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The Lancet this week tackles the ethical issues surrounding the case of Charlie Gard, the 11 month-old baby who died from a rare mitochondrial disorder after a dispute between his parents and doctors over his treatment had blown up into a media storm.

Clinical decisions are rarely black or white and discussing shades of grey is especially difficult when a baby is involved. The Lancet also examines the delicate balance for doctors in ensuring patients have access to innovative treatments but that these treatments are in their best interests.

This would be hard enough in itself but both sides must now also contend with armchair commentators. One of Charlie's medical team at London's Great Ormond Street wrote in The Guardian of the abuse directed at hospital colleagues and criticism from "Donald Trump, the Pope and Boris Johnson, who suddenly knew more about mitochondrial diseases than our expert consultants".

If we imagine a Venn diagram of overlapping circles of medicine, the law and personal autonomy, writes FT columnist Anjana Ahuja, such cases sit uneasily in the shaded part. This overlap will only expand as science blurs the boundaries between life and death.

We can, sadly, expect many more predicaments as experimental medicine continues its pursuit of the impossible, she concludes.


Three questions

Professor Detlev Ganten, president of the World Health Summit (October 15-17) and former chief executive and chair of the Charité university hospital in Berlin.

What is your biggest challenge at the Charité?

The Charité-Universitätsmedizin Berlin is one of the biggest university hospitals in Europe with about 7,000 students and almost 1,000 graduates per year. This is a huge responsibility as teaching has to be based on the best of science but has to incorporate social responsibility and respond to global challenges as well. We experience new developments in medicine, healthcare, public health, digital health, and many other areas at an unprecedented pace.

What explains growing German interest in health in developing countries?

Germany has a long tradition in public and global health: 150 years ago, Rudolf Virchow, Robert Koch, Emil von Behring and Paul Ehrlich pioneered what we know today as global health. I am very happy that politics and academia are revitalising this strong tradition. Wealthy countries like Germany have a responsibility to do more to improve health and wellbeing of less fortunate countries and people around the world. Only countries with healthy people are safe and stable countries.

What do you hope to achieve at the World Health Summit this year?

To improve health worldwide we need international co-operation of stakeholders which is why the World Health Summit brings together experts from academia, politics, the private sector and civil society to work on today’s central topics in global health like universal health coverage, antimicrobial resistance and health-related humanitarian problems. We know we reach the decision makers who can initiate change and help improve the health and wellbeing of people in need.


Chartwatch

Measles on the march Romania is taking action to boost falling vaccination rates after its worst outbreak of measles for decades. The problem highlights a wider resurgence across Europe, despite the availability of an effective vaccine since 1979. Should vaccination be compulsory? Discuss the issues on our Facebook page. (FT)


News round-up

Cholera in Yemen War-torn Yemen has experienced 1,921 cholera deaths and 443,000 suspected cases in three months. The WHO with Unicef and the World Food Programme called for an acceleration of the peace process, protection of civilian infrastructure, the fulfilment of donor promises and support for Yemen's long-term recovery. The UK on Friday stepped up its aid efforts but commentators have been highly critical of the lack of action from the world community (WHO, DfID, Lancet, Politics Home)

US opioid crisis President Trump is set to take the advice of his White House Commission and declare a national emergency as new figures showed overdose deaths rising. Another study shows how much money doctors have received from pharma companies marketing prescription opioids. (Reuters, CNN, Washington Post, Kaiser)

Antibiotic boost A new cloud-based computing platform hopes to "spark" the discovery of new antibiotics. Data-sharing tools have been used in other areas but the Shared Platform for Antibiotic Research and Knowledge is the first for antibiotics. (Cidrap)

Hepatitis vaccine A global shortage of the Hepatitis B vaccine because of supply issues at Merck and GSK is leading to rationing in the UK. The problem is likely to continue until early 2018. (BMJ, Biopharma Reporter, BMA)

Net benefits A new generation of insecticide-treated mosquito nets kill up to 75 per cent of the insects and remain effective after 20 washes. A study showed new tests for malaria have improved treatment, but also that many people still did not get the proper drugs or were overprescribed antibiotics. (SciDevNet, NYT)

GSK strategy shift Emma Walmsley — the first woman to run a big drugmaker — told the FT she would be injecting more commercial rigour into GSK with a greater emphasis on producing blockbuster drugs. (FT)

Shkreli convicted The brash biotech entrepreneur was convicted of fraud after a trial that drew attention to his reputation as a “price gouger” of life-saving medicines. Here's a very entertaining Lunch with the FT piece from 2016. Can the pharma industry now move on? (FT, Stat) 

Mental health A health centre for native Alaskans that embeds mental and emotional healthcare in their primary care practices has delivered better care at lower cost. Could it be rolled out elsewhere? In the UK, research from the Mind charity says men are twice as likely to have mental health problems due to their job. (Politico, Mind)

Living with loneliness Social isolation could be a greater public health threat than obesity. Approximately 42.6m adults over age 45 in the US are estimated to be suffering from chronic loneliness. (American Psychological Association)

Stress signs A look at what happens to your body when you're stressed — from respiratory and immune systems to heart rate and hormones. (The Conversation)

Gene genius A new book tells the story of the Crispr gene-editing project from the point of view of one of the scientific trio credited with its application. Take this quiz to see if you can distinguish gene-editing fact from fiction. (FT, NYT)

Where's the pill for men? A new form of male birth control would likely grab a significant slice of the contraceptive market — expected to pass $33bn by 2023. The male pill has been five years away for the last 40 years. What's taking so long? (Bloomberg)

Football warning As the English Premier League prepares for the big kick-off, an expert says the game must change if it wants to prevent more catastrophic brain injuries. Bennet Omalu first identified chronic traumatic encephalopathy among NFL players and inspired the film Concussion(Telegraph)


Best from the journals

Casualties of war The Eastern Mediterranean Region — 22 countries of more than 500m people — faces severe public health challenges thanks to wars, especially in Yemen, Iraq and Syria, and economic change. There has been a sharp increase in mental health problems and deaths due to HIV/Aids, especially in Somalia, Sudan and Djibouti. (International Journal of Public Health)

Cholera at the Hajj The explosive outbreak of cholera in Yemen — from where many pilgrims originate — represents a serious risk at this year’s Hajj. (The Lancet)

Diabetes hope A treatment to stop the progression of the most common type of diabetes in children and young adults has shown promising results in its first clinical trial. (FT, Science Translational Medicine)

UK health spending A new analysis suggests UK spending on healthcare has been underestimated. The reappraisal reflects a new definition of what constitutes “health” spending, including more of what has traditionally been thought of as “social care”. New data, however, showed waiting lists at their highest for a decade. (BMJ, FT)

North-south divide A study of 50 years of data shows "alarming growth" in early deaths among 25-44 year olds in the north of England since the mid-1990s. This is on top of the gap in lifespan between the two halves of the country that has lasted for decades. (Journal of Epidemiology & Community Health)


Podcast of the week

Sense and sensitivity Being overly sensitive to sights and sounds can be deeply traumatic, but there may be an upside. A look at those suffering from sensory processing disorder. (Mosaic)


In case you missed it

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Final thought

Acid is back Fifty years after the summer of love, LSD is back. But this time it's young Silicon Valley professionals taking microdoses of the drug instead of their usual almond milk latte to sharpen their thinking and improve productivity. Whatever happened to turning on, tuning in and dropping out?

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