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Preference: Statistics, epidemiology and research design

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[Perspectives] The unintended ethics of Henry K Beecher

In the summer of 1966, the medical profession was hit with a bombshell. Henry K Beecher published “Ethics and Clinical Research”, a landmark article, often called “Beecher’s bombshell”, which described 22 examples of clinical research he deemed ethically questionable. Beecher hit his mark. Describing the aftershock in the pages of this journal, one writer explained, “His article aroused controversy among American research-workers and highlighted a problem which had grown insidiously and almost unnoticed by the generality of American doctors”.

[Articles] Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14

Our findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice. These results suggest that English primary care as currently delivered could be reaching saturation point. Notably, our data only explore direct clinical workload and not indirect activities and professional duties, which have probably also increased. This and additional research questions, including the outcomes of workload changes on other sectors of health care, need urgent answers for primary care provision internationally.

[Correspondence] Alcohol use disorders

In their Seminar (March 5, p 988), Jason Connor and colleagues1 stressed that a comprehensive psychiatric assessment is essential to the identification of the primary disorder (psychiatric or alcohol use disorder). They also emphasised that research into health services is needed to improve the identification and treatment of the most common and remediable forms of psychiatric comorbidities in patients with alcohol use disorder, particularly anxiety disorders.

[Editorial] Missing evidence

The UK Government fails to monitor and appropriately report independent research commissioned to inform policy, according to a report published on June 22 by Sense about Science, a charitable trust that aims to make sense of scientific claims in public discussion. The UK Government spends £2·5 billion each year on research, but only four out of 24 government departments maintain a database of commissioned research, leading to fears of “ghost” research that is created and paid for, but unrecorded, unpublished, and therefore unfindable and uninformative.

[Articles] Sustained-release dexamfetamine in the treatment of chronic cocaine-dependent patients on heroin-assisted treatment: a randomised, double-blind, placebo-controlled trial

Sustained-release dexamfetamine is a well accepted, effective, and safe agonist pharmacotherapy for comorbid treatment-refractory cocaine dependence in heroin-dependent patients in heroin-assisted treatment. Future research should aim to replicate these findings in chronic cocaine-dependent and other stimulant-dependent patients in more routine treatment settings, including strategies to optimise treatment adherence like medication management interventions and contingency management.

[Correspondence] Coordinating funding in public health emergencies

In an increasingly globalised world, an infectious disease can travel to the other side of the globe before symptoms manifest, yet setting up an effective research response can take months. This delay can cost lives. To save valuable time, we must improve coordination of global research efforts in preparedness of and response to public health emergencies.

[Perspectives] Jean-Paul Moatti: charismatic French leader in global health

“This is my first real job in management”, says Jean-Paul Moatti, who was appointed jointly as Chairman and Executive Director of France’s National Research Institute for Development (IRD) in March, 2015. A leading figure behind the Lancet France: nation and world Series, Moatti’s role at IRD puts him in a unique position to steer France’s output in global health research over the next few years. “International research is my love, and IRD is the best place I could be”, he says. “Our job is to help and collaborate with the scientific communities in the countries where we have a presence, to strengthen research capacity, and ultimately health systems globally.” IRD, jointly funded by France’s research and foreign affairs ministries, is involved in biomedical and human development research in 28 countries, many of them Francophone nations, but also with reach in southeast Asia and in Latin America.

[Editorial] Towards a better understanding of type 1 diabetes

According to the NCD Risk Factor Collaboration, an estimated 422 million people worldwide were living with diabetes in 2014—four fold more than 35 years ago. Type 2 diabetes represents the majority of the epidemic (85–95%), and as a consequence type 1 diabetes has too often been overlooked. Today’s Lancet features a clinical Series on type 1 diabetes—an autoimmune disease in which insulin-producing β cells of the pancreas are destroyed. The precise aetiology and pathogenesis of type 1 diabetes remain a subject for research.