications for updating global vaccine strategies
Invasive meningococcal disease caused by Neisseria meningitidis is primarily associated with serogroups A, B, C, W, X, and Y and is characterised by its sudden, unpredictable nature and devastating consequences, predominantly affecting children, adolescents, and young adults.1,2 Case-fatality rates range from 5–10% in Europe but can reach up to 15% despite appropriate treatment, particularly in severe septicaemic disease.3 Approximately 10–25% of survivors experience disabling long-term sequelae, including neurological impairment and cognitive and psychosocial disability, with substantial soci
The Lancet5/8/2026
[Articles] Endovascular thrombectomy for patients with large-core ischaemic stroke presenting up to 24 h after onset (ATLAS): a systematic review and individual patient data meta-analysis with central imaging adjudication
Endovascular thrombectomy was associated with improved functional outcomes and reduced mortality versus medical management in patients with large-core ischaemic stroke presenting within 24 h of onset. With the exception of very extensive ischaemic changes (core volume ≥150 mL) presenting beyond 6 h, where evidence remains limited, benefit was sustained across ASPECTS and ischaemic core strata for patients presenting up to 24 h after onset.
The Lancet5/7/2026
[Comment] Is ATLAS lifting the burden of stroke in people with large-vessel occlusion and low ASPECTS scores?
In Greek mythology, Atlas is the powerful Titan condemned by Zeus to eternally bear the celestial spheres—a profound symbol of endurance and strength. These very virtues are necessitated in patients suffering from severe ischaemic stroke, a condition often resulting in disability and reduced quality of life. In The Lancet, Amrou Sarraj and colleagues report the results of the ATLAS study, a large individual participant data meta-analysis evaluating whether endovascular thrombectomy, compared with best medical management, could effectively alleviate the burden of stroke in these severely affect
The Lancet5/7/2026
[Viewpoint] The role of community-based blood pressure screening in improving hypertension care
In their recent Viewpoint, Frieden and colleagues argue that mass blood pressure screening diverts resources from improving hypertension care. We present a counterargument that community-based blood pressure screening can complement health-care services by increasing hypertension detection, particularly in populations with limited access to health care. Opportunistic community-based screening can be delivered at relatively low cost and reach individuals who might not otherwise engage with health-care systems.
The Lancet5/6/2026
[Viewpoint] Who's really in the loop? Rethinking oversight in AI-assisted health care
Human-in-the-loop oversight is widely invoked as a safeguard against potential harm from artificial intelligence (AI) used in health care, yet it functions more as symbolic reassurance than substantive protection. We argue that human-in-the-loop fails for three interconnected reasons: AI used in health care can amplify existing structural inequities at unprecedented scale, intersectional harms elude detection by oversight models premised on neutral singular reviewers, and clinicians operate under constraints that preclude meaningful interrogation of algorithmic outputs.
The Lancet4/30/2026
[Comment] The Lancet Commission on the European Health Union: strengthening the union for and through health
The key purposes of the European Union (EU) to date have been peace, prosperity, environmental protection, and the promotion of common interests in the wider world.1,2 In some ways, health has always been integral to these aims: during the 1980s, Europe Against Cancer and Europe Against HIV paved the way for EU public health policy, consolidated in the Maastricht (1992) and Amsterdam (1997) Treaties and Article 168 of the Treaty on the Functioning of the EU on public health.3 Concrete EU health policies do not, however, amount to a comprehensive vision of a union that reaps the full benefits o
The Lancet4/29/2026
[Comment] From prediction to navigation for artificial intelligence in medicine
Whether estimating the probability that a disease is present or forecasting risk of deterioration,1 readmission,2 or death,3 most contemporary clinical artificial intelligence (AI) systems are designed to predict and estimate clinical status and outcomes. These systems include applications in diagnosis and medical image interpretation,4 which is important, but only provides information about what is present or what might happen and does not support clinicians in decision making about how best to help the patient.
The Lancet4/27/2026
[Perspectives] The art of Julia Davenne
In September, 2023, Julia Davenne was painting, as she always did, in the small studio she built at the end of her beautifully tended garden, framed by tall, wildflowers, surrounded by the dramatic landscapes of the Brecon Beacons in Wales, UK. For Davenne, who had trained at London's St Martin's School of Art and the Royal Academy of Arts, working from nature was important. Woods, water, soil, and animals took new form on her canvas, painted in watercolours, oils, or collaged onto expanses of fabric.
The Lancet4/24/2026
[Comment] The Lancet Commission on Sepsis: transforming sepsis care and outcomes
Sepsis, a life-threatening organ dysfunction, is caused by dysregulated host responses to infection1 and is common, and often deadly.2,3 The current standard of care for the acutely unwell patient with sepsis relies on early suspicion by the clinician, infection source control (eg, abscess drainage and debridement), administering empirical broad spectrum antimicrobials, and life support for failing vital organs.4 Although such life-sustaining therapies are commonly delivered in intensive care units, globally most patients with sepsis are managed outside intensive care units or in wards without
The Lancet4/22/2026
[Viewpoint] Hepatitis A prevention in the USA depends on routine universal childhood vaccination
On Jan 5, 2026, the Acting Director of the US Centers for Disease Control and Prevention (CDC) signed a decision memorandum from the heads of the National Institutes of Health, the Centers for Medicare & Medicaid Services, and the US Food and Drug Administration, which removed vaccines against meningococcal disease, influenza, COVID-19, hepatitis A, and hepatitis B, including the birth dose, as routinely recommended vaccines for all children.1 Instead, except for certain groups at high risk, these vaccines were recommended for children based on shared clinical decision making.
The Lancet4/22/2026
[Comment] Plastics, plastic chemicals, and microplastics: multiple harms to health
Microplastics and nanoplastics (MNPs) are everywhere. These tiny particles—formed by abrasion, fragmentation, and open burning of plastics—are found in the ocean, the Arctic, Himalayan glaciers, air, food, and drinking water.1 More recently, they have been reported in human lung and faeces, reflecting exposures via inhalation and ingestion, as well as in blood, carotid arteries, heart, brain, liver, ovaries, testes, and placenta.2 Early clinical and epidemiological reports suggest associations between MNPs and health effects, notably cardiovascular disease, adverse reproductive outcomes, and i
The Lancet4/16/2026
[Seminar] Retroperitoneal fibrosis
Retroperitoneal fibrosis is a rare immune-mediated disease characterised by a periaortoiliac fibro-inflammatory tissue that often encases neighbouring structures (eg, ureters). Idiopathic retroperitoneal fibrosis can be isolated or part of IgG4-related disease, whereas secondary forms recognise different aetiologies, such as histiocytosis, malignancies, and infections. Idiopathic retroperitoneal fibrosis has a multifactorial origin, with genetic, environmental, and lifestyle factors being main contributors.
The Lancet3/26/2026
[Comment] Semaglutide for Alzheimer's disease after evoke and evoke+
GLP-1 receptor agonist indications continue to expand beyond glycaemic and weight control, with benefits now shown in chronic kidney disease in type 2 diabetes, obesity-related heart failure, knee osteoarthritis, and metabolic dysfunction-associated steatohepatitis.1–4 Evidence in CNS disorders is less consistent, with signals present in idiopathic intracranial hypertension5 and alcohol use disorder6 but uncertain in Parkinson's disease.7,8
The Lancet3/19/2026
[Comment] Learning from swine influenza, Ebola virus disease, and Legionnaires' disease in 1976
50 years ago during a US election year marked by post-Vietnam war disillusionment, post-Watergate cynicism, and bicentennial optimism, three new infectious threats stress-tested the US public health system. Throughout 1976, a series of challenges emerged: an outbreak of swine influenza A (H1N1) among US troops in New Jersey, NJ, USA; a lethal pneumonia cluster tied to the American Legion Convention in Philadelphia, PA, USA; and an unexplained haemorrhagic fever outbreak in Africa. Although the pathogens and locations were different, the challenge was the same: making sound public health decisi
The Lancet3/19/2026
[Articles] Efficacy and safety of oral semaglutide 14 mg (flexible dose) in early-stage symptomatic Alzheimer's disease (evoke and evoke+): two phase 3, randomised, placebo-controlled trials
Oral semaglutide was not efficacious in slowing clinical progression in participants with early Alzheimer's disease. Safety and tolerability of semaglutide in early Alzheimer's disease is consistent with studies in other indications.
The Lancet3/19/2026
[Department of Error] Department of Error
Stapleton S, Adewale K, Arboleda Y, et al. Visualising relationships between the arts and health. Lancet 2025; published online Sept 23. https://doi.org/10.1016/S0140-6736(25)01918-X—In The Art of Healing photograph in this photo feature, additions and changes have been made to the main title of this photograph and the first sentence of the Project context. These corrections have been made to the online version as of Oct 14, 2025.
The Lancet10/14/2025
[Comment] The imperative for the global community to save the Paris Climate Agreement
Action on climate change is urgently needed if we are to protect public health and health systems from the catastrophic impacts of climate-driven extreme events, including tropical cyclones, heatwaves, and wildfires.1,2 In a global effort to combat climate change and protect the human population from the worst impacts, the Paris Climate Agreement was formally adopted on Dec 12, 2015, at the 21st Conference of the Parties (COP21) under the UN Framework Convention on Climate Change.3 The Paris Agreement aims to reduce greenhouse gas emissions, curb global warming, and protect the planet from the
The Lancet10/9/2025
[Perspectives] Visualising relationships between the arts and health
The American photographer Irving Penn (1917–2009) described a good photograph as one “that communicates a fact, touches the heart and leaves the viewer a changed person for having seen it”. This photography feature bears eloquent testimony to the health initiatives around the world that are supported by the arts—initiatives that encompass a wide range of artistic practices and settings to promote the treatment and management of health conditions across various age groups and cultures—underscoring Penn's triple formula of communication, connection, and change.
The Lancet9/23/2025
[Comment] Global HIV targets: a roadmap to 2030 and beyond
A decade ago, the global community established the goal to end AIDS as a public health threat by 2030 through reducing new HIV infections and AIDS-related deaths by 90% from 2010 levels.1 Progress has been substantial, particularly in the most affected eastern and southern Africa region, where new infections and AIDS-related deaths have each declined by almost 60% between 2010 and 2024.1 Globally, more than 77% of people living with HIV received antiretroviral therapy in 2024. In a subset of countries that achieved targeted 90% treatment coverage by 2024, new HIV infections have declined by 72
The Lancet7/16/2025
[Department of Error] Department of Error
Rodin J, Bratburd JR, Duff N, et al. Charting a path to health for all at net-zero emissions. Lancet 2025; published online April 25. https://doi.org/10.1016/S0140-6736(25)00813-X—In the Declaration of interests section of this Comment, the statement has been corrected for Andy Haines. This correction has been made to the online version as of May 5, 2025.
The Lancet5/5/2025
[Comment] The antimicrobial resistance cube: a framework for identifying policy gaps and driving action
WHO has summarised its commitment to Universal Health Coverage (UHC) with the UHC cube diagram,1,2 a globally recognised visual representation of policy choices to promote UHC and prioritise investments in health-care interventions. Inspired by the concept of the UHC cube, we propose a streamlined framework for policy makers, academics, and civil society to examine a country's response to antimicrobial resistance (AMR)—the AMR cube. The AMR cube integrates three essential dimensions: One Health contexts, interventions, and resources, each representing a critical aspect of combating AMR.
The Lancet4/30/2025
[Comment] Charting a path to health for all at net-zero emissions
Climate change is the defining health challenge of the 21st century, with record-breaking temperatures and extreme weather events already exacting an unprecedented toll on human health and wellbeing. Scientific consensus is clear: rapid and deep reductions in greenhouse gas (GHG) emissions by 2050 are needed not only to reduce the risks of exceeding climate tipping points beyond which irreversible damage occurs to natural systems, but also to safeguard human health, wellbeing, and equity.1,2 Despite growing awareness of the climate–health nexus, climate interventions often fail to consider opp
The Lancet4/25/2025
[Comment] Reflecting on progress, envisioning the future for research in Down syndrome
Individuals with Down syndrome are at risk for several neurodevelopmental and neurodegenerative conditions that cause cognitive, behavioural, and functional decline across the lifespan.1 Two conditions contributing to these challenges are Down syndrome regression disorder and Down syndrome-related Alzheimer's disease, which manifest at an average age of 17 and 53 years, respectively.1 Although both conditions lead to functional impairments, they differ in their onset, speed of progression, and underlying mechanisms.
The Lancet3/20/2025
[Clinical Picture] Feeding dystonia, chorea, psychosis, and self-mutilation in an African patient with neuroacanthocytosis syndrome
A 34-year-old woman with a 2-year history of progressively worsening difficulties in walking, eating and swallowing, presented to our department. The patient's sister reported observing unusual behaviours over the past 6 months: she said her sister had been taking her meals to eat alone in the bathroom and had crafted a doll from leaves gathered from local trees, referring to it as her son (figure A). Additionally, she had been experiencing low mood and general cognitive decline, including memory and attention deficits, along with personality changes such as increased impulsivity and aggressio
The Lancet2/25/2025
[Comment] The long last mile in global poliovirus eradication: what should Pakistan do?
With global poliovirus eradication hinging on just Pakistan and Afghanistan, there is concern about lack of progress in both neighbouring countries. From a low of six cases in 2023, Pakistan's emergency programme for poliovirus eradication has undergone a serious setback with 70 cases of poliomyelitis due to wild poliovirus 1 in the country in 2024 (Pakistan Polio Eradication Programme; personal correspondence). Some 31% of the 2003 environmental surveillance samples from 127 sites were positive, a six-fold increase over 2023 (Pakistan Polio Eradication Programme; personal correspondence).
The Lancet1/15/2025
[Comment] Can molecular cancer signals circulating in blood help us prevent cancer-related deaths?
Breakthroughs in laboratory and data science are increasing interest in blood tests to screen for cancer, with colorectal cancer screening at the forefront of this interest.1 These emerging tests should be judged according to classic criteria—the detection of treatable latent disease, improved outcomes compared with no screening, safety, acceptability, and cost-effectiveness relative to alternative options. Developers of novel colorectal cancer screening blood tests are first seeking regulatory approval in the USA, with plans to expand outside the USA in the future.
The Lancet1/6/2025
[Correspondence] The UK must help end the global tobacco epidemic fuelled by British firms
Although smoking rates have declined in high-income countries over the past two decades, smoking remains the leading modifiable risk factor for mortality globally. More than 80% of current smokers now live in low-income and middle-income countries (LMICs), where the burden of tobacco-related illness and death is now heaviest.1 British transnational tobacco companies, supported by UK trade policy, played a major role in igniting the tobacco epidemic in the 20th century, and continue to fuel the epidemic in the 21st century, particularly in Commonwealth countries.
The Lancet10/30/2024
[Comment] Accelerating rabies elimination in Africa by 2030
Rabies, a preventable yet fatal disease, continues to claim 59 000 lives annually, with Africa shouldering over 60% of this toll.1 Weak surveillance systems mean these numbers are probably underestimates, masking the true scale of the problem and perpetuating health inequities across the continent. World Rabies Day 2024, with the theme Breaking Rabies Boundaries, focuses attention on the actions needed to overcome persistent challenges and make strides towards rabies elimination.
The Lancet9/27/2024
[Correspondence] A strong and independent Africa CDC would benefit the world
The COVID-19 pandemic has sent shockwaves around the world. Yet, the two-tier response that leaves one-third of the world's population unvaccinated demonstrates how the fundamental concerns of statecraft—power, security, influence, and survival—have driven national responses. Few would dispute that a stronger framework for health emergencies, with WHO at the centre, would be beneficial for global health security; however, the failure of member states to comply with the International Health Regulations and other multilateral provisions for COVID-19 signifies not only an institutional weakness b
The Lancet7/20/2022
[Department of Error] Department of Error
Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet 2020; published online May 22. https://doi.org/10.1016/S0140-6736(20)31180-6—In this Article, in the first paragraph of the Results section, the numbers of participants from Asia and Australia should have been 8101 (8·4%) and 63 (0·1%), respectively. One hospital self-designated as belonging to the Australasia continental designation should have been assigned to the Asian continental designation.
The Lancet5/30/2020
[Correspondence] Tracking COVID-19 responsibly
As of March 25, 2020, WHO's online coronavirus disease 2019 (COVID-19) situation dashboard reveals that the pandemic spans 195 countries and territories with 375 498 cases. With this rapid expansion of the pandemic comes a growing need to ensure that accurate and credible information is accessible to public health authorities, researchers, and the wider public. This has prompted WHO, institutions, and individuals to develop online tools to track the spread of the pandemic. Although WHO's emergency preparedness is informed by established principles of international law,1 the multiplicity of act
The Lancet3/27/2020
[Correspondence] The truth about PHEICs
The recent decision by the WHO Director-General that the Ebola virus outbreak in DR Congo does not constitute a Public Health Emergency of International Concern (PHEIC)1 has generated controversy, as articulated by the Editors2 of The Lancet. Members of the WHO Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH) have discussed this Editorial and would like to clarify the role of the International Health Regulations (IHR) and the designation of a PHEIC.
The Lancet7/5/2019
[Review] Current approach of the axilla in patients with early-stage breast cancer
The surgical approach of the axilla in patients with early-stage breast cancer has witnessed considerable evolution during the past 25 years. The previously undisputed gold standard of axillary-lymph-node dissection for staging has now been replaced by sentinel-lymph-node biopsy for patients with clinically negative axilla. For selected patients with limited sentinel-lymph-node involvement, completion axillary-lymph-node dissection can be omitted or replaced by axillary radiotherapy, reducing morbidity.
The Lancet8/14/2017
[Series] The humanitarian system is not just broke, but broken: recommendations for future humanitarian action
An unprecedented number of humanitarian emergencies of large magnitude and duration is causing the largest number of people in a generation to be forcibly displaced. Yet the existing humanitarian system was created for a different time and is no longer fit for purpose. On the basis of lessons learned from recent crises, particularly the Syrian conflict and the Ebola epidemic, I recommend four sets of actions that would make the humanitarian system relevant for future public health responses: (1) operationalise the concept of centrality of protection; (2) integrate affected persons into nationa
The Lancet6/8/2017
[Essay] My dying student
As a doctor for almost 40 years now, and especially as a geriatrician, I have cared for my share of terminal patients. However, to date I have never had to face a dying medical student. As Sakal's Dean, this was especially onerous. And I know that one is not supposed to confess this, as in the eyes of the faculty all students are equal, but Sakal was one of my favourites. That being said, I am sure that none of his classmates would be upset by my admission, since he probably was one of the best liked of his fellows.
The Lancet12/21/2016
[Comment] Women, power, and the cancer divide
Almost 100 years ago, Gabriela Mistral, Chilean poet and Nobel Prize winner, said that “every law, every freedom or culture movement, has left us for a long time in the shadows; that we always have arrived to the feast not as the reluctant guest who is arriving late, but as a comrade who is invited late and then hides in the banquet”.1 Mistral reminds us that, despite many hard won achievements, women in many parts of the world still remain “in the shadows”. Gender inequality and disempowerment of women have deep roots that plunge into the furthest recesses of our societies.
The Lancet11/1/2016
[World Report] 50 years of Medicare
In July, 1965, Medicare, America's landmark national health insurance programme, became law. Today, it covers 55 million people. Susan Jaffe, The Lancet's Washington correspondent, reports.
The Lancet7/29/2015